A 41-year-old man arrives for a diagnostic PSG ordered to rule out obstructive sleep apnea. During intake, his wife describes him punching and shouting during dreams, and the referral note mentions possible nocturnal seizures. What should the technologist do before starting the study?

Contact the ordering or on-call physician to clarify whether the montage should change

Add a full EEG montage and video on the technologist's own judgment

Proceed with the standard montage and mention the history only in the morning

Cancel the study because the order does not match the clinical history

Sharp spikes time-locked to the QRS complex appear in F4-M1, C4-M1, and O2-M1, but not in the backup derivations referenced to M2. What is the most appropriate action?

Reposition M1 or switch to backup derivations referenced to M2

Replace the F4, C4, and O2 electrodes

Turn off the ECG channel to remove the interference

Increase the high-frequency filter to 70 Hz

In a 6-year-old with a baseline respiratory rate of 20 breaths/min, the oronasal thermal sensor drops 95% for 7 seconds, spanning the duration of 2 baseline breaths, with continued thoracoabdominal effort. How should the event be scored?

No event, because it lasts less than 10 seconds

A 24-year-old reports falling asleep in class despite 8 hours of nightly sleep and describes knees buckling when he laughs. His physician wants to evaluate for narcolepsy. Which testing sequence is most consistent with this order?

Overnight PSG followed by an MSLT the next day

Home sleep apnea test followed by an MWT

MSLT alone, scheduled in the morning without a PSG

Two consecutive nights of attended PSG

A restless patient with thick hair is scheduled for an overnight PSG followed by a five-nap MSLT. Which electrode application method gives the most secure scalp electrodes for this long recording?

Collodion applied with gauze and dried with air, used with adequate ventilation

Conductive paste covered with paper tape on the hair

Conductive paste alone, with no gauze or tape over each electrode

Electrode gel under a cloth headband without any adhesive

At 01:40, O2-M1 shows a slow wave occurring once with each breath, timed exactly with the effort belts. The other EEG channels are clean. What is the most appropriate action?

Check whether the patient is lying on the O2 lead or electrode and reposition or secure it

Score the waves as slow-wave activity for staging N3

Raise the low-frequency filter on all EEG channels to 5 Hz for the rest of the study

Cool the room, since this pattern is sweat artifact

A 15-year-old is undergoing diagnostic PSG. Which statement about the respiratory scoring rules is correct?

Either the pediatric or the adult respiratory rules may be used, per lab protocol

Only the adult rules may be used once a patient is older than 12

Infant rules must be used until the patient completes puberty

Only the pediatric rules may be used for any patient younger than 18

A patient asks how an auto-adjusting PAP (APAP) device differs from fixed CPAP. Which explanation is most accurate?

It changes pressure within a set range in response to detected flow limitation, snoring, and apneas

It keeps one fixed pressure all night and only adjusts the humidity level

It delivers machine breaths at a set rate whenever the patient stops breathing

It delivers a higher pressure on inhalation and a lower one on exhalation every breath

RPSGT Exam

Free RPSGT Practice Questions

10 sample questions for the RPSGT Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Clinical Overview, Education, and Patient Support, Sleep Study Preparation and Performance, Scoring, Reporting, and Data Verification, Treatment and Intervention.

