Syllabus for PSG-103

POLYSOMNOGRAPHY SCORING


COURSE DESCRIPTION

Polysomnography Scoring provides a solid foundation in the principles, techniques, and concepts related to polysomnographic scoring. The course covers the fundamental concepts of sleep staging, arousal recognition and scoring, and event scoring for respiratory, limb, and cardiac events.  

The course outlines the standard scoring practices currently in use. Clinical judgment is always necessary, both when scoring and interpreting polysomnograms. Therefore, you are encouraged to stay abreast of changes in the field, including updated practice parameters and newly published standards and guidelines. The quality of the interpretation of the polysomnogram you record has much to do with your ability to understand, and accurately score, the recording.

COURSE OBJECTIVES

After completing this course, you should be able to:

  1. Identify normal adult and pediatric wake and sleep EEG patterns.
  2. Identify and describe normal and abnormal sleep architecture.
  3. Identify and score:
  1. adult and pediatric sleep/wake stages.
  2. arousals and awakenings.
  3. adult and pediatric respiratory events and respiratory effort-related arousals and awakenings.
  4. movements and event-related arousals and awakenings.
  5. cardiac events.
  1. Identify and document unusual occurrences including REM sleep behavior disorder, rhythmic movement disorders, seizure activity, alpha-delta sleep, and drug-induced EEG spindles.
  2. Perform the calculations required to reduce scored data according to standard PSG reporting parameters.
  3. Create and verify the accuracy of a PSG technical report.
  4. Define the scoring process and reporting parameters used for MSLT/MWT testing.
  5. Define the scoring processes and reporting parameters used for portable monitoring procedures.

COURSE MATERIALS

You will need the following material to do the work of the course. Fundamentals of Sleep Technology, 2nd ed., is available from the College's textbook supplier, MBS Direct. The AASM Manual for Scoring . . . Version 2.0 is available by subscription or access code from the American Academy of Sleep Medicine. Course documents are available from within the course space.

Required Texts

  1. Mattice, C., Brooks, R., & Lee-Chiong, T. (Eds). (2012). Fundamentals of sleep technology (2nd ed.). Philadelphia: Lippincott Williams and Wilkins. [N.B. Also used in PSG-101 and PSG-102]

    ISBN-13: 978-1-4511-3203-8

  1. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications Version 2.0. [Available by calendar year subscription or access code from the American Academy of Sleep Medicine. See http://www.aasmnet.org/scoringmanual/default.aspx.]

Course Documents

The following PDF documents are available to you from within individual modules of the course:

  1. Standards of Practice Committee of the American Academy of Sleep Medicine. (2005). Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. SLEEP, 28(1), 113–121. [Module 9]

  1. Collop, N.A., Anderson, W. M., Boehlecke, B., Claman, D., Goldberg, R., Gottlieb, D. J., Hudgel, D., Sateia, M., & Schwab, R. (2007). Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Journal of Clinical Sleep Medicine, 3(7), 737–747. [Module 10]

  1. American Association of Sleep Technologists technical guideline for diagnostic portable monitoring. 2009. Westchester, IL: AAST. Used with permission of the AAST, all rights reserved. [Module 10].

COURSE STRUCTURE

Polysomnography Scoring is a three-credit online course, consisting of  ten (10) modules. Modules include learning objectives, study materials (lecture notes, assigned reading, and /Flash/PowerPoint presentations), and activities (online discussions and scoring assignments and reports). Module titles are listed below along with their respective course and module objectives.

  1. Module 1—Adult Sleep and Staging Rules
  1. Course objectives covered in this module: CO 1, 2, and 3
  2. Module objectives:
  1. Identify normal wake and sleep EEG patterns [CO 1]
  2. List the EEG frequency bands commonly seen in polysomnography [CO 1]
  3. Differentiate sleep/wake stages according to patient-specific factors [CO 3A]
  4. Identify and describe normal sleep architecture [CO 2]
  5. Apply standard criteria for sleep stage scoring [CO 3A]
  6. Measure frequency and amplitude of waveforms [CO 1, 3A]

