Sleep Flashcards
1
Q
Three physiological changes during sleep that contribute to ventilatory instability
A
- Alterations in ventilatory control - decrease responses to hypoxemia and hypercapnia
- FRC reduced by 200-300 ml - decreased tidal volume with increased rate
- Increased upper airway resistance
2
Q
Home sleep apnea test
A
Used to rule in OSA >5 AHI/hour
If less and high suspicion, do full study
Treatment of apnea:
- CPAP in moderate to severe (AHI >15) or mild (>5) with symptoms
3
Q
Narcolepsy
A
- Defined as excessive daytime sleepiness for > 3 months with a mean sleep latency of < 8 minutes on a MSLT and 2 or more sleep onset REM periods (SOREMs)
- SOREM - TEM onset within 15 minutes of sleep in 1 of 5 naps or PSG
- Type 1
- Type 2 - absence of cataplexy and normal hypocretin-1 levels in CSF
Treatment: armodafinil or modafinil for initial treatment
4
Q
Cataplexy
A
Weakness of muscles or paralysis associated with a strong emotion or laughter during wakefulness
5
Q
REM Behavior Disorder
A
- REM sleep without muscle atonia
- Patients act out dreams
- Associated with Parkinson’s, Levy body
- Can be presenting signs of degenerative disease
- Treated with benzos (clonazepam) or melatonin
- benzos contraindindicated in glaucoma
6
Q
Treatment-Emergent Central Sleep Apnea
A
Occurs in 10% of titration studies Spontaneously resolves Should never be treated with bilevel with backup rate Not associated with benzos Is associated with opioids
7
Q
Hypoglossal Nerve Stimulation
A
- AHI 20-65
- BMI < 32
- Age > 22
- Anterior/posterior collapse of soft palate
- second line after CPAP
8
Q
Definitions
A
- Apnea - > 90% drop in flow for 10 seconds
- Hypopnea - > 30% drop in flow with 4% or more drop in saturation
- Mild AHI 5-15
- Moderate 16-30
- Severe > 30
9
Q
CPAP
A
- set pressure to achieve 90% percentile improvement in AHI
10
Q
Biots Breathing Pattern
A
- abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea.
