APT Curriculum Outline

1. Summarize the scope of the practice of sleep medicine and technology

2. Describe the nosology of sleep medicine and technology, and its evolution

3. Paraphrase the history of sleep medicine and technology

4. Give examples of the signs and symptoms of the major categories of sleep disorders

5. Discuss therapeutic modalities (mechanical, pharmacological, behavioral, surgical)

• 1. Appropriate interactions between technologist and patient

• 2. Behavioral observations and documentation

• 3. Appropriate interaction between technologist and other health professionals

• 4. Legal and ethical principles for patient care

• 5. Patient rights and responsibilities

• 6. Confidentiality

• 7. Research ethics

1. Explain brain structure and function as it relates to the generation of sleep

2. Explain circadian sleep/wake rhythms

3. Explain the electrical brain wave/eye movement activity seen during sleep

4. Explain the generation of skin surface muscle potentials

5. Explain the generation of skin surface heart muscle potentials

6. Give examples of human sleep stages

7. Summarize normal sleep architecture

8. Summarize the benefits of sleep and consequences of sleep deprivation

9. Give examples of age-specific sleep patterns

10. Explain brain/spinal cord control of breathing

11. Explain the physiology of the hypoxic and hypercapnic mechanisms of ventilatory drive

12. Explain the mechanics of breathing

13. Explain the anatomic locations of the collapsible portions of the upper airway

1. Explain human anatomy and physiology as it relates to sleep disorders, and how sleep disorders affect anatomy and physiology

2. Identify the major categories of sleep disorders according to the International Classification of Sleep Disorders

3. Describe the signs and symptoms associated with major cat ego ries of sleep and arousal disorders

4. Summarize the major categories of sleep and arousal disorders based on age-specific criteria

5. Describe the most commonly encountered sleep disorders in infants and children

6. Describe the most commonly encountered sleep disorders in the elderly

1. Explain basic electricity and magnetics, electrical conduction, polarity conductors, resistors, capacitors, transistors, insulators, Ohm's law, sensitivity, filters, circuits, AC amplifiers, DC amplifiers, differential amplifiers, signal multiplexers and common mode rejection

2. Summarize the process of measuring the electromechanical functions of the human body,

including extra-cellular potentials created by cardiac, brain, muscle, and integumentary cells

3. Explain principles of the function and handling of electrodes, electrolytic substances and fixatives

4. Explain the frequency and voltage characteristics of EEG, EOG, EMG, and ECG

5. Explain impedance measurements and impedance meters

6. Prepare sample montages indicating the channel derivation and how they differ for referential and bipolar recordings

7. Explain signal calibration, electrical baseline, and mechanical baseline

8. Discuss the origins of artifact and artifact elimination

9. Summarize the effect of different time bases on the PSG signal display

10. Explain the principles of operation of airflow monitors

11. Explain the principles of operation of effort monitors

12. Explain the principles of operation of oximeters and capnometers

13. Give examples of interfacing devices with the acquisition system

14. Discuss the impact of sampling rate, Nyquist theory (Shannon’s sampling theorem), aliasing, horizontal/vertical resolution and screen size on signal display quality

15. Give examples of methods of data storage and retrieval

16. Summarize the principles of electrical safety

17. Explain the principles of PAP theory and application, including calibrating the PAP device with the acquisition system

1. Determine which components of the medical and physical history are necessary to recognize a sleep-related complaint in patients of all age ranges

2. Give examples of categories of medications and substances that have an effect on sleep architecture and sleep-disordered breathing

3. Paraphrase the practitioner’s orders

4. Conclude which types of patients may require special precautions

5. Determine the adequacy of documentation to perform the test as ordered

6. Give examples of routine patient safety precautions

7. Explain the routine PSG protocols including PSG, MSLT, MWT, PAP PSG, as applied across all age ranges

8. Explain the principles of interviewing and observing the patient to assess special physical needs

9. Explain the principles of interviewing and observing the patient to assess special cognitive needs

10. Explain the principles of interviewing and observing the patient to assess special emotional needs

11. Give examples of signs and behaviors that determine the patient's level of cooperation

12. Explain the testing procedures, rules and restrictions to patients of all age ranges

13. Determine electrode location for EEG, EOG, ECG, EMG across patient age ranges and conditions

14. Summarize the principles of site preparation and attachment of electrodes across patient age ranges and conditions

15. Give examples of the location and attachment of routine ancillary equipment

16. Select the appropriate equipment monitors required for practitioner-ordered testing

1. Explain the principles of signal calibration as they pertain to digital and analog recording systems, and substandard signal calibrations