  1. Module 2—Arousal Scoring Rules and Movement Rules
  1. Course objectives covered in this module: CO 2, 3B, 3D, 4, and 5
  2. Module objectives:
  1. Apply criteria for determining arousals [CO 3B]
  2. Categorize EMG activity including body movements [CO 3D]
  3. Categorize EMG activity including PLMS [CO 2, 3D, 4, 5]
  4. Distinguish scoreable limb movement from artifact or other associated events [CO 3D, 4]
  5. Measure frequency, duration, and amplitude of limb movements [CO 3D]
  6. Apply scoring rules for limb movements [CO 3D]

  1. Module 3—Adult Respiratory Rules
  1. Course objectives covered in this module: CO 2, 3C, 3D, and 5
  2. Module objectives:
  1. Subdivide respiratory events into event categories [CO 3C]
  2. Discriminate clinically significant events [CO 2, 3C]
  3. Measure respiratory events [CO 3C]
  4. Measure oxygen desaturations [CO 3C]
  5. Integrate abnormal respiratory event data, associated oxyhemoglobin desaturations, EMG activity, and sleep stage scoring to calculate indices for report generation [CO 3C, 3D, 5]

  1. Module 4—Cardiac Rules
  1. Course objective covered in this module: CO 3E
  2. Module objectives:
  1. Identify and evaluate cardiac events [CO 3E]
  2. Differentiate between lethal and nonlethal ECG arrhythmias [CO 3E]

  1. Module 5—Scoring Unusual or Unexpected Events
  1. Course objectives covered in this module: CO 1, 2, 3A, 3B, 3D, and 4
  2. Module objectives:
  1. Differentiate normal from abnormal activity [CO 2, 3D, 4]
  2. Identify potential causes of abnormal sleep patterns [CO 2]
  3. Revise the montage [CO 1, 3A]
  4. Identify and evaluate abnormal EEG waveforms [CO 1, 2, 4]
  5. Identify and evaluate potential seizure activity [CO 4]
  6. Identify and evaluate unusual motor activity [CO 2, 3D, 4]
  7. Identify and document seizure activity, alpha-delta sleep, REM behavior disorder, rhythmic movement disorder, and drug-induced sleep spindles [CO 4]
  8. Integrate information such as age-specific EEG characteristics, EEG arousals, and alpha-intrusion to customize the sleep scoring rules to each clinical scenario [CO 1, 2, 3A, 3B, 4]

  1. Module 6—Pediatric Sleep Stage and Arousal Scoring Rules
  1. Course objectives covered in this module: CO 1, 3A, 3B, and 3D
  2. Module objectives:
  1. Differentiate sleep/wake stages according to patient-specific factors [CO 3A]
  2. Apply standard criteria for scoring [CO 3A]
  3. Apply criteria for determining arousals [CO 3B]
  4. Measure frequency and amplitude of waveforms [CO 1, 3A]
  5. Categorize EMG activity including body movements [CO 3D]

  1. Module 7—Pediatric Respiratory Rules
  1. Course objectives covered in this module: CO 2, 3C, 3D, and 5
  2. Module objectives:
  1. Subdivide respiratory events into event categories [CO 3C]
  2. Discriminate clinically significant events [CO 2, 5]
  3. Measure respiratory events [CO 3C]
  4. Measure oxygen desaturations [CO 3C]
  5. Integrate abnormal respiratory event data, associated oxyhemoglobin desaturations, EMG activity, and sleep stage scoring to calculate indices for report generation [CO 3C, 3D, 5]

  1. Module 8—Report Generation
  1. Course objectives covered in this module: CO 5 and 6
  2. Module objectives:
  1. Summarize scored data [CO 5]
  2. Apply current AASM standards to reports [CO 5]
  3. Discriminate erroneous data [CO 6]
  4. Verify the accuracy of a computer generated report by manually calculating sleep latencies, sleep stage percentages, and indices [CO 5, 6]
  5. Create an accurate report [CO 5, 6]

  1. Module 9—Score the MSLT/MWT and Generate a Report
  1. Course objectives covered in this module: CO 3A, 5, 6, and 7
  2. Module objectives:
  1. Differentiate sleep/wake stages and assign sleep stages for each epoch according to current standards [CO 3A, 7] 
  2. Calculate sleep onset and REM latencies for each nap and a mean sleep latency for the entire test [CO 5, 7] 
  3. Summarize scored data based on standards, identifying erroneous data [CO 6, 7] 
  4. Verify the accuracy of a computer generated report by manually calculating sleep latencies [CO 5, 6, 7] 
  5. Create an accurate report [CO 6, 7] 
  6. Differentiate between the patient report of subjective sleepiness versus objective evaluation of sleepiness [CO 7]

