Introduction to Polysomnography

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Introduction to Polysomnography:

Introduction to Polysomnography John Murray RRT, RPSGT

The Importance of Sleep:

The Importance of Sleep Sleep occupies 1/3 of every day Sleep or lack of has effect on remaining 2/3 Sleep deprivation is a public health concern Sleep deprivation effects adults and children

The Importance of Sleep:

The Importance of Sleep Approximately 40% of adults report some type of sleep disorder 35% adults complain of insomnia at some time in their life 2% adults have OSA 1% narcolepsy or idiopathic hypersomnolence Sleep disorders are treatable

The Importance of Sleep:

The Importance of Sleep 70 Million people in the US affected by sleep problems 40 Million suffer from chronic sleep disorders Sleep deprivation and disorders cost Americans over 100 billion annually 69% of all children experience one or more sleep problems at least a few nights/week

The Importance of Sleep:

The Importance of Sleep 67% of older adults report frequent sleep problems Only 1 in 8 says problems have been diagnosed 100,000 traffic crashes caused by drowsy drivers each year NSF poll 51% said they drive drowsy 17% actually dozed off behind the wheel

The Importance of Sleep:

The Importance of Sleep Sleep deprivation big factor in all types of accidents Truck accidents Exxon Valdez Challenger disaster Chernobyl Three Mile Island More recent – NY ferry accident

Sleep Disorders Medicine:

Sleep Disorders Medicine Accredited clinical specialty Sleep disorders under diagnosed 10 million with OSA 90% undiagnosed 1 – 3% pediatric population has OSA Estimated 30% incidence in average US primary care clinic population Until recently sleep disorders not part of Med School curriculum

History of Polysomnography:

History of Polysomnography Hans Berger “father of EEG” 1924 First EEG instrument 1935 by Albert Grass Normal sleep patterns Loomis, Harvey and Hobart 1935 REM sleep discovered 1952 by Aserinsky and Kleitman William Dement “father of Sleep Medicine” first Sleep disorders clinic Stanford 1970

History of Polysomnography:

History of Polysomnography Dr. Dement – Founder of AASM, SRS. Principles and Practices of Sleep Medicine Dr. Guilleminault – connection between sleep and “Pickwickian Syndrome” 1965 Discovered “apneas” or pauses in breathing in extremely obese – later called “Sleep Apnea” Lead to addition of respiratory monitors

History of Polysomnography:

History of Polysomnography Early researchers often did their own polysomnographic recordings Early 1970’s APT formed BRPT formed by AAST and AASM RPSGT – currently about 7,000 world wide 2007 AASM develops new scoring guidelines 2008 New educational guidelines go into effect for RPSGT

Sleep Center Staffing:

Sleep Center Staffing AAST Position AARC Position State Licensure Board Opinions

RPSGT Credential:

RPSGT Credential Administered by the BRPT Graduate of Polysomnography Program or CRT, RRT, RN and 6 months experience and AASM Module equivalent OJT with 18 months experience and AASM Module equivalent A-Step Program

AAST Job Descriptions Polysomnographic Trainee:

AAST Job Descriptions Polysomnographic Trainee High School diploma + 6 months direct patient care experience or 1 year of post-secondary education Or Current enrollment in an accredited education program leading to an associate degree with emphasis in polysomnography Must work under the direct supervision of a technician or technologist

AAST Job Descriptions Polysomnographic Technician:

AAST Job Descriptions Polysomnographic Technician Completion of polysomnography program, not less than one year Or Six months experience as trainee with documented competencies Performs under general oversight RPSGT or Clinical Director May oversee trainee

AAST Job Descriptions Polysomnographic Technologist:

AAST Job Descriptions Polysomnographic Technologist Associate degree with an emphasis in polysomnography Or Completion polysomnography program not less than one year or equivalent experience And RPSGT

Licensure Issues:

Licensure Issues Many states are now requiring Sleep Technologist to be credentialed. Most state laws include exemptions for other credentialed practitioners as RRT, RN Problem could arise from on-the-job trained personnel performing CPAP/BIPAP/O2 titrations

Polysomngraphy:

Polysomngraphy Comprehensive recording of physiological changes occurring during sleep EEG, EOG, EMG, EKG, respiratory effort, airflow, and oxygen saturation Used to diagnosis many sleep disorders

Multiple Sleep Latency Testing MSLT:

Multiple Sleep Latency Testing MSLT Used to diagnosis narcolepsy Preformed after nocturnal PSG 5 daytime naps 2 hours apart Looking for REM sleep and sleep latency Sleep latency less than 5 minutes – Idiopathic hypersomnia

Role of the Sleep Technologist:

Role of the Sleep Technologist Clinical understanding of sleep and sleep disorders Perform Polysomnography and MSLT Assess patient’s history and complaints Knowledge of a variety of body systems Scoring and data reduction Decision making – therapeutic interventions

Role of the Sleep Technologist:

Role of the Sleep Technologist Determine life threatening situations Patient education CPAP/BIPAP therapy

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