2. Explain the principles of evaluating impedance and the use of impedance meters

3. Explain the principles of physiological calibration

4. Explain the principles of troubleshooting electrical and mechanical problems

5. Explain the principles of documentation

6. Explain the principles of alteration of amplifier settings

7. Explain the principles of derivation alteration

8. Explain the principles for alteration of the patient's environment

9. Explain the principles for initiation of clinical interventions across age groups

10. Explain the principles for determining validity of clinical data from monitoring equipment and responding to inaccuracy of monitoring equipment in clinical data collection

1. Explain the application of PAP devices for sleep-related breathing disorders

2. Explain the application of oxygen for sleep-related breathing disorders

3. Summarize the concomitant use of PAP devices and oxygen for sleep - related breathing disorders

4. Explain the principles of correct PAP titration techniques

5. Explain the principles of correct oxygen titration techniques

6. Explain the contraindications for PAP

7. Explain the complications of PAP

8. Explain the contraindications for oxygen therapy

9. Explain the complications of oxygen therapy

10. Give examples of responses to complications of PAP

11. Give examples of responses to complications of oxygen therapy

12. Give examples of responses to complications of combined PAP and oxygen therapy

1. Verify the accuracy of medical record information which is pertinent to appropriate data acquisition and therapeutic modalities

2. Select appropriate equipment, data acquisition parameters, and therapeutic modalities from information obtained from the medical record

3. Evaluate the clinical presentation associated with sleep and arousal disorders in order to determine appropriateness of protocol, meet patient's special requirements and determine final testing parameters/ procedures

4. Create and modify a polysomnographic recording montage montage to optimize recognized indications, contraindications, and potential side effects of treatment modalities

5. Explain various types of adult and pediatric procedures performed by the polysomnographic technologist for advanced monitoring including bilevel PAP, NIPPV, Pes, pH, parasomnia and seizure investigation

6. Differentiate between wake, and the sub-classifications of sleep according to professionally accepted guidelines

7. Integrate new information such as age-specific EEG characteristics, EEG arousals, and alpha-intrusion to customize the sleep scoring rules to each clinical scenario

8. Distinguish medication effects on the polysomnogram

9. Separate artifact from physiological signals on polysomnographic recordings

10. Differentiate normal variants and artifact from epileptiform or seizure activity

11. Devise a plan to troubleshoot causes of artifact

12. Devise a linear plan to troubleshoot common equipment problems

13. Categorize abnormal respiratory events according to the definitions and sub-classifications of apnea, hypopnea, hypoventilation, periodic breathing, Cheyne-Stokes respiration and UARS

14. Assess the oximetry recording for normal and abnormal oxyhemoglobin saturation values, and differentiate these values from artifact

15. Categorize EMG activity including PLMs and body movements

16. Integrate abnormal respiratory event data, associated oxyhemoglobin desaturations, EMG activity, and sleep stage scoring to calculate indices for report generation

17. Recommend intervention and titration of O2 and/or PAP therapy based on written protocols when given a clinical scenario

18. Differentiate between lethal and non-lethal ECG dysrhythmias

19. Initiate emergency procedures, such as CPR and airway management, based on a clinical scenario

20. Verify the accuracy of a computer generated report by manually calculating latencies, percentages, and indices

21. Differentiate between the pathophysiologic disorders based on their associated clinical and polygraphic signs and symptoms.

22. Assess individual patient care needs with regard to age, cognitive needs, emotional needs, level of cooperation, disease processes, and risk of infection

1. Distinguish the variety of ancillary equipment devices used in polysomnography and their principles of operation, including capnometers, esophageal pressure monitors, audio-visual equipment, esophageal pH meters, actigraphy, audiovisual equipment, and extended EEG

2. Choose ancillary equipment with respect to various contexts (referring diagnoses, patient characteristics, and PSG protocols)

3. Connect ancillary equipment to the acquisition system according to hardware and software specifications, and to the patient in a manner appropriate to the patient (re: age, gender, medical & psychological conditions)

4. Differentiate normal vs. abnormal , or erroneous vs. true data recorded by ancillary equipment

5. Recommend amplifier parameters for ancillary equipment, appropriate to various contexts (patient's medical history/condition, polysomnographic events and artifacts)

6. Manipulate bilevel titration protocols according to various contexts (pressure modality, polysomnographic indicators, side effects, patient history indications and contraindications)

1. Discriminate between the impact of drugs used to treat sleep disorders and drugs in common use that affect the polysomnogram

2. Select supplemental oxygen therapy protocols and equipment according to various contexts (patient indications and contraindications, as well as polysomnography evidence thereof)

