Coexisting Chapter 1 - Sleep Flashcards
Narcolepsy
Lots of boundaries between the three distinct states of : 1)wakefulness:
2) NREM sleep, and REM sleep.
Parasomnias
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
Opioids increase hypoxia with OSA. True or False
True
Sleep effects of prazosin
Resolves nightmare
Sleep effects of clonidine
Induces nightmare
Sleep effects of Beta Blockers
Increase daytime sleepiness
Induce nightmares
Insomnia
Effects of statins
Insomnia and sleep disruption
Lithium
Increased effects on slow wave sleep
Sleep walking
MAOIs
Almost zero effect on REM
Amphetamines
Bruxism
TCAs
Increase periodic limb movements, RLS
Mallampati predicts 2 things
Difficult Tracheal intubation
Risk of OSA: for every 1 point of Mallampati , odds of OSA increased by 2.5
What factors predispose to OSA
Cigarette smoking Obesity Non - Caucasian Male Narrowing of upper airway Genetic inheritance Menopause Use of alcohol and sedative
What is Central sleep apnea
Sleep apnea that is not associated with respiratory efforts during the apnea event
Primary/idiopathic CSA is
Cause unknown
You see:
Periodic breathing with a cycle length of apnea followed by hyperpnea
Is the most common form of secondary CSA
Narcotic induced CSA
1/2 the pts on chronic opioids
You see:
Biot ’ s breathing or irregular ataxic breathing
What was the first form is of he sleep relate in breathing disorder described
CSA with Cheyen-stokes breathing
Three conditions during which CSA with Cheyne-stockes breathing is encountered
CHF
Stroke
Afib
What are the four cyclical components of cayenne Stokes reading
Hypopnea
apnea
hypoxia
hyperventilation
OSA’s Immediate consequences on the heart
Hypoxemia
Hypercarbia
Arousal
Reduced pleural pressure
Cardiovascular Intermediate term consequences of OSA
Decreased O2 delivery
Oxidative Stress
Inflammation
Hypercoagulopathy
Sympathetic activation
Parasympathetic inactivation
Increases transmural pressure on heart and great vessels
Long term effects of OSA on heart
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
30 to 50% of patients with poly cystic ovarian syndrome also have what condition ?
OSA
OSA is encountered in 50% or patients with NASH. True or False
True
Non Alcoholic Steatohepatitis
What EEG changes are seen due to OSA ?
Overall slowing of EEG
Decrease in deeper sleep stages
Compensatory Increase in light sleep
What metabolic changes seen due to OSA ? Pathophysiological mechanism of these changes specifically
Hypoxic injury Systemic Inflammation Increased sympathetic activity Alterations in hypothalamic pituitary adrenal function Hormonal changes
The metabolic DERANGEMENTS seen with OSA include :
Insulin resistance
Glucose intolerance
Dyslipidemia
The metabolic DISORDERS seen with OSA include
Central Obesity
Metabolic syndrome
Type 2 Diabetes Mellitus
OSA is the result of what 3 events :
Apnea episodes
Arousals
Increased Respiratory efforts
What can Apneic and hypoapneic episodes lead to ?
OSA induced hypoxia + reoxygenation cycles»_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
What do arousal episodes lead to ?
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»_space;transmitted to heart/lung/great vessels
Are Central Sleep apnea events associated with increased Resp effort ?
No . That would be OSA
But still. Hypoxia occur
90% of Obesity Hypoventilation Syndrome (OHS) also have
OSA
Other name for OHS
Pickwickian syndrome
Other name for Central Alveolar Hypoventilation syndrome
Onldine’ s curse
Clinical feature of OHS (8)
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
Define OHS , what are the characteristic of OHS
Hypoventilation during wakefulness
Worsens in the supine position and during sleep
Which is more common ? Primary or comorbid form of sleep related Hypoventilation ?
Comorbid form
What are the major consequences of hypoxia and hypercarbia ?
Pulm HTN
Cor Pulmonale
Increased sudden unexplained nocturnal death
Most common category of sleep disorder is insomnia. What is the second most common ?
Sleep related breathing disorder !
90 % of that is OSA
And Snoring is more common than OSA
CSA is not common. But 1/2 of CSA pts have what condition ?
CHF
