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Pulmonary > Sleep > Flashcards

Sleep Flashcards

1
Q

Hypopnea

A

> 30% decrease from pre-event baseline in peak signal excursions using nasal PRESSURE transducer. Duration > or = 10s and >3 or 4% oxygen desat from baseline (usually occurs after the event)

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2
Q

Apnea

A

decrease in peak signal excursion by >90% or pre-event baseline using oronasal THERMAL sensor (not pressure)

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3
Q

RERA

A

> 10s of breathing characterized by increasing respiratory effort in thoracic/abdominal channels, leading to arousal from sleep where resp event does not meet criteria for apnea or hypoponea

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4
Q

Master circadian rhythm generator in mammals

A

suprachiasmatic nucleus

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5
Q

CNS inhibitory neurotransmitter

A
  1. GABA

2. Adenosine (caffeine blocks adenosine receptors)

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6
Q

CNS excitatory neurotransmitters

A

Activity increases during wake and decrease in sleep:
1. Glutamate (GABA blocks glutamate)
2. Serotonin
3. Norepinephrine
4. Dopamine (Haldol is antago)
5. Hypocretin (deficiency results in narcolepsy with cataplexy)
Histamine (antagonist promotes sleep)

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7
Q

Deficiency of this results in narcoleps with cataplexy

A

Hypocretin

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8
Q

REM sleep neurotransmitter

A

Acetylcholine

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9
Q

Changes in sleep:Resp System

A

decreased PaO2, SaO2, increased PaCO2; decrease Vt, decreased minute vent
Irreg respirations during REM

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10
Q

Changes in sleep: CV

A

NREM: Dec HR, Dec CO, Dec BP

REM (compared to NREM and wake): Increased HR, Increased CO, increased BP

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11
Q

Changes in Sleep: Endocrine

  1. Increased levels in sleep
  2. Decreased levels in sleep
A
  1. GH, prl, parathyroid, testosterone

2. cortisol, insulin, TSH

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12
Q

Changes in sleep: Thermoregulation

A

Core body temp peaks early evening (6-8pm), falls at onset of sleep, nadir 2 hr prior to waking (4-5am)
-sleep occurs during falling phase of temp rhythm, wake occurs during rising phase of temp rhythm

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13
Q

Sleep deprivation on Ghrelin

and Leptin

A

Increased

Leptin is decreased

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14
Q

Various EEG patterns:

A
  1. Beta- >13 Hz, alert and awake
  2. Alpha- 8-13 Hz- Drowsy with eyes close
  3. Theta- 4-7Hz- charac of N1, N1 and REM sleep
  4. Delta- <4 Hz, N3 sleep
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15
Q

K complex

A

sharp negative and slower positive component, stage 2 sleep (PVC of EEG)

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16
Q

Sleep Spindle

A

Short rhythmic waveform, 12-14 Hz, characteristic of stage 2 sleep

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17
Q

Characteristic findings of N2 sleep

A

Low amplitude, K complex and sleep spindle

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18
Q

Characteristic findings of N3 sleep

A

Low frequency, high amplitude delta waves (VT)

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19
Q

Diagnosis: Narcolepsy

A

MSLT with mean latency <8 minutes and at least 2 SOREMPs

  • PSG preceeding this test to assess for confounding conditions like OSA
  • sleep deprivation can lead to abnormal MSLT
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20
Q

How to clinically distinguish Narcolepsy from IH?

A

Naps not refreshing to patients with IH but are to narcoleptics

21
Q

Psycho-physiologic Insomnia

A

Starts as stressor to emotionally distressing event. Response is anxiety about inability to fall asleep leading to insomnia.
Treatment: with sleep restriction

22
Q

Idiopathic Hypersomnia

A

Excessive daytime sleepiness, usually not refreshed by sleep. MSLT with sleep latency <8min but 0-1 (<2) SOREMPs.

