- The Exam at a Glance
- Domain Weights You Should Memorize
- Domain 1: Pre-Testing Quick Facts
- Domain 2: Sleep Disorders Testing Quick Facts
- Domain 3: Study Analysis Quick Facts
- Domains 4 and 5: Administrative Functions and Treatment Plan
- Statistics You Must Be Able to Verify
- Diagnostic Modalities Comparison
- Scheduling Your Review Around the Weights
- Frequently Asked Questions
- The exam has 180 multiple-choice items: 160 scored plus 20 pretest, with 240 minutes to finish.
- Study Analysis is the heaviest domain at 53 of 160 scored items, so it deserves the most review time.
- Sleep Disorders Testing contributes 37 scored items, and therapeutic interventions during testing alone account for 28 of them.
- Administrative Functions is the lightest domain at 8 scored items, but it is still worth a quick pass.
The Exam at a Glance
The Sleep Disorders Specialist credential (CRT-SDS/RRT-SDS) is issued by the National Board for Respiratory Care (NBRC). This cheat sheet condenses the official Detailed Content Outline, effective September 2023, into a scannable review. If you want the full narrative walkthrough, pair it with the SDS Study Guide 2026: How to Pass on Your First Attempt.
| Exam Feature | What to Know |
|---|---|
| Issuer | National Board for Respiratory Care (NBRC) |
| Total items | 180 multiple-choice questions |
| Scored items | 160 |
| Pretest (unscored) items | 20 |
| Time allowed | 240 minutes |
| Content domains | 5 |
| Outline structure | 14 subdomains, 66 numbered objectives, 77 lettered subpoints |
Fees, the exact passing cut score, and current maintenance requirements are not covered here. Confirm those directly with the NBRC, and see our breakdowns of SDS certification cost, the SDS passing score, and SDS eligibility requirements for context.
Domain Weights You Should Memorize
The NBRC publishes scored item counts for each domain rather than percentage labels. The counts total 160.
| Domain | Scored Items |
|---|---|
| 1. Pre-Testing | 29 |
| 2. Sleep Disorders Testing | 37 |
| 3. Study Analysis | 53 |
| 4. Administrative Functions | 8 |
| 5. Treatment Plan | 33 |
Notice the shape of the exam. Study Analysis, Sleep Disorders Testing, and Treatment Plan together account for 123 of 160 scored items. For a deeper dive into each content area, see SDS Exam Domains 2026: Complete Guide to All 5 Content Areas.
Domain 1: Pre-Testing Quick Facts
Pre-Testing carries 29 scored items and splits into two subdomains: Identification and Care of At-Risk Individuals (12 items) and Study Preparations (17 items).
I.A Identification and Care of At-Risk Individuals (12 items)
You must recognize who needs testing and choose the right test.
- Recognize sleep disorder signs and symptoms from history, interview, or clinical assessment, across outpatient, perioperative, and inpatient settings.
- Identify special factors: cultural and gender identity, primary language, disabilities, and co-morbid conditions.
- Select the diagnostic modality based on patient factors, co-morbid conditions, and insurance requirements.
- Communicate diagnostic findings and therapeutic recommendations to the health care team.
The six modalities the outline names are polysomnography (with or without therapeutic intervention), home sleep apnea testing, the Multiple Sleep Latency Test (MSLT), the Maintenance of Wakefulness Test (MWT), actigraphy, and overnight oximetry. Expect scenario questions that ask which one fits a given patient.
I.B Study Preparations (17 items)
This is the larger half of Domain 1 and is heavily hands-on.
- Pull critical information from the medical record and select the appropriate study montage.
- Set up equipment, evaluate calibrations for accuracy and linearity of amplified signals, and confirm adequate audiovisual signals.
- Recommend modifications to the prescriber's order when necessary.
- Document medications, especially those that may affect test results, and obtain informed consent from the patient or caregiver.
- Apply sensors for airflow, snoring, body position, ECG, respiratory effort, EEG, leg movements, eye movements, chin EMG, and SpO2.
- Apply exhaled CO2 or transcutaneous CO2 sensors when required.
- Document signal quality, including electrode impedances and physiologic calibration results.