  1. Module 10—Scoring Portable Monitoring Studies
  1. Course objectives covered in this module: CO 3C, 3E, and 8
  2. Module objectives:
  1. Score oximetry studies and generate a report [CO 3C, 8] 
  2. Score cardiorespiratory studies and generate a report [CO 3C, 3E, 8] 
  3. Score actigraphy studies and generate a report [CO 8] 
  4. Score and generate reports for downloadable PAP equipment [CO 8]

ASSESSMENT METHODS

For your formal work in the course, you are required to participate in online discussion forums, to submit scoring assignments and reports, to take a proctored midterm examination, and to complete a final project. See below for more details.

Consult the course Calendar for due dates.

Discussion Forums

Polysomnography Scoring requires you to participate in ten (10) graded discussion forums worth 16% of your course grade. There is also an ungraded but required Introductions Forum in Module 1.

Communication among fellow students and with the mentor is a critical component of online learning. Participation in online discussions involves two distinct activities: an initial response to a posted question (discussion thread) and subsequent comments on classmates' responses. Meaningful participation is relevant to the content, adds value, and advances the discussion. Comments such as "I agree" and "ditto" are not considered value-adding participation. Therefore, when you agree or disagree with a classmate, the reading, or your mentor, state and support your agreement or disagreement. You will be evaluated on the quality and quantity of your participation. Responses and comments should be properly proofread and edited, professional, and respectful.

Deadlines for posting discussion topics are given in the course Calendar.

Click the link below for an evaluation rubric that will aid in the grading of online discussion forums.

  1. Evaluation rubric for online discussion

Scoring Assignments

Each module concludes with one or more scoring assignments or reports, collectively worth 44% of your course grade. Scoring assignments and reports entail working with sample sleep studies that you will download and save to your computer, along with their respective scoring spreadsheets.

Midterm Examination

You are required to take a proctored midterm examination worth 15% of your course grade. You must take the midterm online using the College's Online Proctor Service. Please refer to the "Examinations and Proctors" section of the Online Student Handbook (see General Information tab in the course Web site) for further information about scheduling and taking online exams and for all exam policies and procedures. You are strongly advised to schedule your exam within the first week of the semester.

The midterm exam is two hours long and covers all topics and material from Modules 1–5 of the course. It consists of multiple-choice questions based on the lecture notes and assigned reading.

Online exams are administered in the Examinations section of the course Web site. Consult the course Calendar for the official dates of midterm exam week.

Final Project

For your final project, you will stage, score, and report on 200 epochs of an adult PSG study. The final project is worth 25% of your course grade.

Please see the Final Project section of the course Web site for further details about the project. Consult the course Calendar for its due date.

GRADING AND EVALUATION

Your grade in the course will be determined as follows:

  1. Scoring assignments and reports (11)—44%

  1. Online discussions (10)—16%

  1. Midterm exam (proctored, modules 1–5)—15%

  1. Final project—25%

All activities will receive a numerical grade of 0–100. You will receive a score of 0 for any work not submitted. Your final grade in the course will be a letter grade. Letter grade equivalents for numerical grades are as follows:

A

=

93–100

C+

=

78–79

A–

=

90–92

C

=

73–77

B+

=

88–89

C–

=

70–72

B

=

83–87

D

=

60–69

B–

=

80–82

F

=

Below 60

To receive credit for the course, you must earn a letter grade of C or better (for an area of study course) or D or better (for a nonarea of study course), based on the weighted average of all assigned course work (e.g., exams, assignments, discussion postings, etc.).

STRATEGIES FOR SUCCESS

First Steps to Success

To succeed in this course, take the following first steps:

  1. Read carefully the entire Syllabus, making sure that all aspects of the course are clear to you and that you have all the materials required for the course.

  1. Take the time to read the entire Online Student Handbook. The Handbook answers many questions about how to proceed through the course, how to schedule exams and arrange for proctors, and how to get the most from your educational experience at Thomas Edison State College.

