Sleep disorders Flashcards

1
Q

What conditions must be ruled out with insomnia?

A

restless leg syndrome and disordered breathing

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2
Q

What do maintenance difficulties indicated?

A

intrinsic sleep disorder that requires sleep study

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3
Q

What causes psychophysiologic insomnia?

A

learned sleep-preventing associations

paradoxical improvement in sleeping lab

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4
Q

What causes fatal familial insomnia?

A

prion protein
autonomic dysfunction
rare neurodegenerative process

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5
Q

What is the prevalence sleep apnea?

A

2-4% of population

rising due to rising obesity

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6
Q

What are some clinical aspects of obstructive sleep apnea?

A

17” neck circumfrence
obesity
excessive daytime sleepiness, pseudodepression
morning headache
crowded oropharynx, nasal disorders
positionally worse, and aggravated by sedatives or alcohol
common in neuromuscular disorders
polychythemia (increased rbc) and hypothyroidism

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7
Q

Define apnea vs. hypopnea

A

Apnea: absent airflow for 10 seocnds
hypopnea: reduced airflow for 10 seconds

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8
Q

What are the types of apnea/hypopnea?

A

Obstructive
central
Mixed: starts central, becomes obstructive

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9
Q

What is the cutoff for apnea/hypopnea index/ Respiratory disturbance index?

A

<5 (events/hour sleep)

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10
Q

How is apnea/hypopnea treated?

A

conservative measures and cpap (contineous positive airway pressure), dental devices, sometimes surgery

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11
Q

What are possible causes of central apnea?

A
Lateral medullary syndrome
atlantoaxial sublaxation
myotonic dystrophy
heart failure
syringobulbia
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12
Q

Define restless leg syndrome

A

urge to move
begins or worsens with rest
partially/totally relived by moving
worse at night/evening

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13
Q

What is the difference between restless leg syndrome and periodic limb movement disorder?

A

RLS: sensation
PLMD: manifestation 0.5-10 s, at 5-90 s intervals
90% of RLS have PLMD
50% of PLMD have RLS

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14
Q

What are common causes of RLP/PLMD?

A

Central (spastisity) or peripheral (radiculopathies, and neuropathies)
pregnancy
ferritin deficiency

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15
Q

How is RLS/PLMD treated

A

underlying cause ex. iron folate def
Firs line role for dopaminergic agonists an hour or two before bed
Sinemet (carba-levo dopa)
clonazepam may cause tachyphylaxis (reduced response)
opioids in some circumstances

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16
Q

What is the classic tetrad for narcolepsy?

A

1- excessive daytime sleepiness
2- cataplexy (full muscle weakness while awake)
3- hypnagogic hallucinations
4- sleep paralysis

17
Q

How is narcolepsy treated?

A

strategic napping
alerting agents: modafininl, methylphenidate, other amphetamines
anticataplectic: anticholinergic agents (TCA)
SSRI
Methlphenidate
sodium oxybate/GHB

18
Q

Where is hypocretin/orexin synthesized? where does it project to?

A

Synthesized in the lateral and posterior hypothalamus
projects diffusely to anterior projecting systems important for maintaing wakefulness
explains a series of symptomatic narcolepsies