2020 AASM Board Review Questions Flashcards
What PSG feature is most compatible with a diagnosis of chronic insomnia?
Decrease in SWS
A 16-year-old patient presents with difficulty falling asleep and complaints of leg discomfort at bedtime and while doing homework in the evening. She notices that there is some improvement when she gets up to go to the bathroom or to the kitchen to get snacks. She wakes up tired and wants to get more sleep. Her history is significant for asthma, obesity, and heavy menstrual periods. Her mother reports similar symptoms. The patient had a recent sleep study which showed a periodic limb movement index of 50/hour.
Which brain region most consistently shows the biologic abnormality in this adolescent’s sleep disorder?
Substantia Nigra
The single best documented biological abnormality in restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is brain iron deficiency due to impaired iron transport through the blood brain barrier. The brain area where iron deficiency is most consistently seen is the substantia nigra. This patient has markedly elevated PLMS on polysomnography. New data indicate that decreased iron in the substantia nigra correlates with increased PLMS in RLS.
A 53-year-old man presents complaining about his disruptive vocalization during sleep. This behavior has been present from his 30’s, being noted by prior bed partners. The patient is completely unaware of this. There is no reported motor activity in head or limbs. The vocalization is articulate, with appropriate emotion. He is otherwise well, on no current medications, and does not have sleep or daytime symptoms. He did use a serotonin reuptake inhibitor for a period of 2 years for an episode of anxiety related to job switch, but this was discontinued within 6 months of presentation
What is the likely diagnosis?
Sleep talking
Articulate vocalizations without associations is the hallmark of sleep talking.
What are the characteristics of primary central sleep apnea?
Disorder of unknown etiology
Recurrent central apneas
No clear familial pattern
Associated with PaCO2 decreases during sleep to below the hypocapnic apnea threshold resulting in respiratory effort cessation.
A four-year-old boy has abnormal body movements during sleep. Parents describe that the boy has rolling movements from side to side rather than body rocking movements.
In what sleep stage are the rolling body movements most likely to occur?
Stage REM
While rhythmic body movements can occur in both stage NREM and REM sleep, there is some evidence that the rolling body type most commonly occurs in stage REM sleep.
An adult male patient presents with snoring and fatigue. What clinical data is most supportive of the diagnosis of primary snoring?
AHI =3
A diagnosis of primary snoring cannot be made in those who exhibit symptoms (i.e. daytime sleepiness/fatigue) or report possible apneas, without objective measurement of breathing during sleep. The patient described in the vignette exhibits fatigue as well as snoring, thus a PSG or OCST (out of center sleep testing) is required to exclude OSA. Since the patient has an AHI =3, OSA is excluded, and the diagnosis of snoring can be made.
A 70-year-old woman presents to your office complaining of insomnia characterized as difficulty maintaining sleep. Her symptoms began 5 years ago, shortly after she retired from her work as a manager of a large company. She goes to bed every night at 10:00 PM, a routine she has not changed in over 40 years, and she is able to fall asleep within 10 minutes. She never had problems sleeping while she was working, but she relates that she now wakes up several times per night and often has difficulty falling back to sleep for several hours. The patient stays in bed when she is awake during the night since she has been told to avoid engaging in any stimulating activity. She remains in bed until 10:00 AM, “a luxury that she gave herself” soon after retiring, since she was required to get up at 6:00 AM every morning when she was working. She relates that she still misses work at times, but stays active and participates in organizations and enjoys playing with her grandchildren.
What would be your first recommended step in treatment for this patient’s insomnia?
Reduce time in bed to 8 hours on a regular schedule 7 days per week
