Sleep

Question 1

What is the magic number for ODI?

Answer 1

15-30 is moderate
>30 is severe

Question 2

What are the DVLA rules?

Answer 2

excessive sleepiness w mild OSA
should not drive- should be controlled over a 3/12 period or inform DVLA

suspected OSA
Group 1 and 2-can not drive. unitl symptoms under control for >3months

mod/severe OSA
Group 1- inform DVLA and can not drive until control, adherence and improvment with medical confirmation every 3 years
Group 2- inform DVLA and can not drive until control, adherence and improvment with medical confirmation every year

Question 3

which gene is associated with narcolepsy?

Answer 3

HLA-DQB1*06:02

Question 4

What are the criteria for narcolepsy type 1 (with hypocretin def)?

Answer 4

• daily daytime lapses of sleep >3months
• sleep latency <8mins and 2+SO REMs
  CSF hypcretin <1/3 normal value or <110

Question 5

What are the criteria for narcolepsy type 2 (without hypocretin def)?

Answer 5

must meet 5 criteria:
1. daily daytime lapses of sleep >3months
2. sleep latency <8mins and 2+SO REMs
3. cataplexy is absent
4. normal or no result of CSF hypocretin
5. hypersomnolence not better explained by other causes

Question 6

What other conditions are associated with narcolepsy type 2?

Answer 6

Neuro:
parkinsons, MS, MD

infiltrative disorders:
sarcoid, tumours involving the hypothalamus

autoimmune/paraneoplasia:
anti-Ma-2 and antiaquaporin-4

prader willi

trauma

Question 7

what is the pathophysiology of REM behavioural disorder?

Answer 7

not fully understood
brainstem areas affecting REM sleep
locus subcoeruleus

Question 8

How do you diagnose for RBD?

Answer 8

RBD1Q, RBDSQ
Gold standard: polysomnography

Question 9

prevalance of RBD?

Answer 9

rare
usually over 50, under reported/diagnosed in women

Question 10

genetic factor of RBD?

Answer 10

GBA1 mutation

Question 11

What is the prevalance of Narcolepsy?

Answer 11

1 in 2000 in UK, in Japan it is 1 in 600
Peaks at 15 and again in late 30s

Question 12

Main clinical features of narcolepsy?

Answer 12

breakdown of boundary between REM and NREM sleep

• daytime sleepiness (15m-1h) which are refreshing
• start dreaming in early sleep (almost straight from being awake)
• sleep paralysis
• cataplexy

Question 13

Is there a test for narcolepsy?

Answer 13

Can test CSF hypocreitin- deficiency

HLA DQB1 0602 almost 98% diagnostic