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APT NewZzzPublication of the Association of Polysomnographic Technologists • 2006, Volume 15, Number 4 • www.aptweb.orgAPT — Practice Parameter forStandard Polysomnographycontinued from page 11and sleep state, i.e. NREM and REM.3.3.4 Sleep Related Breathing EventsThe summary should document sleep related breathing events withrespect to sleep state. Information should be provided concerning the breathingrate while awake and asleep, the presence or absence of snoring, thepresence of paradoxical breathing, the number and index of apneic and/orhypopneic events, the longest apneic and/or hypopneic event, the mean andnadir oxygen desaturation. Notation should be made if sleep state or bodyposition is related to the apnea/hypopnea index and/or desaturation.3.3.5 Heart Rate/ECG ObservationTypical heart rate values while awake and asleep (REM and NREM)should be annotated and the summary should document extreme valuesoccurring transiently. Arrhythmias should be documented with respect tofrequency of occurrence and type. It is particularly important to describethe occurrence of heart rate changes or arrhythmias with respect to sleepstate (REM, NREM) and sleep related breathing events such as O 2 desaturationsand apneic events. 133.3.6 Limb MovementsLimb movement activity is recorded from the extremities and must beevaluated in terms of frequency of occurrence and periodicity, sleep/wakestatus, and presence or absence of subsequent arousal.Rhythmic leg movements observed during wakefulness can indicateRestless Legs Syndrome (RLS). The sleep technologist should ask aboutsymptoms of RLS during patient assessment (difficulty initiating sleep due toa need to move) and document any relevant patient comments as well as evidenceof RLS in the recording.3.3.7 Behavioral ObservationsAny unusual or atypical behavioral events should be documented duringthe patient’s sleep and wakefulness by the sleep technologist during thestandard PSG. The sleep technologist should describe in detail what thebehavior is and how it relates to the polysomnographic recording (i.e. nocturnaleating, enuresis, rocking). When arousals are noted during the standardPSG, the sleep technologist should document the cause of the arousal,i.e. as the result of apneic events, myoclonus, spontaneous or environmentallyevoked.4.0 Standards of Practice4.1 Qualifications of Sleep TechnologistsSleep technologists performing sleep studies should demonstrateknowledge of the polysomnographic recording instrumentation, includingoperating procedures, electrode application, calibration methods and routinetroubleshooting as well as the ability to recognize sleep stages, as outlinedin the APT/AASM Sleep Technologist, Technician and Trainee JobDescriptions 14 . The sleep technologist must have a thorough understandingof normal and abnormal sleep patterns and sleep disorders. The sleep technologistalso must be trained in basic cardiopulmonary resuscitation (CPR)or professional rescuer adult/child CPR and automated external defibrillator(AED). Refer to the AASM accreditation guidelines for standards onpatient: technologist ratio 15 . The facility should consider the experience ofthe technologists as well as the difficulty of the studies being performedwhen deviating from a 2:1 ratio.124.2 Sleep Facility Organization and Record KeepingThe sleep technologists should follow the sleep facility departmental policyand procedure manual. Patient charts, in either print or electronic formatshould be organized and available for appropriate use in the sleep facility.HIPAA guidelines should be followed regarding confidentiality of patientrecords 16 . Equipment, sensor and recording procedures should meet thestandards of the manufacturer.Storage of the recorded PSG data on CD, DVD, hard drive or othermedia should be both secure and easily available for retrieval. If video recording,either digital or VHS, is used, an edited version that preserves therecorded events is acceptable and should be referenced appropriately. Thelength of storage all patient data should be in compliance with the statutesset forth by the state in which the data is obtained and stored.4.3 Patient SafetyIn the context of the