Sleep

Question 1

What sleep stage?

Answer 1

N3 with delta waves

Question 2

What Stage?

Answer 2

REM
low voltage with eye movements
Sawtooth waves
Chin muscle atonic

Question 3

When is home sleep apnea not appropriate?

Answer 3

Medical conditions: CHF, hypovent syndromes, COPD, Stroke
Other sleep disorders: insomnia, restless leg syndrome, narcolepsy

Question 4

AHI in mild sleep apnea

Answer 4

5-14 (CMS says +comorbid or sx)

Question 5

AHI in moderate sleep apnea

Answer 5

15-29

Question 6

AHI in severe

Answer 6

> /=30

Question 7

When to treat OSA?

Answer 7

Moderate to severe OSA w/ or w/o symptoms

Mild if symptoms

Question 8

Does treating OSA improve…
Mortality?
CV?
BP?
Excessive Daytime Sleepiness?
Mood?
Metabolic?
QOL?

Answer 8

Mortality- yes
CV- not proven
BP- probably YES (rHTN - yes)
Excessive Daytime Sleepiness -yes
Mood- Not proven
Metabolic- Not proven
QOL- Sleep yes, general not proven

Question 9

Effect of finding a mask that fits and is comfortable for the patient?

Answer 9

Better adherence. Tends to be better with nasal interface.

Question 10

How to improve adherence to CPAP? (evidence based methods)

Answer 10

frequent contact with sleep team
CBT
education re benefits
Making sure mask is comfortable
Short term use of eszopiclone (2-6wk)

Question 11

what to do with periodic limb movements on PSG?

Answer 11

If asymptomatic and not associated with arousals then nothing

if symptomatic (excessive day time sleepiness) then check iron and consider tx

Question 12

Work up for restless legs syndrome

Answer 12

Iron levels

Does not need sleep study

Question 13

Effect of acute opiates on sleep architecture

Answer 13

More stage 2 and wake time after sleep onset
decreases slow wave sleep

Question 14

Risk factors for central sleep apnea iso opiate use

Answer 14

Opiate dose
low to normal BMI

All opiates can lead to central apnea

Question 15

Respiratory patterns associated with opioid induced central apnea

Answer 15

ataxic breathing (disorganized, variable rr and TV)
cluster breathing (run of several deep breaths then central apnea)

Question 16

Recurrent pneumonia, slurred speech, chronic cough, weight loss, hyperreflexia

Answer 16

ALS
Get EMG

Question 17

When to initiate noninvasive nocturnal vent in pt with muscle weakness

Answer 17

• FVC<50% predicted
• MIP <-60
• MEP <40 (poor cough)
• VC <20, <60%, <1L, or decreased >30% compared to baseline
• sniff insp force <40
• PaCO2 >45 in day

20-30-40 rule – VC<20, MIP >-30, MEP <40

Question 18

Indication for Trach in neuromsk disorders

Answer 18

• cant clear secretions
• Contraindicated NIV (severe bulbar dysfunction) and need MV
• Worsening chronic resp failure and NIV is not sufficient
• Fail to wean MV after acute event

Question 19

Medications that worsen myasthenia gravis

Answer 19

macrolides, fluoroquinolones, aminoglycosides, mg, beta blocker

Question 20

When to go straight to in lab sleep study?

Answer 20

Comorbidities - COPD, HF, neuromsk disorders, awake hypoxemia or hypercapnea
conditions that increase risk for central sleep apnea
insomnia

Question 21

Effect of altitude on OSA

Answer 21

Develop central apneas (not worsening OSA)
hypobaric hypoxia leads to increased ventilation and decreased CO2 –> over shoot and get central apnea

Question 22

How to treat pt with OSA going to high altitude

Answer 22

Treat with acetazolamide