Sleep Apnea Flashcards
How long does stage 1 last?
30 seconds to 7 minutes
What kind of dreaming happens in slow save?
short dreams -
you’ll feel like your’e awake if asked
What kin dof eye movements in stage 1?
disconjugate
what EEG waves in stage 1?
theta
Wht percentage of sleep time occurs in stage 2?
50%
The EEK in REM will look like what stage?
stage 1
Why is the EMG activity lowest in REM?
you’re paralyzed
What percentage of sleep time is spend in REM?
20%
What does a nocturnal polysmnogram measure?
EEG oculogram ( EOG) EMG of chin and leg respiratory effort and airflow EKG Oximetry Videiotape
What are the two ends of the sleep divide?
DIMS: disorders of initiating and maitnaining sleep
DOES: Disorders of excessive sleepiness
Who should get a sleep study - DIMS or DOES?
DOES (not insmoniacs)
loud snorers, witnessed apneas, marked daytime somnoledge, lifeling sleepiness, movement sidsorders, seizures, etc.
What are the characteristics of clinically significant EDS?
Persistent and unremitting
Increasing sleep time may not fix the sleepiness
Patient may c/o sleep loss consequences, i.e., loss of energy, memory loss or fatigue
What is the EEX for excesive daytime sleepiness?
Sleep apnea syndromes Neurologic conditions Narcolepsy Idiopathic CNS hypersomnolence Sleeping Sickness (African Trypanosomiasis) Klein-Levine syndrome Chronically insufficient sleep Circadian rhythm abnormality Disturbed nocturnal sleep Periodic leg movement Central sleep apnea CHF/exaggerated Cheyne-Stokes CNS Altitude Medical disorders Asthma Angina, CHF Chronic pain syndrome, i.e., R.A. Reflux Drugs Depression – 10% with major depression
In general, what are the four causes of EDS?
Sleep at night Quantity Quality Circadian rhythm Drugs CNS pathology
THe body is basically designed to sleep at night and wake during the day. THere is a natural mid-teenage thing that extends it out and then aging shifts it back. What are the two nadirs of when we typically ar enaturally slseepy?
5 in the morning and 2 in the afternoon
WHat antihypertensive is associated with sleep problems?
beta blockers
WHat is the problemw tih alcohol?
it decreases sleep latency
has a short half life so when you metabolize it out, it wakes you up and messes up the rest of your sleep
worsens underlying sleep pathology
fragments sleep
WHat is the apnea/hypipnea index and what is considered abnormal?
it’s a measure of how many times you stop breathing in an hour
over 5 is abnormal
What are the three places that can obstruct in sleep apnea?
- in the nose
- back by the uvula
- at the base of the tongue
What happens with partial obstruction?
the snoring
What happens in complete obstruction
don't breath O@ sats drop catecholamine burst wakes them up resume breathing go back to sleep
repeat
What are the typical symptoms of sleep apnea?
Excessive daytime sleepiness after adequate sleep time
Loud snoring with silent pauses - witnessed apnea
Irritability, Memory Loss
Morning headaches - Hypoxemia, Hypercapnia
Interfering with daily life
Which gender is more often effected?
males - until after menopause, after which women start to get it to (progesterone is a respiratory stimulant)
What percentage will have personality change and intellectual deterioration?
50%
What are associated with the morning headaches?
hypozemis and hypercapcnia
What percentage of males will be impotent?
50%
What are osme of the physical characteristics that suggest apnea?
facial reconstruction downsyndrome broken nose with deviated septum severe rosacea causing rhinophyma maxillary or mandibular insufficiency crowding from a small jaw or asymmetric mandibular arch big tonsils obesity
What neck collar size is a robust predcitor of obstructive apnea?
over 17 inches (43 cenimeters)
What happens to the cardiovascular system in sleep apnea?
you’ll have huge variability in heart rate and it will increase in general
blood pressure will go up and vary highly
arrhythmias more likely
higher rates of a fib, CAD, CHF and HTN
What percentage of people with HTN have OSA? How about refractory HTN?
40%!
87% in those with retractory!!!
What are the 4 treatments for OSA?
- seight loss
- oral surgery
- postivie airway pressure device (CPAP)
- oral appliances
What’s the most effective?
the CPAP - 99% of the time it works
What’s a second choice that works about 70% of the time in mild cases?
oral devices - you wear an dupper and lower guard that will push the mandible forward to try to open up the airway
What are the two surgical treatment you can do?
tracheostomy
uvulopalatopharyngoplasty
What is narcolepsy
you have a hypothalamic deficiency in oxycretin, so your sleep cycle gets all messed up
awake intrudes on REM and REM intrudes on sleep
What will narcoleptics present with?
- excessive sleeping
- hypnopopnic hallucinations
- cataplexy
- sleep paralysis
How do we diagnosed narcolesy?
- Do actigraphy to make sure they’re not sleep deprived - if they prove they’re sleepin genough…
- do an overnight sleep study. if normal….
- that following morning do a multiple sleep latency test (a nap test) - do 5 naps spaced by hour and a half and they sleep for 20 minutes. Measure how long it takes you to sleep and then how long you are in REM.
DIangnosis of narcolepsy = sleep latency less than 8 minutes and 2 early REM onsets
What are the 2 parts of treatment for narcolepsy?
- stimulants to help them not be so sleepy
2. REM suppressants - like toprenil
What’s the most common “movement disorder” during sleep?
a hypnic jerk - the random twitch in response to a trigger
a stage 1 phenomena
usually means you’re excessively sleepy that day and either had too much caffeine or nicotine
What is restless leg syndrom?
comes out of the substantia nigra
it’s an uncomfortable sense of not being able to hold the leg still while you try to sleep
leads to periodic leg movements during sleep at night (which can be measured)
What’s one lab to check in restless leg syndrome?
check that iron levels are ok
If you see stereotypic rhythmic motions repeatedly at night, what do you need to rule out?
seizures
If an elderly gentleman comes in saying he acts out his dreams, what is the diagnosis?
REM Behavior disorder
To be paralyzed at night, what has to happen in your brain?
the pons needs to be stimulated, which will then inhibit your muscle centers
so volunteer cats who get their pons taken away will act out their dreams
WHat’s the management for REM behavior disorder?
low dose clonopin
What’s the scary thing about having REM Behavior disorder?
50% will get a diagnosis of a brain disorder in 10 year - usually parkinsons or lewy body dementia