technical sleep study, patient safety begins from thepoint of the patient’s arrival until the patient leaves the lab (see 4.4.5). Ofcourse, ordering and performing the appropriate test based on the patient’shistory and physical and previous test results is the responsibility of the sleepfacility under direction from a physician.4.3.1 Safety of the Sleep FacilityThe sleep facility must be safe and easily accessible to all staff andpatients. The sleep facility must be handicapped accessible, meet fire codeand health department regulations, and maintain electrical and mechanicalsafety. The patient rooms must be clean and have adequate audio and videomonitors for patient safety and clinical assessment 17 . All products used onpatients should have Material Safety Data Sheets available in the sleep facility.All flammable materials must be stored in a fire safe. Follow the sleepfacility policy related to patient safety and security.4.3.2 Safety equipmentThe sleep facility should have equipment available for patient care andemergencies: resuscitation bags, back boards, oxygen, biohazard spill kits,refrigeration for patient medication, blood pressure cuffs, AutomatedExternal Defibrillators (AED) and first aid kits.4.3.3 Patient Medical History and CurrentMedical StatusIt is the sleep technologist’s responsibility to know and understand thepatient’s medical history, allergies and current medical status in order toalter procedures, contact a physician, or transfer the patient to emergencycare, as necessary.4.3.4 CPR CertificationAll sleep technologists must be CPR certified. The Professional Rescuerby the American Red Cross or BLS Healthcare Provider Course by theAmerican Heart Association is recommended.4.3.4 Clinical Intervention and Emergency ProceduresThe sleep facility should have written guidelines for initiating any medicalintervention (supplemental oxygen, patient transfer, CPR). There should alsobe a written plan for handling environmental disasters (e.g. tornado, fire,flood, etc.) 184.3.5 Patient Discharge GuidelinesThe sleep technologist should make sure that the patient has hadenough sleep and is not under the influence of medication or alcohol beforerelease from the sleep facility. An early release form should be completedper sleep facility policy. Patients who have not had enough sleep should be➟
APT NewZzzPublication of the Association of Polysomnographic Technologists • 2006, Volume 15, Number 4 • www.aptweb.orgencouraged to stay and sleep (with visual monitoring), even if the recordinghas been discontinued per facility policy.4.4 Infection Control4.4.1 Patient Contact ProceduresSleep technologists should exercise Universal Precautions and precautionsfor prevention of the spread of tuberculosis or other infectious diseasesas appropriate 19,20 . Frequent hand washing is essential for the protection ofboth patients and sleep technologists. All items that will be in contact with apatient must be cleaned and disinfected before use.4.4.2 Equipment DecontaminationThere must be clearly designated areas for clean and dirty equipmentand sensors.4.4.3 Non-Disposable or Reusable ItemsNon-disposable or reusable items include items such as pneumo-tachometers,electrodes, respiratory belts, thermocouples, and body position sensors.Various disinfectant products are available commercially. These products arelabeled with the instructions for disinfecting reusable items and the reusableitems should have instructions for disinfecting and cleaning recommended bythe manufacturer. When reusable items become contaminated and disinfectingis not feasible, gas or heat sterilization may be used or the item should beproperly disposed of. Bed linens should be handled with the assumption thatbiohazard could be present. Overall, it is recommended to use disinfectingproducts or procedures that are approved for the medical setting.4.4.4 Disposable ItemsThe syringe and flat-tipped needle used to inject electrolyte into the cupof electrodes should be discarded after use with the needle placed in areceptacle for needles 21 . Disposable sensors should be disposed of afteruse. Likewise, nasal cannulas used for administering oxygen or to monitorflow with a pressure transducer are for single patient use