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HAT 470: Polysomnographic Technology I COURSE SYLLABUS 2016

INSTRUCTOR INFORMATION: Lisa Endee, MPHc, RRT-SDS, RPSGT, RST Clinical Assistant Professor

Office: Room 449 Phone: 444-6627 Email: lisa.endee@stonybrook.edu

GOAL: The goal of this course is to provide instruction and laboratory based training to build competency in the theory, principles and practices of Basic Polysomnography. COURSE DESCRIPTION: This course is designed to provide entry-level personnel with both didactic and laboratory training in polysomnographic technology. Presents medical terminology, instrumentation setup and calibration, recording and monitoring techniques, documentation, professional issues, and patient-technologist interactions. Laboratory sessions will provide practical experience in the skills required of an entry-level Polysomnographic Technologist. Lecture and laboratory. Prerequisites: HAT 331 2.0 credits, Modules 3 & 4 COURSE LOCATION: Lecture RC Lab B Lab Sleep Lab Room 502 COURSE DATES: Modules 3 and 4: Monday, November 7th – Friday, February 3rd CLASS HOURS: Lecture: Monday 12:45 pm - 2:45 pm Lab Group A: Tuesday 10:15 am -1:15 pm Lab Group B: Tuesday 1:30 pm - 4:30 pm TEACHING STRATEGIES: Didactic instruction will utilize a combination of PowerPoint presentations, group discussions, and guest lectures. Laboratory instruction will utilize hands-on demonstrations and return demonstrations in a small group environment. Students will also be required to complete assignments related to material covered throughout the course.

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REQUIRED AND RECOMMENDED TEXT(S) Textbooks can be purchased in the book store or on-line and are available for reference on the shelf in the HSC Library. Required: Spriggs, W. H. (2015). Essentials of polysomnography: a training guide and reference for sleep technicians (Second ed.). Burlington: Jones and Bartlett Learning. ISBN-13: 9781284030273 Recommended: Mattice, C. (2012). Fundamentals of sleep technology (2nd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. ISBN 978-1-4511-3203-8 Robertson, B., Marshall, B., & Carno, M. (2014). Polysomnography for the sleep technologist: Instrumentation, monitoring, and related procedures. St Louis, MI: Elsevier. ISBN 9780323100199 Pressman, M. R. (2002). Primer of polysomnogram interpretation. Boston: Butterworth-Heinemann. ISBN-13: 978-0750697828

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ATTENDANCE: Attendance/punctuality for all courses is mandatory. All instructors are encouraged to take attendance and keep track of lateness. Each instructor has the prerogative to decrease a student’s final grade for repeated lateness or unexcused absences. Excessive unexcused lateness or absences (3 or more occurrences) are grounds for a grade of “F” in the course. The student is required to leave a message for the instructor concerning the circumstances of the lateness or absence. It is the instructor’s prerogative to require written documentation to excuse lateness or absences. Failure to provide requested written documentation will classify the event as unexcused. Students receiving a grade of “F” in any course may be subject to termination from the program. METHODS OF EVALUATION:

Demonstration of 10-20 for Electrode Placement (10%) Each student will be required to demonstrate accurate performance of the 10-20 measurement system for electrode placement in Polysomnography by Week 3. (Laboratory session) Mid-Term Exam (25%) This exam will cover topics from weeks 1 through 5. The format will be multiple-choice, multiple answer and short answer and will include sleep study images. Homework Assignments/Quizzes (15%) Homework assignments will include journal article review, sleep study image interpretation and report calculations. Additional assignments/Quizzes may be utilized as needed. Final Exam (25%) This exam will cover topics from weeks 1 through 9. The format will be multiple-choice, multiple answer and short answer and will include sleep study images. Final Lab Practical (25%) The lab practical will evaluate competency in skills learned during the lab sessions. Topics include sleep history, patient hook-up procedures, electrode application techniques, impedance testing, montage selection, machine and bio calibration procedures, documentation, and sleep stage, artifact and event recognition.