Domain 2: Sleep Disorders Testing Quick Facts
Domain 2 has 37 scored items across three subdomains. The key number to remember is 28, because Therapeutic Interventions During Testing is the single largest subdomain in this section.
| Subdomain | Scored Items |
|---|---|
| II.A Signal Maintenance During Testing | 4 |
| II.B Therapeutic Interventions During Testing | 28 |
| II.C Study Conclusion | 5 |
II.B Therapeutic Interventions: The Big One
What to Master in II.B
Recognize, start, optimize, coach, and respond.
- Recognize disorders: sleep, cardiac, neurological, pulmonary, and gastrointestinal (for example, pH and distention).
- Start therapy: PAP (continuous, auto, bilevel), other non-invasive therapy (Adaptive Servo Ventilation, Average Volume-Assured Pressure Support), oxygen, and mandibular advancement devices such as a disposable oral appliance.
- Optimize therapy based on the patient's response, including permanent oral appliances and patient positioning.
- Coach the patient in cooperative behaviors while adjusting therapy.
- Medical emergencies: recognize seizures, stroke, and respiratory distress, then implement interventions appropriate to an in-hospital sleep center or a freestanding sleep center.
- Unsafe environments: respond to a combative patient or family member, fire, or earthquake.
- Document times for artifacts, recording abnormalities, therapeutic adjustments, parasomnias, lights off and on, and staff entering the room.
II.A and II.C in Brief
Signal Maintenance asks you to recognize inadequate signals and artifacts, correct them as appropriate, and document the corrections. Study Conclusion covers post-study calibrations, equipment removal, reviewing the post-study questionnaire, describing the post-study process (including equipment removal and study interpretation), and summarizing observations for analysis.
Domain 3: Study Analysis Quick Facts
Study Analysis is the heaviest domain at 53 scored items, spread across four subdomains.
| Subdomain | Scored Items |
|---|---|
| III.A Record Review | 2 |
| III.B Sleep Staging | 8 |
| III.C Sleep Event Identification | 27 |
| III.D Sleep Event Reporting | 16 |
III.B Sleep Staging (8 items)
You must score sleep stages for both adult and pediatric patients. Do not neglect the pediatric half of the objective.
III.C Sleep Event Identification (27 items)
This is the second-largest subdomain on the whole exam.
- In-lab events: sleep-disordered breathing, abnormal limb movements, abnormal cardiac rhythm, abnormal EEG waveforms (seizure, voltage changes), parasomnias (night terrors, REM behavior disorder), arousals, and abnormal CO2 levels or hypoventilation.
- Home sleep apnea testing: evaluate validity, sleep-disordered breathing, oximetry, artifacts, and cardiac rhythm.
Because Study Analysis is where the points are, our guide to how hard the SDS exam is explains why many candidates find the scoring and reporting material the most demanding part of preparation.
Domains 4 and 5: Administrative Functions and Treatment Plan
Domain 4: Administrative Functions (8 items)
IV.A Data and Equipment Maintenance (4 items) and IV.B Management (4 items)
- Store patient information according to government and industry standards.
- Correct problems with data acquisition and recording equipment.
- Satisfy requirements for biomedical equipment quality control, routine equipment processing, and inventory maintenance.
- Implement policies and procedures such as secure data archiving, patient confidentiality, and safety.
- Implement quality improvement programs, including patient satisfaction and inter-scorer reliability.
Domain 5: Treatment Plan (33 items)
| Subdomain | Scored Items | Core Theme |
|---|---|---|
| V.A Development | 9 | Assess needs and barriers, select equipment and interface, build the plan |
| V.B Implementation | 9 | Prescription, education, equipment settings, documentation |
| V.C Evaluation | 15 | Data downloads, mask fit, follow-up studies, outcomes |
V.C Evaluation (15 items)
The largest piece of Domain 5 is about closing the loop after therapy begins.
- Analyze PAP data downloads.
- Evaluate mask fit.
- Analyze follow-up results from nocturnal oximetry, a repeated home sleep test, or actigraphy.
- Document treatment outcomes.
- Communicate results and recommended revisions to the healthcare provider.
In V.A, remember that barriers to optimal therapy include educational level, cultural and gender identity, disabilities, and insurance requirements. In V.B, documentation is not optional: you document educational assessments, interventions, and the patient or caregiver's comprehension of the treatment plan.
Statistics You Must Be Able to Verify
Subdomain III.D asks you to verify the accuracy of generated statistics, not just define them. Be able to check each of these against a report.
