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Polysomnography > Common Sleep Disorders > Flashcards

Common Sleep Disorders Flashcards

1
Q

COMMON SLEEP DISORDERS

A

Sleep Apnea
Cheyne-Stoke Breathing
Obesity-Hypoventilation Syndrome
Narcolepsy
Restless Leg Syndrome

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2
Q

is a sleep disorder characterized by the temporary cessation or absence of breathing during sleep for 10 seconds or longer.

A

SLEEP APNEA

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3
Q

Types of Sleep Apnea

A

Obstructive Sleep Apnea
Central Sleep Apnea
Mixed Sleep Apnea

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4
Q

-is defined as the cessation of airflow through the nose and mouth with the persistence of the diaphragmatic and intercostal muscle activities.

A

OBSTRUCTIVE SLEEP APNEA (OSA)

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5
Q

the sleeper attempts to inhale during a period in which the upper airway muscle tone is momentarily absent.

A

obstructive sleep apnea

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6
Q

The negative pressure generated during inspiration causes the throat to narrow and the tongue to be sucked back into the oropharyngeal area.

A

obstructive sleep apnea

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7
Q

osa is defined as _____ abnormal obstructed breathing events per hour of sleep and sleepiness.

A

five or more

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8
Q

-Studies have reported a prevalence of OSAS in _____ of middle-aged men and ____ of middle-aged women.

A

4%
2%

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9
Q

the upper airway tends to narrow during sleep, resulting in _____, which cause repeated _____ despite continued efforts to breathe.

A

recurrent closures
apneas

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10
Q

the upper airway tends to narrow during sleep, resulting in recurrent closures, which cause repeated apneas despite continued efforts to breathe. results in

A

intermittent hypoxemia and frequent arousals

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11
Q

Intermittent hypoxemia and arousals cause an increase in ______, which increases the risk of ______

A

sympathetic activity
cardiovascular complications and arrhythmia.

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12
Q

Frequent apneas during sleep disturb the sleep architecture, resulting in ____

A

poor sleep quality and daytime sleepiness.

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13
Q

osa Signs & symptoms

A

1.Snoring. (not all snorers have OSA); may present with choking attacks during sleep
2.witnessed apnea
3.Decline in mental function
4.mouth breathing with dry mouth and throat on awakening
5.excessive salivation during sleep
6.excessive sweating
7.morning headache
8.nocturnal palpitation
9.unrefreshing sleep excessive daytime sleepiness (EDS)

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14
Q

osa Risk Factors

A

Obesity
Increased neck circumference
Gender
Age
Craniofacial abnormalities affecting the jaw size
Enlarged tonsils and adenoids

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15
Q

approximately, ____ of OSA patients are obese.

A

70%

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16
Q

Nevertheless, severe OSA can be seen in non-obese subjects with

A

craniofacial abnormalities.

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17
Q

Increased neck circumference in osa (____ inches for men and ____ inches in women)

A

> 17
16

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18
Q

Gender: OSA is more prevalent in

A

men

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19
Q

Age: osa is more prevalent in

A

older people

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20
Q

The risk of osa in women increases significantly

A

post-menopause.

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21
Q

Craniofacial abnormalities affecting the jaw size:

A

retrognathic and micrognathia

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22
Q

appears as a small mandible and an overbite

A

retrognathic and micrognathia

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23
Q

Enlarged tonsils and adenoids particularly in ____; nevertheless, occasionally it can be seen in ______.

A

children
adults

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24
Q

OSA can lead to ______, which increases the risk of motor vehicle and other accidents.

A

EDS

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25
Q

there is a great link between OSA and cardiovascular and cerebrovascular complications, such as:

A

Hypertension
ischemic heart disease
Arrhythmias
heart failure
pulmonary hypertension
stroke

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26
Q

The American Academy of Sleep Medicine (AASM) considers ______ to be routinely indicated “Standard” for the diagnosis of sleep disordered breathing

A

polysomnography

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27
Q

recent studies have shown that ______ can be used in patients with high clinical likelihood of moderate to severe OSA.

A

level-III portable studies (home sleep testing)

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28
Q

osa is determined by the

A

number of apneas and hypopneas per hour of sleep

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29
Q

determined by the number of apneas and hypopneas per hour of sleep

A

apnea hypopnea index (AHI).

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30
Q

apnea hypopnea index (AHI).