1. Explain procedure to patient

2. Identify and respond to the needs of the patient

3. Identify proper placement of electrodes

4. Demonstrate consistent placement of electrodes

5. Prepare electrode sites

6. Fasten electrodes

7. Demonstrate calibrations and bio-cals, verify if correct, and manipulate amplifier settings to maintain data integrity

1. Prepare the components of a montage

2. Communicate to the patient and significant others the complaint to be evaluated

3. Manipulate the montage as indicated

4. Apply and adjust amplifier settings as appropriate to patient conditions, protocol, and artifact

5. Differentiate artifact from expected signal

6. Manipulate time base and display widths

7. Differentiate changes in signal wave morphology

8. Isolate equipment problems

9. Resolve equipment problems

10. Label patient information

11. Demonstrate procedure for initiating and ending a polysomnogram

1. Apply and adjust PAP devices for sleep-related breathing disorders

2. Apply and adjust oxygen for sleep-related breathing disorders

3. Prepare equipment for the concomitant use of PAP devices and oxygen

4. Demonstrate the correct application of PAP titration techniques

5. Demonstrate the correct application of oxygen titration techniques

1. Differentiate sleep/wake stages according to patient-specific factors

2. Apply standard criteria for scoring

3. Apply criteria for determining arousals

4. Measure frequency and amplitude of waveforms

1. Distinguish scoreable limb movement from artifact or other associated events

2. Measure frequency, duration, and amplitude of limb movements

3. Apply scoring rules for limb movements

1. Subdivide events into correct category

2. Discriminate clinically significant events

3. Measure respiratory events

4. Measure oxygen desaturations

1. Differentiate normal activity from abnormal

2. Revise the montage

3. Evaluate abnormal waveforms

1. Summarize scored data

2. Apply standards to reports

3. Discriminate erroneous data

4. Create an accurate report

1. Determine that documentation is present

2. Verify medication requirements

3. Determine appropriateness of protocol

4. Determine special precautions related to infection control and other patient-specific factors

5. Analyze unclear, inappropriate, or contradictory orders

6. Communicate above analysis with the physician

1. Identify caffeine or alcohol intake

2. Confirm patient’s medications

3. Assess and respond to the patient's special needs (age, cognitive level, physical or emotional

discomfort, ability to cooperate, etc.)

4. Recognize and respond to any special testing considerations (prosthetic devices, electromechanical devices, etc.)

5. Determine and respond to clinical needs based on vital signs and interview

6. Identify and document patient’s current sleep pattern

7. Administer pre- and post- procedure questionnaires, and follow-up processes

1. Show the patient their sleep room and bathroom/changing area

2. Show the patient where to access food, water, and medication storage

3. Orient the patient to their preparation/testing schedule based on the physician's orders

4. Describe the testing procedure to the patient, (hook-up, light off/on)

1. Determine equipment/supplies needed based on the patient specific order/procedure

2. Prepare the equipment/supplies for use

1. Correctly apply electrodes and monitors based on patient specific order/procedure

1. Enter patient information

2. Choose correct montage based on patient orders/procedure and verify that proper filter and sensitivity settings are selected

3. Calibrate all necessary equipment for the procedure as ordered

4. Implement biological calibrations

5. Verify proper electrode impedance values and signal quality of all channels

6. Correct and report deviations from the ordered procedure

1. Identify and document lights out/on, out of bed, body positions, and PAP pressures

2. Determine and document heart rate, respiratory rate and pattern, and Sp02 values

3. Determine and document patient behaviors: snoring, vocalizations, movements, complaints, etc.

4. Distinguish between EEG patterns to accurately document sleep onset and sleep stages

5. Document manipulations of amplifier settings and derivations, and equipment malfunctions

6. Adjust and document conditions of the testing environment required for optimal recording quality and patient comfort

7. Modify and document parameters to ensure the integrity and quality of the recording

8. Determine and document required interventions and treatments

9. Maintain accurate and timely documentation

1. Recognize events

2. Determine appropriate action

3. Differentiate artifact from expected signal

4. Rapid analysis and appropriate response to events (patient or equipment)

1. Determine appropriate procedures in response to events

2. Recognize complications and contraindications of prescribed therapy

3. Assemble required equipment

4. Orient patient to procedure

5. Apply devices to patient

6. Titrate therapy appropriately

7. Document therapy

1. Recognize and respond to patient safety and emergency situations

2. Follow emergency procedures

3. Demonstrate proper use of emergency equipment

4. Demonstrate proper techniques for infection control

1. Perform MSLT/MWT

2. Score and generate report

1. Score and generate reports