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Advanced Principles III > Coexisting Chapter 1 - Sleep > Flashcards

Coexisting Chapter 1 - Sleep Flashcards

1
Q

Narcolepsy

A

Lots of boundaries between the three distinct states of : 1)wakefulness:
2) NREM sleep, and REM sleep.

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2
Q

Parasomnias

A

Admixture of wakefulness with either NREM sleep or REM sleep

Wakefulness+NREM = Confusional arousal, sleep tower, and sleep acting( talking, walking)
Or
Wakefulness+REM =REM nightmares, REM sleep behavior disorder ( REM without usual Atonia ) allowing physical enactment of dreams which can result in injury to self or others

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3
Q

Opioids increase hypoxia with OSA. True or False

A

True

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4
Q

Sleep effects of prazosin

A

Resolves nightmare

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5
Q

Sleep effects of clonidine

A

Induces nightmare

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6
Q

Sleep effects of Beta Blockers

A

Increase daytime sleepiness
Induce nightmares
Insomnia

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7
Q

Effects of statins

A

Insomnia and sleep disruption

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8
Q

Lithium

A

Increased effects on slow wave sleep

Sleep walking

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9
Q

MAOIs

A

Almost zero effect on REM

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10
Q

Amphetamines

A

Bruxism

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11
Q

TCAs

A

Increase periodic limb movements, RLS

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12
Q

Mallampati predicts 2 things

A

Difficult Tracheal intubation

Risk of OSA: for every 1 point of Mallampati , odds of OSA increased by 2.5

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13
Q

What factors predispose to OSA

A 
Cigarette smoking
Obesity
Non - Caucasian 
Male 
Narrowing of upper airway 
Genetic inheritance 
Menopause 
Use of alcohol and sedative
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14
Q

What is Central sleep apnea

A

Sleep apnea that is not associated with respiratory efforts during the apnea event

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15
Q

Primary/idiopathic CSA is

A

Cause unknown
You see:
Periodic breathing with a cycle length of apnea followed by hyperpnea

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16
Q

Is the most common form of secondary CSA

A

Narcotic induced CSA
1/2 the pts on chronic opioids
You see:
Biot ’ s breathing or irregular ataxic breathing

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17
Q

What was the first form is of he sleep relate in breathing disorder described

A

CSA with Cheyen-stokes breathing

18
Q

Three conditions during which CSA with Cheyne-stockes breathing is encountered

A

CHF
Stroke
Afib

19
Q

What are the four cyclical components of cayenne Stokes reading

A

Hypopnea
apnea
hypoxia
hyperventilation

20
Q

OSA’s Immediate consequences on the heart

A

Hypoxemia
Hypercarbia

Arousal

Reduced pleural pressure

21
Q

Cardiovascular Intermediate term consequences of OSA

A

Decreased O2 delivery
Oxidative Stress
Inflammation
Hypercoagulopathy

Sympathetic activation
Parasympathetic inactivation

Increases transmural pressure on heart and great vessels

22
Q

Long term effects of OSA on heart

A

Cardiac dysfunction ; endothelial dysfunction ; Increased RV afterload ; Right ventricular hypertrophy

Tachycardia 
Hypertension 
Increased LV afterload 
Increased myocardial O2 consumption 
Myocardial toxicity 
Dysrhythmias

Increased Rt and Left Ventricular afterload
Dysrhythmias
Aortic dilation
Increased Lung water

23
Q

30 to 50% of patients with poly cystic ovarian syndrome also have what condition ?

A

OSA

24
Q

OSA is encountered in 50% or patients with NASH. True or False

A

True

Non Alcoholic Steatohepatitis

25
Q

What EEG changes are seen due to OSA ?

A

Overall slowing of EEG
Decrease in deeper sleep stages
Compensatory Increase in light sleep

26
Q

What metabolic changes seen due to OSA ? Pathophysiological mechanism of these changes specifically

A 
Hypoxic injury 
Systemic Inflammation 
Increased sympathetic activity 
Alterations in hypothalamic pituitary adrenal function 
Hormonal changes
27
Q

The metabolic DERANGEMENTS seen with OSA include :

A

Insulin resistance
Glucose intolerance
Dyslipidemia

28
Q

The metabolic DISORDERS seen with OSA include

A

Central Obesity
Metabolic syndrome
Type 2 Diabetes Mellitus

29
Q

OSA is the result of what 3 events :

A

Apnea episodes
Arousals
Increased Respiratory efforts

30
Q

What can Apneic and hypoapneic episodes lead to ?

A

OSA induced hypoxia + reoxygenation cycles&raquo_space;activation of : redox-sensitive genes oxidative stress , inflammatory process, SNS, coagulation cascade = endothelial dysfunction =» systemic HTN + Pulm HTN + Atheroslerosis + Rt/ Lt ventricular systolic/diastolic dysfunction + CAD + CHF + Afib + stroke + sudden death

31
Q

What do arousal episodes lead to ?

A

Increased sympathetic system activity + Decreased PSNS = increased : HR , LV afterload , Myo O2 consumption , dysrhythmias, Myo toxicity , apoptosis .

Sleep deprivation = increased SNS , inflammation and hypermetabolic state

Increased inspiratory efforts = large swing in neg intrathoracic pressure&raquo_space;transmitted to heart/lung/great vessels

32
Q

Are Central Sleep apnea events associated with increased Resp effort ?

A

No . That would be OSA

But still. Hypoxia occur

33
Q

90% of Obesity Hypoventilation Syndrome (OHS) also have

A

OSA

34
Q

Other name for OHS

A

Pickwickian syndrome

35
Q

Other name for Central Alveolar Hypoventilation syndrome

A

Onldine’ s curse

36
Q

Clinical feature of OHS (8)

A

1) marked obesity
2) Somnolence
3) Twitching
4) Cyanosis
5) periodic respiration
6) secondary polycythemia
7) Right ventricular hypertrophy
8) Right ventricular failure/cor pulmonale

37
Q

Define OHS , what are the characteristic of OHS

A

Hypoventilation during wakefulness

Worsens in the supine position and during sleep

38
Q

Which is more common ? Primary or comorbid form of sleep related Hypoventilation ?

A

Comorbid form

39
Q

What are the major consequences of hypoxia and hypercarbia ?

A

Pulm HTN
Cor Pulmonale
Increased sudden unexplained nocturnal death

40
Q

Most common category of sleep disorder is insomnia. What is the second most common ?

A

Sleep related breathing disorder !
90 % of that is OSA
And Snoring is more common than OSA

41
Q

CSA is not common. But 1/2 of CSA pts have what condition ?

A

CHF

Advanced Principles III (11 decks)

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