A

Normal = AHI < 5/hour
mild = 5 –15/ hour
moderate = 15 –30/hour
severe = >30/hour

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31
Q

Other parameters that may indicate the severity of OSA include

A

desaturation index (the number of desaturations with a 4% (or 3%) drop in SpO2 compared of baseline/ hour of sleep) and time spent with SpO2 less than 90%.

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32
Q

gold-standard treatment of osa

A

positive airway pressure (PAP) therapy

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33
Q

PAP therapy applied non-invasively via an ______ in the form of _____

A

interfacing mask
continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BPAP)

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34
Q

The AASM considers _______ as the treatment of choice for mild, moderate, and severe OSA.

A

PAP therapy

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35
Q

-is characterized by the cessation of airflow with no respiratory efforts, that is, both the diaphragmatic and intercostals muscle activities are absent.

A

CENTRAL SLEEP APNEA (CSA)

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36
Q

-is characterized by an initial cessation of airflow with no respiratory effort (central apnea), followed by a period of upper airway obstruction (obstructive apnea).

A

MIXED SLEEP APNEA

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37
Q

-defines as a breathing disorder in which there are cyclical fluctuations in breathing, with periods of central apneas or hypopneas that alternate with periods of hyperpnea in a gradual waxing and waning fashion.

A

CHEYNE-STOKES BREATHING (CSB)

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38
Q

-seen mostly in patients with heart failure (HF)

A

CHEYNE-STOKES BREATHING (CSB)

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39
Q

CHEYNE-STOKES BREATHING (CSB) are -described in patients recovering from:

A

acute pulmonary edema
advanced renal failure
central nervous system lesions

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40
Q

-is a condition in some obese people in which poor breathing leads to lower oxygen and higher carbon dioxide levels in the blood

A

OBESITY HYPOVENTILATION SYNDROME

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41
Q

To diagnose OHS, the following criteria must be met:

A

The presence of hypoventilation during wakefulness (PaCO2> 45 mm Hg) as measured by arterial PCO2, end-tidal PCO2, or transcutaneous PCO2.

Presence of obesity (BMI > 30 kg/m2).

Associated sleep-related breathing disorder

Absence of other known causes of hypoventilation

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42
Q

It is important to note that OSA often coexists with _____, in those cases, the diagnosis of both OSA and OHS should be made.

A

OHS

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43
Q

About ______ of patients with OHS have coexisting OSA; therefore, symptoms and many of the physical findings of OHS patients are similar to those in patients with OSA,

A

90%

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44
Q

About 90% of patients with OHS have coexisting OSA; therefore, symptoms and many of the physical findings of OHS patients are similar to those in patients with OSA, such as:

A

excessive day-time sleepiness
impairments of memory or concentration
Snoring
 mood disturbance
choking during sleep
Fatigue
morning headaches

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45
Q

However, when compared to eucapnic OSA patients, those with OHS tend to complain more often of

A

shortness of breath.

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46
Q

OHS is a diagnosis of

A

exclusion

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47
Q

many diagnostic tests should be carried out to distinguish OHS from other disorders in which hypercapnia is a common finding, such as

A

pulmonary diseases, skeletal restriction, neuromuscular disorders, hypothyroidism or pleural pathology.

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48
Q

ohs Tests should include:

A

ABG
PFT
chest imaging

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49
Q

ABG sampling is a key test since hypercapnia is a fundamental feature of the disorder =reveals _______, which reflects the chronic nature of the disease.

A

low PaO2 and a high bicarbonate level

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50
Q

PFT are essential to exclude other causes of hypercapnia such as _____. Although PFTs can be normal, they usually reveal______

A

chronic pulmonary diseases
mild -to-moderate restrictive pattern due to obesity.

51
Q

Untreated OHS is associated with a

A

high mortality rate, a reduced quality of life, and numerous morbidities, including hypertension, pulmonary hypertension, right heart failure, angina, and acute hypercapnic respiratory failure.

52
Q

Although there are no treatment guidelines for OHS, treatment approaches are based on

A

reversing the underlying pathophysiology of OHS including the reversal of sleep-disordered- breathing, weight reduction, and treatment of comorbid conditions

53
Q

ohs Management

A

A.PAP
B.Weight loss
C.Oxygen

54
Q

_____ is desirable in patients with OHS and will lead to improvement in ______ including improvement in _______

A

Significant weight loss
pulmonary physiology and function
alveolar ventilation and nocturnal oxyhemoglobin saturation.

55
Q

it is important to realize that _____ cannot be used as the sole initial treatment in ohs

A

weight loss

56
Q

is the mainstay of therapy for OHS.

