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Flashcards in Sleep Disorders Deck (12)
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1
Q

What is obstructive apnea on a polysomnogram?
What is the presentation?

A

No flow with effort
Flat lines in flow channels
Activity in abdominal/thoracic

Presentation: 56 yo man with HBP and diabetes who snores/stop breathing in sleep

2
Q

What are the OSA effects on the cardiac and nervous system?
What does it increase risk for?

A

Cardiac

Throat closing during OSA closes upper air tract
Right ventricle fills up with blood
Left ventricle underfills
Cardiac output drops by as much as 25%

Nervous system

BP jumps up after event
SNS starts to periodic firing
Eventually this will result in hypertension even during the day

Increase risk for MI, arrhythmias

3
Q

What is hypopnea?
How is it shown on the polysomnogram?

A

Shallow breathing episode
Reduced flow in one channel

4
Q

What is central apnea?

A

No flow with no effort

5
Q

How does Cheyne-Stokes present on polysomnogram?
What is its patient presentation?
What is the common clinical correlate?
What is the physiology?

A

Crescendo-decrescendo

Same presentation as obstructive in terms of patient history

Think of bad heart: Heart failure often cause
Also occurs with bad strokes and attempted hangings

Latency between lung blood carbon dioxide is too long
Restrictive lung problems often resulting in overcompensation

6
Q

What is the history of narcolepsy?
How does narcolepsy present on sleep study?
On MSLT?

A

History: sleepy for many years even though gets adequate

Lots of REM during sleep study - REM usually diminished during sleep study due to threatening environment

Mean sleep latency for narcoleptics typically 5 minutes: enters REM

7
Q

What is the prevalence of narcolepsy?
What are the genetics of narcolepsy?
What are other causes of narcolepsy?

A

Affects 0.03% to 0.1% of the general population

Most cases of narcolepsy are sporadic
1% to 2% of first degree relatives have narcolepsy-cataplexy (20 to 40 times greater risk than general population)
Familial clustering occurs in about 10% of cases
Monozygotic twins often discordant for narcolepsy

Environmental factors are implicated: unknown antigen binding, head trauma, virus, toxins, sleep deprivation, change in sleep/wake cycle
Hormonal shifts: Aging/puberty

8
Q

What is the pathophysiology of narcolepsy?

A

Hypocretin cell loss
Essentially breaking of the physiological switch
Cataplexy – REM intrusion while awake resulting in paralysis, falls, etc.
Dreaming while awake

9
Q

What is periodic limb movement disorder shown as on sleep study?
What are its causes?

A

Many limb movements, poor sleep quality, no REM
Causes: iron deficiency, RLS, drug

10
Q

Actinograph disorder trivia!
What hours do late sleep disorder patients typically sleep?
Who are suceptible to non-24 hour circadian rhythm disorder?
What does insomnia manifest as?
What edoes shift work sleep disorder manifest as?
What is advanced sleep disorder?

A

3 am to 12 am

The blind (lack 24 hour signaling)

Completely random sleep cycle and also psych patients

Sleep during the day

Sleep earlier than normal

11
Q

How are parasomnias diagnosed?
What are the non-REM disorders?
What are the REM disorders?

A

Actigraphy used to diagnosis

NREM
Partial arousal during delta wave sleep
Sleep walking
Sleep talking
Sleep related eating
Confusional arousal
Night Terror

REM
Nightmare
Paralysis
REM Behavioral Disorder

12
Q

What is REMBD characterized by?
How is it diagnosed?

A

Non-paralysis during REM
Violent actions/talking during sleep

MSLT not used, polysomography