Core Study Statistics (III.D.3)
- Oxygen saturation
- Sleep latency and REM latency
- Sleep efficiency
- Total sleep time, total time in bed, and total recording time
- Sleep stage percentages
- Wake after sleep onset
Event Frequencies and Indices (III.D.5 and III.D.6)
- Obstructive, central, and mixed apneas; obstructive and central hypopneas
- Arousals, abnormal limb movements, and snoring
- Respiratory Effort Related Arousals (RERAs)
- Cheyne-Stokes respirations, sleep-related hypoventilation, and periodic breathing
- CO2 levels, desaturations, and respiratory events from portable monitors
Specialty Documentation
- MSLT and MWT statistics, such as mean sleep latency and REM periods (III.D.4)
- EEG abnormalities such as spike wave, alpha-delta, and alpha-intrusion; REM density and latency; ECG activity (III.D.7)
- A valid written report that includes both objective and subjective information (III.D.8)
Key Takeaway
Practice recomputing sleep efficiency, sleep latency, and stage percentages by hand from raw time values. Questions in Sleep Event Reporting reward candidates who can spot an incorrect generated statistic, not only those who can define the term.
Diagnostic Modalities Comparison
Objective I.A.3 requires you to match the test to the patient. Use this table as a memory aid, and confirm clinical details against your training materials and the NBRC outline.
| Modality | Where It Appears in the Outline | Review Focus |
|---|---|---|
| Polysomnography (with or without therapeutic intervention) | I.A.3.a; Domains 2 and 3 | Full montage, in-lab events, titration |
| Home sleep apnea testing | I.A.3.b; III.C.2 | Validity, oximetry, artifacts, cardiac rhythm |
| MSLT | I.A.3.c; III.D.4 | Mean sleep latency, REM periods |
| MWT | I.A.3.d; III.D.4 | Mean sleep latency documentation |
| Actigraphy | I.A.3.e; V.C.3.c | Selection and follow-up use |
| Overnight oximetry | I.A.3.f; V.C.3.a | Selection and follow-up use |
Note how often these modalities reappear in later domains. Actigraphy, oximetry, and repeat home testing show up again as follow-up tools in Treatment Plan evaluation, so you will meet them more than once.
Scheduling Your Review Around the Weights
Use the scored item counts to decide where your hours go. This sample sequence is built from the domain weights, not from a generic template. Adjust it to your own timeline, and check SDS exam dates and scheduling before locking anything in.
Study Analysis (53 items)
- Adult and pediatric staging, then in-lab event identification.
- Home sleep apnea test validity and artifact review.
- Recompute generated statistics by hand.
Sleep Disorders Testing (37 items)
- PAP, ASV, AVAPS, oxygen, and oral appliance logic.
- Emergency and unsafe-environment scenarios by sleep center type.
Treatment Plan (33 items) and Pre-Testing (29 items)
- PAP downloads, mask fit, and follow-up study interpretation.
- Montage selection, calibration, sensor placement, and consent.
Administrative Functions (8 items) and Mixed Review
- Data storage, quality control, and inter-scorer reliability.
- Timed mixed sets to build pacing across the 240 minutes.
Test your pacing with timed questions on the main practice test site. With 180 items in 240 minutes, you have a little over a minute and a half per question on average, so practice at that speed before exam day.
Frequently Asked Questions
The exam contains 180 multiple-choice items. Of those, 160 are scored and 20 are unscored pretest items, and you have 240 minutes to complete it.
Study Analysis carries the most scored items at 53 of 160. Sleep Disorders Testing follows with 37, then Treatment Plan with 33, Pre-Testing with 29, and Administrative Functions with 8.
The NBRC publishes the Detailed Content Outline for the SDS examination, effective September 2023, on nbrc.org under its content outlines and SDS examination program pages. It is the authoritative source for cognitive-level details and supplemental specifications, so review it directly alongside this cheat sheet.
No. A cheat sheet is a retention and review tool, not a substitute for hands-on competence in signal recognition, scoring, and titration. Use it to organize what you know, then verify weak spots with the full study guide and practice questions. For context on whether the credential fits your goals, see whether the SDS certification is worth it and the SDS salary guide.
This sheet does not quote a pass rate because the figures should come from the NBRC. For a discussion of what is and is not publicly known, read SDS pass rate 2026: what the data shows.