Insp/Exp, OSA, OHS, Narcolepsy, Insomnia

Question 1

Insomnia

Answer 1

(1) difficulty falling asleep, staying asleep or nonrestorative sleep; (
2) this difficulty is present despite adequate opportunity and circumstance to sleep;
(3) this impairment in sleep is associated with daytime impairment or distress; and (4) this sleep difficulty occurs at least 3 times per week and has been a problem for at least 1 month.

Question 2

OSA - RF

*biggest RF

Answer 2

Obesity - biggest RF
Male
Macroglossia
CAD --> more severe OSA
Older

Question 3

OSA Cx

Answer 3

MVA
Daytime somnolence
Compensated resp acidosis
HTN
Worsens AF
All cause mortality
Metabolic syndrome

Question 4

OSA Diagnosis

1. Score
2. Tests

Answer 4

1. Scores
   - STOP BANG
   - OSA 50
   - Epworth Sleepiness Scale
2. Tests
   - Sleep study - polysomnography
   - MSLT (measures the time to fall asleep in a dark room (using EEG criteria)

Question 5

OSA Mx

Answer 5

Weight loss
Reduce ETOH
Positional therapy
Surgical procedures
PEEP

*severe OSA (AHI>30/hour) needs PEEP as initial therapy

Question 6

OHS

• definition
• causes
• treatment
• Cx

Answer 6

• BMI >30 + d/o breathing + awake hypercapnia
• Increased CVS risk + all cause mortality
• Leptin resistance (Leptin helps control breathing) + atelectasis + weak diaphrgam
• Mx - CPAP or NIV

Question 7

Narcolepsy

Cause
Types
Mx

Answer 7

Autoimmune destruction of hypothalamic neurons that produce Orexin (Hypocretin)

Type 1 - with cataplexy and positive MSLT (or low CSF hypocretin - not done in aus)

Type 2 - W/o cataplexy, + MSLT + low or normal CSF Hypocretin

Mx - stimulates (SSRI, SNRI, Dexamphetamine)

Question 8

Muscles of Inspiration

Muscles of Exp

Muscles of Forced Exp

Answer 8

Insp - External intercostal muscles, scalene, SCM, accessory muscles, diaphragm, ext oblique

Exp - passive, spends on lung recoil/elastin in lung

Forced Exp - INternal intercostal muscles, abdominal muscles