Question 1 · Clinical Overview, Education, and Patient Support
A 41-year-old man arrives for a diagnostic PSG ordered to rule out obstructive sleep apnea. During intake, his wife describes him punching and shouting during dreams, and the referral note mentions possible nocturnal seizures. What should the technologist do before starting the study?
- A.Contact the ordering or on-call physician to clarify whether the montage should change
- B.Add a full EEG montage and video on the technologist's own judgment
- C.Proceed with the standard montage and mention the history only in the morning
- D.Cancel the study because the order does not match the clinical history
Show answer and explanation
Answer: A. Contact the ordering or on-call physician to clarify whether the montage should change
The physician's order defines the study, so a history suggesting parasomnia or seizures that the order does not address should be clarified with the ordering or on-call physician before hook-up. Changing the montage independently exceeds the technologist's scope, while ignoring the history risks an inadequate study.
Question 2 · Sleep Study Preparation and Performance
Using the 10-20 system, the distance between the left and right preauricular points over the vertex measures 36 cm. Where should the C4 electrode be placed?
- A.3.6 cm to the right of Cz
- B.7.2 cm to the right of Cz
- C.7.2 cm to the left of Cz
- D.10.8 cm to the right of Cz
Show answer and explanation
Answer: B. 7.2 cm to the right of Cz
C4 lies on the coronal line 20% of the preauricular-to-preauricular distance to the right of Cz: 0.20 × 36 = 7.2 cm. Even numbers designate the right hemisphere, so 7.2 cm to the left of Cz would be C3.
Question 3 · Sleep Study Preparation and Performance
Sharp spikes time-locked to the QRS complex appear in F4-M1, C4-M1, and O2-M1, but not in the backup derivations referenced to M2. What is the most appropriate action?
- A.Reposition M1 or switch to backup derivations referenced to M2
- B.Replace the F4, C4, and O2 electrodes
- C.Turn off the ECG channel to remove the interference
- D.Increase the high-frequency filter to 70 Hz
Show answer and explanation
Answer: A. Reposition M1 or switch to backup derivations referenced to M2
When all derivations sharing a common reference show the same artifact, the reference electrode (M1) is the source, so it is repositioned or the backup M2-referenced derivations are used. Replacing three exploring electrodes would not correct a reference problem.
Question 4 · Scoring, Reporting, and Data Verification
In a 6-year-old with a baseline respiratory rate of 20 breaths/min, the oronasal thermal sensor drops 95% for 7 seconds, spanning the duration of 2 baseline breaths, with continued thoracoabdominal effort. How should the event be scored?
- A.Obstructive apnea
- B.No event, because it lasts less than 10 seconds
- C.Central apnea
- D.Obstructive hypopnea
Show answer and explanation
Answer: A. Obstructive apnea
Pediatric rules score an apnea when flow drops at least 90% for at least the duration of 2 baseline breaths; continued effort makes it obstructive. The 10-second minimum is the adult criterion.
Question 5 · Treatment and Intervention
At the final pressure, the RDI was 3/h for 30 minutes, but only lateral NREM sleep was recorded at that pressure. How should the titration be graded?
- A.Optimal
- B.Adequate
- C.Good
- D.Unacceptable
Show answer and explanation
Answer: B. Adequate
When the RDI criteria for optimal or good are met but supine REM sleep was not recorded at that pressure, the titration is graded adequate. Optimal requires supine REM at the selected pressure.
Question 6 · Clinical Overview, Education, and Patient Support
A 24-year-old reports falling asleep in class despite 8 hours of nightly sleep and describes knees buckling when he laughs. His physician wants to evaluate for narcolepsy. Which testing sequence is most consistent with this order?
- A.Home sleep apnea test followed by an MWT
- B.Overnight PSG followed by an MSLT the next day
- C.MSLT alone, scheduled in the morning without a PSG
- D.Two consecutive nights of attended PSG
Show answer and explanation
Answer: B. Overnight PSG followed by an MSLT the next day
The MSLT used to evaluate narcolepsy must follow an overnight PSG on the preceding night to document adequate sleep and exclude other causes of sleepiness. An MSLT without the preceding PSG cannot be interpreted reliably, and an HSAT does not measure sleep.
Question 7 · Sleep Study Preparation and Performance
A restless patient with thick hair is scheduled for an overnight PSG followed by a five-nap MSLT. Which electrode application method gives the most secure scalp electrodes for this long recording?
- A.Conductive paste covered with paper tape on the hair
- B.Collodion applied with gauze and dried with air, used with adequate ventilation
- C.Conductive paste alone, with no gauze or tape over each electrode
- D.Electrode gel under a cloth headband without any adhesive
Show answer and explanation
Answer: B. Collodion applied with gauze and dried with air, used with adequate ventilation
Collodion forms a firm, durable bond that holds well through long recordings and movement, though it requires good ventilation and acetone for removal. Paste alone is quicker to apply but loosens more easily over many hours.
Question 8 · Sleep Study Preparation and Performance
At 01:40, O2-M1 shows a slow wave occurring once with each breath, timed exactly with the effort belts. The other EEG channels are clean. What is the most appropriate action?
- A.Score the waves as slow-wave activity for staging N3
- B.Check whether the patient is lying on the O2 lead or electrode and reposition or secure it
- C.Raise the low-frequency filter on all EEG channels to 5 Hz for the rest of the study
- D.Cool the room, since this pattern is sweat artifact
Show answer and explanation
Answer: B. Check whether the patient is lying on the O2 lead or electrode and reposition or secure it
A slow wave timed with each breath in one channel is respiratory artifact, often from an electrode or lead moving as the patient breathes against it. Sweat artifact causes slow drifting that is not tied to the breathing cycle.
Question 9 · Scoring, Reporting, and Data Verification
A 15-year-old is undergoing diagnostic PSG. Which statement about the respiratory scoring rules is correct?
- A.Only the adult rules may be used once a patient is older than 12
- B.Infant rules must be used until the patient completes puberty
- C.Only the pediatric rules may be used for any patient younger than 18
- D.Either the pediatric or the adult respiratory rules may be used, per lab protocol
Show answer and explanation
Answer: D. Either the pediatric or the adult respiratory rules may be used, per lab protocol
The AASM allows pediatric rules for patients younger than 18, and patients 13 or older may be scored with adult rules, so either is acceptable for a 15-year-old. Requiring pediatric rules only ignores this option.
Question 10 · Treatment and Intervention
A patient asks how an auto-adjusting PAP (APAP) device differs from fixed CPAP. Which explanation is most accurate?
- A.It keeps one fixed pressure all night and only adjusts the humidity level
- B.It delivers machine breaths at a set rate whenever the patient stops breathing
- C.It changes pressure within a set range in response to detected flow limitation, snoring, and apneas
- D.It delivers a higher pressure on inhalation and a lower one on exhalation every breath
Show answer and explanation
Answer: C. It changes pressure within a set range in response to detected flow limitation, snoring, and apneas
APAP devices detect events such as flow limitation, snoring, and apneas and adjust pressure within a prescribed range. A different inspiratory and expiratory pressure each breath describes bilevel PAP.

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