ACADEMIC INTEGRITY: Each student must pursue his or her academic goals honestly and be personally accountable for all submitted work. Representing another person's work as your own is always wrong. Faculty are required to report any suspected instances of academic dishonesty to the Academic Judiciary. Faculty in the Health Sciences Center (School of Health Technology & Management, Nursing, Social Welfare, and Dental Medicine) and School of Medicine are required to follow their school-specific procedures. For more comprehensive information on academic integrity,

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including categories of academic dishonesty, please refer to the academic judiciary website at http://www.stonybrook.edu/uaa/academicjudiciary/. The Department of Respiratory Care considers any unauthorized possession of its previous exams, papers etc. to be a violation of the School’s policy. The Respiratory Care faculty does not allow past exams to circulate, and therefore any student possessing or circulating them is subject to disciplinary action and/or dismissal. The student should refer to the SHTM's guidelines regarding the policy as it applies to the core courses (ethics, research design and management concepts), and the basic sciences (anatomy, physiology, pathology, pharmacology). No programmable calculators or other study aids are allowed in any exam, except where the instructor has specifically designated such items as permissible. If in doubt, ask your instructor prior to the start of any examination. GRADING SCALE: Unless otherwise approved by the Department Chair, the final percent grade is assigned a letter grade in the course syllabus, as follows: 95 - 100% A 73 - 76.9% C 90 - 94.9% A- 70 - 72.9% C- 87 - 89.9% B+ 66 - 69.9% D+ 83 - 86.9% B 60 - 65.9% D 80 - 82.9% B- 0 - 59.9% F 77 - 79.9% C+ ACCESS TO COURSE VIA BLACKBOARD: You can access class information, including the syllabus, class announcements, all power points, handouts and assignments on-line at: http://blackboard.sunysb.edu. "The materials in this course available online or via a website link are for the exclusive use of registered students currently enrolled in this course and may not be further distributed. In addition to legal sanctions, violation of these copyright prohibitions may result in University disciplinary action."

IT IS RECOMMENDED THAT YOU CHECK BLACKBOARD DAILY FOR COURSE ANNOUNCEMENTS AND INFORMATION. Blackboard assignments are required to be submitted on time and be uploaded to Blackboard. Depending on the assignment, late submissions will not be accepted or will result in a lowering of your grade.

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INSTRUCTIONS FOR BLACKBOARD: If you have used Stony Brook’s Blackboard system previously, your login information (Username and Password) has not changed. If you have never used the Blackboard system, your initial password is your SOLAR ID# and your username is the same as your Stony Brook username, which is generally your first initial and the first 7 letters of your last name.

For help or more information, see: http://www.sinc.sunysb.edu/helpdesk/docs/blackboard/bbstudent.php For problems logging in, go to the helpdesk in the Main Library SINC Site or the Union SINC site. You can also call: 631-632-9602 or email: helpme@ic.sunysb.edu. ELECTRONIC COMMUNICATION STATEMENT Email and especially email sent via Blackboard (http://blackboard.stonybrook.edu) is one of the ways the faculty officially communicates with you for this course. It is your responsibility to make sure that you read your email in your official University email account. For most students that is Google Apps for Education (http://www.stonybrook.edu/mycloud), but you may verify your official Electronic Post Office (EPO) address at http://it.stonybrook.edu/help/kb/checking-or-changing-your-mail-forwarding-address-in-the-epo. If you choose to forward your official University email to another off-campus account, faculty are not responsible for any undeliverable messages to your alternative personal accounts. You can set up Google Mail forwarding using these DoIT-provided instructions found at http://it.stonybrook.edu/help/kb/setting-up-mail-forwarding-in-google-mail. If you need technical assistance, please contact Client Support at (631) 632-9800 or supportteam@stonybrook.edu. The University Senate has authorized that the following required statements appear in all teaching syllabi on the Stony Brook Campus. This information is also located on the Office of the Provost website: http://www.stonybrook.edu/commcms/provost/policies.shtml DISABILITY SUPPORT SERVICES (DSS) STATEMENT: If you have a physical, psychological, medical or learning disability that may impact your course work, please contact Disability Support Services, ECC (Educational Communications Center) Building, Room 128, (631) 632-6748. They will determine with you what accommodations are necessary and appropriate. All information and documentation is confidential. Students who require assistance during emergency evacuation are encouraged to discuss their needs with their professors and Disability Support Services. For procedures and information go to the following web site: http://www.stonybrook.edu/ehs/fire/disabilities and search Fire Safety and Evacuation and Disabilities.

