Sleep Apnea Flashcards by Emily Prazak

How long does stage 1 last?

30 seconds to 7 minutes

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What kind of dreaming happens in slow save?

short dreams -

you’ll feel like your’e awake if asked

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What kin dof eye movements in stage 1?

disconjugate

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what EEG waves in stage 1?

theta

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Wht percentage of sleep time occurs in stage 2?

50%

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The EEK in REM will look like what stage?

stage 1

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Why is the EMG activity lowest in REM?

you’re paralyzed

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What percentage of sleep time is spend in REM?

20%

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What does a nocturnal polysmnogram measure?

EEG
oculogram ( EOG)
EMG of chin and leg
respiratory effort and airflow
EKG
Oximetry
Videiotape

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What are the two ends of the sleep divide?

DIMS: disorders of initiating and maitnaining sleep
DOES: Disorders of excessive sleepiness

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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.

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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

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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

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In general, what are the four causes of EDS?

Sleep at night
Quantity
Quality
Circadian rhythm
Drugs
CNS pathology

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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

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WHat antihypertensive is associated with sleep problems?

beta blockers

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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

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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

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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?

1. seight loss 2. oral surgery 3. postivie airway pressure device (CPAP) 4. 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?

1. excessive sleeping 2. hypnopopnic hallucinations 3. cataplexy 4. sleep paralysis

How do we diagnosed narcolesy?

1. Do actigraphy to make sure they're not sleep deprived - if they prove they're sleepin genough... 2. do an overnight sleep study. if normal.... 3. 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?

1. 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