Sleep and related disorders Oct13 M1

Question 1

electrodes placement for sleep graphs

Answer 1

electro oculography, (eye mvmt)
electro myography (muscles)
electroencephalography (EEG)

Question 2

stages of sleep (4)

Answer 2

non-REM (N1,N2,N3), REM

Question 3

N1 sleep

Answer 3

alpha wave activity

Question 4

N2 sleep

Answer 4

spindles and K complexes

Question 5

N3 sleep

Answer 5

delta wave activity

Question 6

REM sleep

Answer 6

bursts of eye activity, change in breathing patterns, muscle inhibition

Question 7

how sleep cycles vary as night goes

Answer 7

more REM sleep.
more N2
less N3

Question 8

where more N2 and where more N3 in night

Answer 8

more N2 in end

more N3 in beginning

Question 9

micro-arousal def

Answer 9

transient disruption in sleep (increase in EMG, EEG)

Question 10

ascending arousal system location

Answer 10

midbrain and basal forebrain

Question 11

ascending arousal system ntr types (2)

Answer 11

monoaminergic

orexinergic (hypocretin)

Question 12

main ntr involved in arousal

Answer 12

orexin (hypocretin)

Question 13

inhibition of arousal system location

Answer 13

ventrolateral preoptic nucleus (VLPO) (two nuclei ventrally and laterally to optic chiasm)

Question 14

inhibition of arousal system promotes what type of sleep

Answer 14

non REM

Question 15

inhibition of arousal system what it does

Answer 15

inhibits arousal areas

Question 16

nucleus of the circadian rhythm

Answer 16

superchiasmatic nucleus

Question 17

what generates REM sleep

Answer 17

midbrain and pontine areas

Question 18

why sleep related to breathing

Answer 18

wakefulness and sleep areas project to resp control areas

Question 19

how breathing changes during sleep and during transition to sleep

Answer 19

decreased minute ventilation, increased PaCO2.

transition to sleep: periods of instable breathing

Question 20

3 sleep disordered breathings

Answer 20

• obstructive apnea-hypopnea
• central apnea-hypopnea
• sleep-associated hypoventilation

Question 21

OSA vs CSA

Answer 21

OSA has resp drive

Question 22

hypopnea def

Answer 22

20-30 s of reduction in breathing

Question 23

broad cause of OSA

Answer 23

upper airway closing

Question 24

symptoms of OSA

Answer 24

heavy snoring, nocturia, excessive daytime sleepiness

Question 25

important complication of OSA

Answer 25

cardiovascular problems

Question 26

3 causes of CV problems in OSA

Answer 26

• arousals-sleep fragmentation
• hypoxia-reoxygenation
• negative intrathoracic pressures

Question 27

how arousals-sleep fragmentation in OSa cause CV disease

Answer 27

lead to SS activation and higher HR following apnea

Question 28

how hypoxia-reoxygenation in OSA causes CV disease

Answer 28

induces oxidative stress, decreases O2 delivery

Question 29

how negative intrathoracic pressures generated in OSA

Answer 29

during obstructed inspiratory efforts

Question 30

how negative intrathoracic pressures generated in OSA cause CV disease

Answer 30

increase left ventricle transmural P, hypertrophy

Question 31

CV symptoms of cardiovascular complications of OSA

Answer 31

hypertension, arrhythmias, acute coronary events, ischemic attacks, pulm hypertension, CHF

Question 32

treatment to OSA

Answer 32

weight loss, no alcohol, CPAP

Question 33

apnea def

Answer 33

cessation of breathing for 10s or more

Question 34

CSA: why central

Answer 34

absence of airflow is due to absence of resp effort

Question 35

characteristic breathing seen in CSA

Answer 35

Cheyne-Stokes: increeasing and decreasing pattern, apnea alternating with hyperpnea

Question 36

treatment for Cheyne-Stokes breathing

Answer 36

bi-level non-invasive ventilation with adapting variation of inspiratory positive airway pressure
IPAP

Question 37

causes of CSA

Answer 37

hypercapnic, idiopathic, CNS lesions, congestive heart failure

Question 38

Loop gain def

Answer 38

relationship between magnitude of ventilatory disturbance and ventilatory reponse

Question 39

high loop gain def

Answer 39

response much more important than ventilatory disturbance

Question 40

high loop gain consequence

Answer 40

resp instability: promotes hyperventilation and the decrease in PCO2 prevents respiratory drive

Question 41

SAH (sleep associated hypoventilation) causes

Answer 41

CNS disease, drugs, metabolism, neuromuscular disease, chest wall deformities, COPD, obesity

Question 42

treatment to sleep associated hypoventilation

Answer 42

treat underlying cause. Also:

• ventilatory stimulant medication
• O2
• non invasive ventilation