only. These typesof products should be disposed after each patient use.Footnotes1. Kushida CA, et al., Practice Parameters for the Indications forPolysomnography and Related Procedures: An Update for 2005 Sleep2005;28:499-529.2. Association of Polysomnographic Technologists, eds. Job Descriptions.Westchester, IL. Available at: http://aptweb.org/pdf/JobDescriptions.pdf3. American Academy of Sleep Medicine, eds. International Classification ofSLEEP DISORDERS, 2nd ed, Diagnostic and Coding Manual. Westchester,Illinois, 2005.4. Chokroverty S. Polysomnographic technique: an overview. In: SleepDisorders Medicine 2nd ed. Boston: Butterworth Heinemann; 1999:158. ; Butkov N. Atlas of Clinical Polysomnography, vol.1. Ashland, OR:Synapse Media, 1996: 11. Lee-Chiong T, Sateia M, Carskadon M, eds.Sleep Medicine. Hanley & Belfus, 2002: 615.5. Tyner F, Knott J, Mayer W Jr. Fundamentals of EEG Technology Volume1: Basic Concepts and Methods. New York: Raven Press;1983: 126.6. Lee-Chiong T, Sateia M, Carskadon M, eds. Sleep Medicine. Hanley &Belfus, 2002: 647.7. Jasper H.H. The ten twenty system of the International Federation.Electrencephalogr Clin Neurophysiol, 1958; 10:371-375.9. Butkov N. Atlas of Clinical Polysomnography, vol.1. Ashland, OR: SynapseMedia, 1996: 6.10. Forouzan BA, Fegan SC. Data Communications and Networking 2nd ed.Boston: McGraw-Hill, 2001:105.10. Chokroverty S. Polysomnographic technique: an overview. In: SleepDisorders Medicine 2nd ed. Boston: Butterworth Heinemann; 1999: 159.11. American Academy of Sleep Medicine, eds. Standard 17: Charting. In:Standards for Accreditation of a Sleep Disorders Center. Westchester,Illinois: 2006.12. Redline S, Kirchner HL, Quan SF, et al. The effects of age, sex, ethnicity,and sleep-disordered breathing on sleep architecture. Arch InternMed 2004; 164:406-418.13. Somers VK, Javaheri S. Cardiavascular effects of sleep-related breathingdisorders. In: Kryger MH, Roth T, Dement WC, eds. Principles andPractices of Sleep Medicine, 4th ed. Philadelphia: Elsevier Saunders;2005: 1182-1186.14. Association of Polysomnographic Technologists, eds. Job Descriptions.Westchester, IL. Available at: http://aptweb.org/pdf/JobDescriptions.pdf15. American Academy of Sleep Medicine, eds. Standard 3: Personnel.Standards for Accreditation of a Sleep Disorders Center. Westchester,IL: 2006.16. Health Insurance Portability and Accountability Act of 1996 Available at:http://www.cms.hhs.gov/HIPAAGenInfo.17. American Academy of Sleep Medicine, eds. Standard 8: Facility andEquipment. Standards for Accreditation of a Sleep Disorders Center.Westchester, Illinois: 2006.18. Occupational Safety & Health Administration, Occupational Safety andHealth Standards: Exit Routes, Emergency Action Plans, and FirePrevention Plans — 1910 Subpart E App. Available at:http://www.osha.gov/pls/oshaweb.19. Centers for Disease Control. Guidelines for preventing the transmissionof tuberculosis in health-care settings, with special focus on HIV-relatedtissues. MMWR 1990; 39 (RR-17): 1-29.20. Centers for Disease Control. Update: Universal Precautions for preventionof transmission of human immunodeficiency virus, hepatitis B virus,and other bloodborne pathogens in healthcare settings. MMWR 1988;37: 377-382, 387-388.21. Occupational Safety & Health Administration, Occupational Safety andHealth Standards: Bloodborne pathogens — 1910.1030. Available at:http://www.osha.gov/pls/oshaweb.APT Continuing EducationCredit Program —NEW Applications areNow AvailableTo meet the growing professional and educational needs of theSleep Technology Profession, the Association of PolysomnographicTechnologists (APT) has revised and expanded the ContinuingEducation Credit (CEC) Program. Educational Providers now havethe opportunity to apply for APT CECs through four educationalcategories:1. In-Service/Case Conference — (one to two hour program)2. Single Lecture/Workshop — (one to two hour program)3. Educational Programs, Training Course, Seminar, etc. —(more than two hour program)4. Computer Based Learning Activities (i.e. CD-ROM’s,DVD’s, Webinars, and Internet)For additional information on the new APT CEC applications,visit the APT Web site at www.APTWeb.org.13
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