  1. Arrange to take your midterm examination by following the instructions in the Online Student Handbook. You must make arrangements to take your examination before the end of the first week of the current semester.

  1. Familiarize yourself with the learning management systems environment—how to navigate it and what the various course areas contain. If you know what to expect as you navigate the course, you can better pace yourself and complete the work on time.

  1. If you are not familiar with Web-based learning be sure to review the processes for posting responses online and submitting assignments before class begins.

Study Tips

Consider the following study tips for success:

  1. To stay on track throughout the course, begin each week by consulting the course Calendar. The calendar provides an overview of the course and indicates due dates for submitting assignments, posting discussions, and scheduling and taking examinations.

  1. Check the Announcements and regularly for new course information.

ACADEMIC INTEGRITY

Students at Thomas Edison State College are expected to exhibit the highest level of academic citizenship. In particular, students are expected to read and follow all policies, procedures, and program information guidelines contained in publications; pursue their learning goals with honesty and integrity; demonstrate that they are progressing satisfactorily and in a timely fashion by meeting course deadlines and following outlined procedures; observe a code of mutual respect in dealing with mentors, staff, and other students; behave in a manner consistent with the standards and codes of the profession in which they are practicing; keep official records updated regarding changes in name, address, telephone number, or e-mail address; and meet financial obligations in a timely manner. Students not practicing good academic citizenship may be subject to disciplinary action including suspension, dismissal, or financial holds on records.

Academic Dishonesty

Thomas Edison State College expects all of its students to approach their education with academic integrity—the pursuit of scholarly activity free from fraud and deception. All mentors and administrative staff members at the College insist on strict standards of academic honesty in all courses. Academic dishonesty undermines this objective. Academic dishonesty takes the following forms:

  1. Cheating
  2. Plagiarizing (including copying and pasting from the Internet without using quotation marks and without acknowledging sources)
  3. Fabricating information or citations
  4. Facilitating acts of dishonesty by others
  5. Unauthorized access to examinations or the use of unauthorized materials during exam administration
  6. Submitting the work of another person or work previously used without informing the mentor
  7. Tampering with the academic work of other students

Academic dishonesty will result in disciplinary action and possible dismissal from the College. Students who submit papers that are found to be plagiarized will receive an F on the plagiarized assignment, may receive a grade of F for the course, and may face dismissal from the College.

A student who is charged with academic dishonesty will be given oral or written notice of the charge. If a mentor or College official believes the infraction is serious enough to warrant referral of the case to the academic dean, or if the mentor awards a final grade of F in the course because of the infraction, the student and the mentor will be afforded formal due process.

If a student is found cheating or using unauthorized materials on an examination, he or she will automatically receive a grade of F on that examination. Students who believe they have been falsely accused of academic dishonesty should seek redress through informal discussions with the mentor, through the office of the dean, or through an executive officer of Thomas Edison State College.

Plagiarism

Using someone else's work as your own is plagiarism. Although it may seem like simple dishonesty, plagiarism is against the law. Thomas Edison State College takes a strong stance against plagiarism, and students found to be plagiarizing will be severely penalized. If you copy phrases, sentences, paragraphs, or whole documents word-for-word—or if you paraphrase by changing a word here and there—without identifying the author, then you are plagiarizing. Please keep in mind that this type of identification applies to Internet sources as well as to print-based sources. Copying and pasting from the Internet, without using quotation marks and without acknowledging sources, constitutes plagiarism. (For information about how to cite Internet sources, see Online Student Handbook > Academic Standards > "Citing Sources.")

Accidentally copying the words and ideas of another writer does not excuse the charge of plagiarism. It is easy to jot down notes and ideas from many sources and then write your own paper without knowing which words are your own and which are someone else's. It is more difficult to keep track of each and every source. However, the conscientious writer who wishes to avoid plagiarizing never fails to keep careful track of sources.

Always be aware that if you write without acknowledging the sources of your ideas, you run the risk of being charged with plagiarism.

Clearly, plagiarism, no matter the degree of intent to deceive, defeats the purpose of education. If you plagiarize deliberately, you are not educating yourself, and you are wasting your time on courses meant to improve your skills. If you plagiarize through carelessness, you are deceiving yourself.

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