23
Q

Narcolepsy type 1

A

Narcolepsy with cataplexy

24
Q

Narcolepsy type 2

A

Narcolepsy without cataplexy

25
Q

Long sleeper vs Idiopathic Hypersomnia

A

Sleep >10h but feel refreshed (as opposed to IH where still feel excessively sleepy)

26
Q

AHI:
Normal
Severity

A

0-5 is normal
mild 5-15
moderate 15-30
Severe >30

27
Q

Use of ASV led to increased CV mortality in patients with:

A

symptomatic CHF

LVEF

28
Q

Defn: SOREMP

A

onset of REM within 15min of sleep

29
Q

Qualify for bronch LVRS

A

FEV1 15-45%, heterogeneous emphysema, hyperinflation and air trapping (TLC >100%, RV >150%)

30
Q

Wake:

A

> 50% of epoch has alpha, chin EMG tone high, fast eye movement

31
Q

Sleep N1

A

Alpha activity diminished or disappears, low amplitude/mixed frequency, slow rolling/roaving eye movements, chin EMG lower than wake

32
Q

Characteristic EEG of REM

A

Low amplitude, mixed frequency, low chin EMG, REM

33
Q

In whom to consider hypoglossal nerve stimulation?

A
  • AHI 20-65
  • BMI < or = 32
  • AP collapse of soft palate (on DISE)

-contraindications- concentric collapse of soft palate, BMI >32

34
Q

Cheyne Stokes Respirations (CSR)

A

Normal or low PaCO2, increased vent drive to hypercapnia

  • Increased chemoreceptor sensitivity to CO2
  • Increased circulation time secondary to decreased CO
35
Q

CSR during sleep stages

A

occurs in N1 and N2, improves with REM

36
Q

ASV in Cheyne Stokes Respir:

A

with symptomatic CHF and LVEF <45%, increased CV mortalitity

37
Q

CPAP in CSA with CHF:

A

modest improvement in LVEF but does not improve survival (CANPAP)

38
Q

Congenital Central Hypoventilation associated with mutation in gene:

A

PHOX2B

  • alveolar hypovent
  • autonomic nervous system dysregulation- esophageal dysmotility, Hirschsprung, neural crest tumors
39
Q

OSA by sleep stage:

A
  • goes away in N3

- worse in REM

40
Q

Treatment of Narcolepsy:

A
  1. Nonpharm- structure sleep, scheduled naps
  2. Pharm-
    stimulant (modafinil) first-line treatment for excessive daytime sleepiness
  3. Cataplexy:
    -mild- SSRI
    -GHB (sodium oxybate) for cataplexy and EDS
41
Q

RLS related to:

A

Low CNS iron stores. Fe is cofactor for tyrosine hydroxylase, rate-limiting step for dopamine synthesis.

42
Q

Tx for RLS

A

-dopamine agonist (pramipexole, ropinirole)

Tx Fe-defic anemia

Side effect: increased impulsive behaviors

Second line: gabapentin, opioids

43
Q

Tx for REM related behavioral disorder

A

Keep partner and patient safe.

  • Benzo
  • Melatonin is second line
44
Q

Tx of insomnia in COPD: preferred agent

A

Ramelteon- melatonin (MT1/MT2) agonist
-safe and effective in COPD

-CBT- longterm effects are better

  • avoid nicotine
  • tx concurrent OSA, PLM
45
Q

Zalepelon- mechanism

A

Short-acting benzo receptor agonist

-use for sleep onset insomnia (short-acting)

46
Q

Features suggesting GBS;

A

Ascending paralysis

  • neuropathic pain
  • autonomic dysfunction
47
Q

Botulism:

  • present
  • treatment
A
  • descending weakness

- tx with IVIG

48
Q

Typical PFT findings in obesity:

A

Decreased: ERV, FRC
RV is spared
FEV1 and FVC both reduced but FEV1:FVC preserved

Pulmonary (14 decks)

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