Sleep Disorders

Question 1

Good benefits sleep provides physiologically

Answer 1

1) stabilizes regulation of the autonomic and endocrine systems
2) enhances attention and concentration
3) promotes a sense of well being

Question 2

Two basic states of sleep:

Answer 2

1) rapid eye movement (REM)

2) non-rapid eye movement (NREM)

Question 3

NREM sleep consists of:

Answer 3

Stages 1-4

Question 4

Dreams occur in which stage of sleep

Answer 4

REM stage

Question 5

Sleep cycle divided into minutes

Answer 5

90 min - first 80 min NREM followed by 10 min of REM.

Question 6

Stage 1 of sleep

Answer 6

can be awakened without difficulty
lasts 5-10 minutes
may notice feeling of falling

Question 7

Stage 2

Answer 7

light sleep w/ intermittent peaks & valleys
spontaneous periods of muscle tone & relaxation
heart rate slows
body temp decreases

Question 8

Stages 3 & 4

Answer 8

deep sleep
slow-wave/delta sleep
disoriented if awaken from this sleep

Question 9

Benefits of NREM sleep

Answer 9

body repairs & regenerates tissues
builds bone & muscle
strengthens immune system

Question 10

Physiologic changes during REM sleep

Answer 10

increased heart rate
increased respiration rate
intense dreaming occurs
paralysis occurs

Question 11

REM sleep is sometimes called

Answer 11

paradoxical sleep

Question 12

In REM muscle atonia results in decreased peripheral vascular tone

Answer 12

1) surge in sympathetic activity
2) respiratory response to hypercapnia & hypoxia is reduced
3) Physiological vulnerability during REM may increase risk of arrhythmias reduce coronary blood flow, hypoxia, and obstructive apnea

Question 13

Short Term Sleep deprivation is associated with

Answer 13

greater sympathetic nerve activation
higher blood pressure
increased appetite
lower leptin levels
higher cortisol
increased inflammation

Question 14

Chronic sleep deprivation is related to

Answer 14

weight gain/obesity
coronary artery disease (5 hrs or less)
diabetes

Question 15

OSA - Obstructive Sleep Apnea

Answer 15

1. repetitive collapse of upper airway structures for 10 seconds or longer
2. cessation of airflow in the setting of continuous respiratory effor

Question 16

Symptoms of OSA

Answer 16

1. Snoring
2. Daytime sleepiness
3. witnesses apnea or gasping during sleep
4. insomnia
5. hypertension
6. morning headaches
7. decreased cognition

Question 17

AHI - apnea-hypopnea index is used for

Answer 17

determining the severity of the sleep apnea disorder based on the number of hypopnea events per hour

Question 18

Normal AHI

Answer 18

0 - 5

Question 19

Mild AHI

Answer 19

5-15

Question 20

Moderate AHI

Answer 20

15-29

Question 21

Severe AHI

Answer 21

over 30

Question 22

Risk Factors for OSA

Answer 22

1) male
2) over 56 yrs
3) obesity
4) micrognathia (undersized jaw)
5) retrognathia (posterior positioning of maxilla or mandible)
6) high arched palate
7) snoring
8. Neck size greater than 16.5 inches

Question 23

True/False - OSA can lead to a gradual increase in peripheral vascular tone and decrease in cardiac output, which causes hypertension

Answer 23

True

Question 24

CPAP

Answer 24

Continuous Positive Airway Pressure

Question 25

OSA associated with increased incidence of:

Answer 25

1) hypertension
2) MI
3) Infarction
4) early cardiac death
5) heart failure
6) pulmonary hypertension
7) arrhythmias

Question 26

What percentage of patients with heart failure have OSA

Answer 26

11 - 59%

Question 27

OSA can exacerbate heart failure by:

Answer 27

1) repeated oxygen desaturation
2) increased sympathetic activation
3) increased afterload
4) increased oxygen demand

Question 28

Treatment of Heart Failure and OSA

Answer 28

1) management of fluid in heart

2) Use of CPAP

Question 29

Management and therapy of OSA

Answer 29

1) treat and manage comorbidities
2) CPAPA therapy
3) surgery
4) oral appliances
5) weight loss
6) positional therapy

Question 30

CSA

Answer 30

Central Sleep Apnea - loss of ventilatory drive for 10 sec or more. Brief respiratory pauses even in healthy individuals

Question 31

CSA may occur from:

Answer 31

1) Endogenous brain dysfunction
2) high CO2 threshold
3) increased CO2 sensitivity
4) abnormal respiratory cycling
5) use of narcotics
6) excessive alcohol

Question 32

CSR

Answer 32

Cheyne-Stokes Respirations - form of central apnea w/ repetitive crescendo-decrescendo pattern of hyper to hypo ventilation. Related to heart failure or CNS deficits.

Question 33

Clinical presentation of CSR

Answer 33

1) snoring
2) witnessed apnea
3) paroxysmal nocturnal dyspnea
4) frequent awakenings
5) unrefreshing sleep

Question 34

Pickwickian syndrome

Answer 34

someone who is excessively sleepy and probably suffering from obesity hypoventilation syndrome

Question 35

Obesity hypoventilation syndrome

Answer 35

BMI over 30 kg/m2 & resting arterial pCO2 greater than 46 mmHG.

Question 36

The most frequent cause of traumatic death in athletes

Answer 36

Commotio cordis

Question 37

Commotio cordis

Answer 37

blunt, non-penetrating blow to the chest wall that results in sudden cardiac death.