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CRITICAL INCIDENT MANAGEMENT: Stony Brook University expects students to respect the rights, privileges, and property of other people. Faculty are required to report to the Office of University Community Standards any disruptive behavior that interrupts their ability to teach, compromises the safety of the learning environment, or inhibits students' ability to learn. Faculty in the HSC Schools and the School of Medicine are required to follow their school-specific procedures. Further information about most academic matters can be found in the Undergraduate Bulletin, the Undergraduate Class Schedule, and the Faculty-Employee Handbook.

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COURSE SCHEDULE:

WEEK DATE: TOPIC: ASSIGNED READING:

1: Lecture NOTE DATE/TIME CHANGE

TUES 11/8 10:15a- 12:15p LAB B

Review course syllabus

Overview of Sleep Diagnostics

Taking a Sleep History: study orders and paperwork for initiating

sleep studies

Spriggs: Ch. 3 & 4 Mattice: Ch. 1, 3, 28 Robertson: Ch. 1 Handouts available on Blackboard: Sleep Terminology AAST Position Statement AAST Scope of Practice Role of the Sleep Technologist

1: LAB Combined NOTE DATE/TIME CHANGE

WED 11/9 1:00 pm- 3:00 pm LAB B

Patient preparation – Part 1: Collecting and processing

information gathered from the sleep history, patient interview,

and other clinically-relevant documents

Handouts posted to Blackboard. Please print out and bring to class.

2: 11/14,15 NO CLASS/LAB THIS WEEK (WOHOO!)

Assigned Readings for next week

3: Lecture

Monday 11/21 12:45 pm

Instrumentation for monitoring and recording sleep parameters

Electrical Theory

Electrical and Instrument Safety

Overview of patient, technician,

and laboratory safety issues

Spriggs: Ch 1, 5, 6, & 9 Mattice: Ch 26,27,29 Robertson: Ch. 3,4,6,14 Handouts available on Blackboard: AAST Core Competencies: Maintenance, Cleaning and Safety Precautions Polysomnography Standard PSG Staffing Ratios

3: Lab Tuesday 11/22 L01, L02

Patient preparation – Part 2 International 10-20 System of

Electrode placement

Handouts posted to Blackboard. Please have available in class.

Thanksgiving Recess from 11/23 thru 11/27

4: Lecture MON 11/28

Quiz on Weeks 1- 3

Week 4 Topic: Sleep staging criteria and normal

sleep architecture

Spriggs : Chapter 7, 12 Mattice: Ch. 32 Robertson: Ch. 5 Handouts available on Blackboard: AAST Competency Scoring Sleep AASM Manual for Scoring Sleep

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4: LAB TUESDAY 11/29

DEMONSTRATION OF 10-20 EVALUATION

Patient preparation – Part 3 International 10-20 System of

Electrode placement Principles of sensor application

Be prepared to demonstrate the ability to perform the 10-20 System Robertson: Ch. 8,9 Handouts posted to Blackboard. Please have available in class.

5: Lecture MON 12/5

Artifact recognition and troubleshooting

Arousal rules and guidelines

Spriggs : Chapter 8 & 13 Mattice: 30, 32 Robertson: Ch. 10 Handouts available on Blackboard: ASDA Arousal Rules and Examples

5: Lab TUES 12/6

Patient preparation – Part 4 Instrument and bio-cals,

verifying and adjusting signals, troubleshooting suboptimal signals

Sleep Stage Scoring Review

Arousal recognition

Robertson: Ch. 6 Handouts posted to Blackboard. Please have available in class. AASM Manual for the Scoring of Sleep and Associated Events

