Sleep Flashcards
Definitions of apnea adult vs pediatric
Adult: Apnea is defined by cessation of air movement for at least 10 seconds.
Pediatric: Cessation of air movement over two breath cycles.
Definitions of hypoventilation
Sleep related hypoventilation is defined as >10 mmHg increase in pCO2 compared to awake for at least 10 minutes OR rise in pCO2 > 55 mmHg for at least 10 minutes.
Definition of hypopnea
Decrease of air movement >/_ 30% for OVER 10 seconds, WITH at least 3% decrease in O2 sats (4% for medicare) (over 10 seconds for adults, over 2 breaths for kids)
Definition of arousal
Defined by an abrupt shift of EEG >16 Hz lasting at least 3 seconds.
What is the Mueller maneuver?
Performed with patient awake sitting up or supine. Patient asked to perform a valsalva while scope assess the degree of retropalatal or retrolingual collapse.
Sleep terror vs nightmare?
Sleep terrors - Occur in 1st third of night, non REM. Usually in kids, wake up scared, confused (don’t necessarily remember).
Nightmare - Occur during REM sleep. Patient wake up and can remember their dream (not confused).
What test to use for narcolepsy and results interpretation? ALSO type I vs type II narcolepsy?
MSLT < 8 minutes and rapid onset of REM (during PSG) are characteristic for narcolepsy.
Increased stage I sleep
Type I: WITH cataplexy, LOW CSF hypocretin
Type 2: WITHOUT cataplexy, NORMAL CSF hypocretin –> MOST COMMON TYPE!
What is periodic limb disorder?
Periodic limb disorder refers specifically to repetitive movement of anterior tibialis muscle.
What is RDI?
Respiratory disturbance index: apnea + hypopnea plus RERAs divided by total sleep time
What is OSAHS score?
Calculated by adding grades for BMI, tonsil size and Friedman tongue size. Scores of 8 or more have 90% chance of having at least moderate OSA.
Findings for Awake, REM, N1, N2, N3, and OSA on sleep study?
Awake - beta waves (beta off awake)!
Relaxed wakefulness - Alpha waves
REM - Sawtooth, rapid eye movements, 25% of sleep
N1 - Vertex sharp waves
N2 - K complexes and sleep spindles,** 50% of night**, 2nd half of night
N3 - Delta (Deepest sleep, 1st half of night)
OSA - Irregularity/flattening on PTAF and airflow tracings
Current criteria for INSPIRE?
Age >18
AHI 15 to 65, non-obstructive events <25% of total events, BMI<35 (although many commercial insurers use BMI<32), CPAP intolerance
Absence of complete concentric collapse at the velum on DISE.
What is periodic limb movement disorder defined as (PLMI) and first line treatment?
PLMI > 5/h and TX: Iron, dopamine agonists (pramipexole)
Definition of Apnea Index? Apnea Hypopnea Index?
Apnea Index: Apnea/Hr
Apnea Hypopnea Index: Apnea + Hypopnea/Hr
Indications for PSG in a pediatric patient?
-Confirm OSA prior to T&A
-POST OP PSG indicated in those who had preoperative evidence of moderate to severe OSA; obesity; craniofacial anomalies obstructing the upper airway; or neurologic disorders, such as Down syndrome, Prader-Willi syndrome, and myelomeningocele.
-PSG should be considered in children with chronic asthma, cystic fibrosis, pulmonary hypertension, bronchopulmonary dysplasia, or chest wall abnormality if there is clinical suspicion of an accompanying sleep-related breathing disorder.
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