A

Application of PAP

57
Q

It seems reasonable to start with _____ knowing that the majority of OHS patients have coexisting OSA.

A

CPAP

58
Q

_____has been shown to be effective in a group of patients with stable OHS, especially in those with severe OSA.

A

CPAP

59
Q

There are no clear guidelines on when to start or switch to bi-level PAP (BPAP); however, BPAP should be strongly considered in patients with _____, if CPAP is _______, or if they fail to _____. In addition, BPAP should be used in patients with ______

A

OHS without OSA, and in patients with OHS and coexisting OSA

insufficient and hypercapnia persists despite being on long- term CPAP

tolerate CPAP

OHS who experience acute-on-chronic respiratory failure

60
Q

Treatment of OHS with PAP improves ____, this improvement could be achieved in _____

A

blood gasses

2 to 4 weeks.

61
Q

in ohs ____ is important and should include ______

A

early follow-up

repeated measurement of ABG with an assessment of adherence to PAP

62
Q

patients with OHS commonly suffer from ______during sleep, in addition to ______.

A

prolonged episodes of hypoxemia

daytime hypoxemia

63
Q

 is needed if hypoxemia persists despite the relief of upper airway obstruction and hypoventilation with _____, in order to prevent the long-term consequences of hypoxemia on pulmonary vasculature and other vital organs

A

Oxygen therapy

PAP therapy

64
Q

-Is a relatively rare autoimmune disease and has pentad of clinical features including:

A

NARCOLEPSY

65
Q

-Irresistible attacks of sleep, which is usually present in all patients.

A

NARCOLEPSY

66
Q

is characterized by sudden “sleep attacks” that often occur several times a day.

A

narcolepsy

67
Q

-The narcolepsy attacks last from several seconds to more than

A

30 minutes.

68
Q

narcolepsy Is a relatively rare autoimmune disease and has pentad of clinical features including:

A

-Irresistible attacks of sleep, which is usually present in all patients.

69
Q

The other feature of narcolepsy is not present in all patients.

A

Cataplexy
Hypnagogic hallucination\
Sleep paralysis
Interrupted fragmented sleep

70
Q

characterized by sudden bilateral loss of muscle tone brought on by emotions, which can be limited to certain muscles or generalized, resulting in falling down.

A

Cataplexy

71
Q

____ consciousness during cataplexy.

A

Full

72
Q

Cataplexy is _____ for narcolepsy and is not present in all narcolepsy patients.

A

pathognomonic

73
Q

If cataplexy is present, the patient has

A

narcolepsy type 1.

74
Q

 is appropriate when excessive daytime sleepiness is present with REM phenomenology (hypnogogic hallucinations and sleep paralysis) but without cataplexy.

A

A diagnosis of narcolepsy without cataplexy (Narcolepsy type 2)

75
Q

Vivid dreams that occur at the transition from wakefulness to sleep or from sleep to wakefulness

A

Hypnagogic hallucination:

76
Q

from wakefulness to sleep

A

hypnagogic

77
Q

from sleep to wakefulness

A

hypnopompic

78
Q

It is a temporary inability to move or speak that happens when the patient is waking up or falling asleep.

A

Sleep paralysis

79
Q

Narcolepsy patients may complain of ________ sleep

A

Interrupted fragmented sleep

80
Q

gives good clues to diagnose narcolepsy.

A

History

81
Q

To confirm the diagnosis, a patient with narcolepsy undergoes an

A

overnight sleep study (PSG),

82
Q

To confirm the diagnosis, a patient with narcolepsy undergoes fan overnight sleep study (PSG), followed by ___

A

multiple sleep latency test (MSLT).

83
Q

MSLT starts

A

1.5–2 hours after waking up in the morning.

84
Q

in mlst The patient is given

A

4–5 chances to nap separated by 2 hours.

85
Q

in mslt If the patient falls asleep, he is allowed to sleep for

A

15 min.

86
Q

in mlst _______ are monitored.

A

Sleep latency and sleep onset REM (SOREM)

87
Q

in mlst The presence of a ________ support the diagnosis of narcolepsy.

A

short sleep latency (<8 min) and two or more SOREM

88
Q

are common among patients with narcolepsy.

A

Periodic leg movement and restless legs syndrome

89
Q

The management of patients with narcolepsy and cataplexy aims to improve

A

daytime sleepiness and control cataplexy.