6: EXAM MON 2/12 MIDTERM EXAM (covers material week 1-5)

6: Combined Lab, Lab B 10:15 am- 1:00 pm

TUESDAY 12/13

Review of Midterm Exam

AASM Rules for scoring respiratory events in sleep

Spriggs : Chapter 13, 15 Mattice: Ch. 16, 17, 32-33 Robertson: Ch. 7 Handouts available on Blackboard:

Instrumentation of respiratory devices

HAPPY HOLIDAYS!! WINTER RECESS THROUGH SUNDAY, JAN 1st

7:Lecture MON 1/2

Movement Disorders in Sleep

Spriggs : Chapter 13 Mattice: 14, 15, 32 Handouts posted to Blackboard.

7: Combined Lab Lab B

TUESDAY 1/3 10:15 am- 1:00 pm

Scoring Calculations Reporting of sleep studies Discussion of Clinical Case

Presentation

Handouts posted to Blackboard. Please print out and bring to class.

Homework Assignment #1: Calculations of Sleep Data

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DUE MON 1/9 Homework Assignment #1 DUE by 10 am

8: Lecture MON 1/9 PAP Therapies for Sleep Disordered Breathing

Spriggs : Chapter 10 Mattice: 34 Handouts posted to Blackboard.

8: Lab TUESDAY 1/10

Mask Selection and Fittings PAP Devices and Basic Therapies

10-20 Electrode Placement/Sensor Application/Calibration procedures

Sleep Record Scoring

Homework Assignment #2: Staging and Scoring of Events

Due Tuesday, Jan 17th at 10 am

AASM Manual for the Scoring of Sleep and Associated Events Handouts posted to Blackboard. Please have available in class.

9: Lecture MON 1/16 NO CLASSES IN SESSION- MLK HOLIDAY

DUE TUES 1/17 Homework Assignment #1 DUE by 10 am

9: Lab

TUESDAY 1/17

Lab Review/Questions/Practice: 10-20 Electrode Placement/Sensor Application/Calibration procedures Sleep Record Scoring/Calculations

AASM Manual for the Scoring of Sleep and Associated Events

10: Lecture 1/23 Surgical Options for SDB Oral Appliance Therapy

Mattice: 38 BB: Supp. Readings TBD

10: LAB EXAM

1/24 LAB PRACTICALS (covers material from week 1 thru 10)

11: EXAM 1/30 FINAL EXAM (covers material from week 1 thru 10)

11:Lab 1/31 RESERVE FOR FINAL EXAM/PRACTICAL IN THE EVENT OF SNOW DAY

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COURSE OBJECTIVES Week 1 1. Give an overview of sleep diagnostics and procedures. 2. Define the technical terms used in the field of polysomnographic technology. 3. Discuss the role of the technologist in sleep diagnostics. 4. Explain the indications for sleep testing. 5. Demonstrate the procedure for obtaining and reviewing the sleep history and pre-sleep

questionnaires. 6. Verify the medical order and protocol. 7. Perform an effective patient interview. 8. Orient the subject to the sleep laboratory. 9. Explain pre-testing, testing procedures to a subject in terms appropriate for the subject's

age and mental or cognitive status.

Week 3 1. Explain the principles of electrical conduction, grounding, polarity, frequency, voltage, and

impedance as they relate to sleep diagnostics. 2. Explain the principles of sensitivity, amplitude, filters, and common mode rejection as they

relate to sleep diagnostics. 3. Define the terms “electroencephalogram, electrooculogram, electromyogram, and

electrocardiogram.” 4. Describe the waveform characteristics of the EEG, EOG, EMG, and ECG. 5. Differentiate between bipolar and referential signal derivations. 6. Discuss the measures for ensuring proper electrical, instrument and patient safety. 7. Describe how EEG electrodes are placed according to internationally-accepted

standards. 8. Discuss importance of safe practices with regard to sleep testing. 9. Be familiar with cleaning and maintenance of equipment used in sleep diagnostics. Week 4 1. Become familiar with recognizing patterns of EEG activity with regards to sleep. 2. Identify and describe the characteristics of each stage of normal sleep. 3. Describe the characteristics of normal sleep architecture. 4. Demonstrate proper measurement of EEG electrode sites according to the

International 10-20 system. 5. Clean and prepare patient electrode sites in accordance with internationally-accepted

standards. 6. Apply electro-conductive material where applicable. 7. Apply patient electrodes in accordance with internationally-accepted standards. 8. Describe the purpose and operation of the head box.

