111214 sleep disorders cases

Question 1

obstructive sleep apnea’s effects on heart

Answer 1

pressure swing
negative pressure will augment venous return to right heart
at the same time, b/c you have blockage, you’ll have pulmonary artery constriction, so you can’t get blood flow through to the left heart.

at same time, left ventricle feels pressure swing so you have right ventricle filled with blood and L ventricle underfilled. creates DIASTOLIC DYSFXN.

cardiac output can decrease by as much as 20%

Question 2

obstructive sleep apnea’s effect on BP

Answer 2

get BP spikes after respiratory flow returns

Question 3

obstructive sleep apnea’s effect on sympath nerv sys

Answer 3

during apnea, sympathetic nervous system activity increases b/c of hypoxia and hypercapnia. the vasoconstriction will cause increases in BP, which will peak in hyperventilation

Question 4

Cheyne stokes breathing occurs due to what problems?

Answer 4

heart failure–blood PCO2 is not getting back to brain quick enough as a result

second problem is that these pts, due to CHF, have stiffer lungs and so the respiratory neurons are overly sensitive and when they sense they need to breathe, they overcompensate with bigger tidal breaths and for longer than they need to so they ened up overshooting and CO2 dips too low

Question 5

when you think of Cheyne stokes and central sleep apnea, you should think of

Answer 5

heart failure

Question 6

what is mean sleep latency on MSLT for narcolepsy pt?

Answer 6

3

Question 7

pathophysiology of narcolepsy

Answer 7

hypocretin cell loss in hypothalamus

Question 8

periodic limb reflex disorder

Answer 8

no rem sleep

Question 9

on actigraphy, when you see chaos in sleep, what condition is it?

Answer 9

insomnia, or pt is cognitively impaired

Question 10

advanced sleep phase syndrome

Answer 10

circadian rhythm disorder in which pt sleeps early every night and wakes up early

can be genetic

Question 11

night terror occurs in what stage of sleep

Answer 11

slow wave sleep
increased HR
diffuse hypersyndrhnous high voltage delta wave

Question 12

parasomnia

Answer 12

arising from sleep

NREM: sleep walking, sleep talking, sleep related eating, confusional arousal, night terror

REM: nightmare, sleep paralysis, REM behavior disorder (actually limb movements in REM when there shouldn’t be)

Question 13

night terror is different from REM sleep nightmare how?

Answer 13

in night terror, you can’t calm down and there’s little recall of dream and of waking up. you awaken only partially, if at all. pt is not aware of others.

Question 14

restless leg syndrome is diagnosed how

Answer 14

clinical diagnosis

can see limb movements on polysomnography, but it’s a clinical diagnosis