90
Q

For the irresistible attacks of sleep, _____ are used.

A

behavioral therapy and medication

91
Q

in management of narcolepsy ______ are used.

A

Good sleep hygiene, obtaining enough sleep at night, and strategic naps

92
Q

entail getting short naps for a few minutes when circumstances allow

A

Strategic naps

93
Q

short naps increase alertness in patients with narcolepsy for

A

1–2 hr

94
Q

are used to reduce sleepiness

A

stimulants

95
Q

The first-line treatment in narcolepsy is

A

Modafinil.

96
Q

may be used in patients who do not respond to Modafinil.

A

Methylphenidate

97
Q

For cataplexy, _______ are used as first-line treatment.

A

the Serotonin Reuptake inhibitors (SSRI) Fluoxetine, or the Serotonin-Norepinephrine Reuptake inhibitors (SNRI) Venlafaxine

98
Q

For difficult cases of cataplexy, _______ can be used.

A

Sodium Oxybate (Xyrem)

99
Q

is a sensory-motor disorder characterized by unpleasant “creepy-crawly” sensations in the lower limbs.

A

RESTLESS LEG SYNDROME (RLS)

100
Q

Movement of the legs temporarily relieves rls symptoms but disrupts the ability to

A

stay asleep during the night, resulting in delayed or fragmented sleep.

101
Q

The major symptoms of RLS are

A

very disturbing sensations in the limbs (98%), and sleep disturbance is often the primary complaint (95%).

102
Q

4 diagnostic criteria of rls

A

I.an urge to move the legs, usually accompanied or caused by an uncomfortable sensation in the legs

II.beginning or worsening of symptoms during periods of rest or inactivity;

III.partial or total relief of symptoms by movement;

IV.symptoms that are worse in the evening or night compared to during the day or that occur only in the evening or night (it follows a circadian rhythm).

103
Q

have suggested four diagnostic criteria for rls

A

The International Restless Legs Syndrome Study Group (IRLSSG)

104
Q

Roughly, _______ of RLS patients are estimated to have a positive family history;

A

60%

105
Q

Roughly, _______ of RLS patients are estimated to have a positive family history;

A

60%

106
Q

genetic association studies have linked ______ to RLS.

A

5 genes and 10 different alleles

107
Q

The symptoms of RLS follow the circadian fluctuation of dopamine in the

A

substantia nigra and the putamen.

108
Q

RLS patients have lower dopamine and iron levels in the substantia nigra and, therefore, respond to both

A

dopaminergic therapy and iron administration.

109
Q

-RLS can be primary

A

(idiopathic)

110
Q

This entity usually has a genetic predisposition and is seen more in young people and is usually more difficult to treat.

A

RLS can be primary (idiopathic)

111
Q

RLS has been linked to a number of comorbid conditions, such as

A

iron deficiency
renal failure (uremia)
diabetes mellitus
neurological disorders = multiple sclerosis and Parkinson’s disease
rheumatologic diseases = rheumatoid arthritis.

112
Q

specific tests for RLS diagnosis.

A

none

113
Q

RLS is a ___ diagnosis based on____

A

clinical
clinical findings.

114
Q

is not required to diagnose RLS.

A

PSG overnight sleep study

115
Q

If iron deficiency is suspected in rls, _____ should be obtained.

A

serum ferritin levels

116
Q

The goal of treatment of patients with RLS is to have

A

uninterrupted sleep with minimal sleep latency.

117
Q

In patients with intermittent RLS symptoms that disturb sleep, treatment may be used on an _____

A

intermittent basis during symptomatic episodes.

118
Q

In intermittent rls cases, the _______ can use as needed.

A

dopamine agonist carbidopa-levodopa (Sinemet) at bedtime

119
Q

For severe persistent RLS, dopamine agonists, such as

A

pramipexole or ropinirole can be used 1–2 hour before bedtime.

120
Q

Secondary RLS is dependent on the ______, which once managed, RLS can be cured.

A

causative conditions

121
Q

RLS patients with_____, symptoms may remit after treatment or resolution of these conditions.

A

iron deficiency, pregnancy, and uremia

122
Q

For rls patients with ______, iron treatment can be initially started and ferritin levels monitored.

A

ferritin level <112 picomols/L (50 nanograms/mL)

123
Q

If ferritin levels of rls patient are _______ and symptoms persist, they can be treated based on their severity.

A

> 112 picomols/L (50 nanograms/mL)

Polysomnography (3 decks)

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