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9. Connect electrodes and sensors to the appropriate input of the head box. 10. Verify appropriate impedance level for each electrode. Week 5 1. Describe the artifacts commonly seen during an instrument and bio calibration. 2. Explain the proper troubleshooting techniques used to correct these artifacts. 3. Explain the AASM rules for scoring of arousals on the sleep study. 4. Identify arousals on the sleep study. 5. Prepare and calibrate equipment required for testing to determine proper functioning. 6. Provide a definition for the term "montage." 7. Select a sleep montage on the polysomnograph consistent with the type of test

requested. 8. Appropriately place and securely attach electrodes and ancillary equipment to the subject. 9. Interface ancillary equipment to data recording devices. 10. Verify proper function and signal quality for electrodes and ancillary monitoring equipment. 11. Describe the clinical importance and procedure for performing an impedance check. 12. Describe the clinical importance and procedure for performing a bio calibration procedure.

Week 6 1. Explain the anatomic locations and physiologic forces that maintain airway patency. 2. Explain the normal ventilatory response to sleep and arousal. 3. Explain the effects of normal sleep on control of breathing and oxygenation. 4. Explain the principles of operation of pressure transducers, airflow sensors, respiratory and

abdominal effort sensors, snore sensors, position sensors, and oximeters as they relate to sleep diagnostics.

5. Define the AASM rules for scoring respiratory events. 6. Explain the purpose and indications for using audiovisual equipment in a sleep laboratory. 7. Correctly perform an impedance check. 8. Correctly perform a bio-calibration procedure. 9. Describe common artifacts seen during a bio calibration. 10. Take appropriate corrective action to assure proper signal display during recording of a

sleep study. Week 7 1. Describe RLS and PLMD. 2. Apply the AASM rules for scoring leg movements in sleep. 3. Describe the procedure for documenting and reporting routine observations, clinical

events, changes in procedure/protocol, and other significant events in order to facilitate scoring and interpretation of polysomnographic results.

4. Become familiar with sleep reports and the data included in them. 5. Understand the numerical data of sleep reporting.

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6. Demonstrate the ability to calculate sleep indices manually. 7. Perform manual calculations of statistics and generate accurate reports.

Week 8 1. Understand the theory of PAP therapy for the treatment of sleep disordered breathing. 2. Describe basic PAP modalities and discuss the appropriate use, benefits and limitations of

each. 3. Discuss indications, contraindications, applications, and goals of PAP therapy for the

treatment of sleep disordered breathing. 4. Be familiar with interface options and appropriate selection for patients using PAP therapy. 5. Identify various barriers to treatment with PAP therapy for SDB and discuss ways the

technologist can address those issues. 6. Gain confidence in the identification of sleep stages and significant events on the digital

polysomnogram. 7. Follow “lights on” procedures to verify integrity of collected data and complete the data

collection process (e.g. repeats the physiological and instrument calibrations and instructs the subject on completing questionnaires, etc.).

8. Remove electrodes and other recording devices using appropriate technique. 9. Explain the procedure for properly cleaning and maintaining sleep monitoring equipment. 10. Gently and effectively clean all electrodes/adhesive contact points.

Week 9 1. Demonstrate the ability to use all knowledge and skills from the course to perform a

complete standard polysomnogram including all aspects of patient interaction, 10-20 electrode measurement and application, ancillary equipment, calibration procedures, and monitoring of the record to ensure it is for artifact free and has a quality consistent with AASM standards.

Week 10 1. Describe the different therapeutic modalities for sleep disordered breathing, including

surgical options and oral appliance therapies. 2. Discuss the appropriate use, benefits and limitations of each.