Sleep Disorders

Question 1

actigraphy particularly usefulf or

Answer 1

confirming sleep quantity prior to MSLT

child or cognitively impaired

Question 1

pathogenesis cheyne stokes

Answer 1

PCO2 climbs, sensory info from peripheral receptors don’t reach heart fast enough because of heart failure

HF > still lungs > oversensitive sensors > breathe longer, deepr, overshoot needed > overcompensate and CO2 gets too low > cycle repeats

Question 1

parasominias arising from REM sleep

Answer 1

nightmare

sleep paralysis

REM behavior disorder

Question 2

impact of OSA on heart

Answer 2

hypoxic PA vasoconstriction

exagerated negative intrathoracic pressure

increased venous return

(LV underfilled > diastolic dysfunction)

Question 3

sign of mixed sleep apnea

Answer 3

signs of effort before flow

Question 4

impact of REM intrusion into wakefullness seen in narcolepsy

Answer 4

dreaming

paralysis - limbic discharge, halucination, feelings of psychosis

cataplexi

Question 5

exagerated limb movements in sleep

sleep walking symptoms

Answer 5

REM behavior disorder

Question 6

non-24hr-circadian-disorder

Answer 6

seen in retinally blind

sleep cycles advance day to day

Question 7

allowable levels of REM in MSLT

Answer 7

1 or fewer

Question 9

actigraphy reinforces/compliments

Answer 9

sleep diary

Question 10

sleep diaries most helpful for

Answer 10

hypersomnia

Question 10

pathologically sleep on MSLT if

Answer 10

<8min latency

Question 12

cheyene stokes pattern

Answer 12

crescendo decrescendo respiration

Question 13

determine if shallow breathing effort is obstruction driven vs centrally driven by

Answer 13

measuring intrathoracic pressure (larger change = obstructive event)

Question 13

____ cell loss seen in narcolepsy with cataplexy

Answer 13

hypocretin cell loss

Question 15

polysomnography indications

Answer 15

OSA

periodic limb movement disorder

Question 16

actigraphy not useful for

Answer 16

insomnia (lying awake, still)

Question 17

action of hypothalamus in sleep

Answer 17

Suprachiastmatic nucleus communicates time info to dorsomedial nucleus

>venterolateral preoptic nuclues > sleep promoting

>lateral hypothalamus > hypocretin neurons > wake promoting

Question 18

worsening HF in central sleep apnea due to

Answer 18

driving up of sympathetic activiity

Question 19

EEGfindings night terrors

associations

Answer 19

“tight” EEG activity

brief detla discharge preceding episode

arises from slowwave delta sleep

increased heart rate

associated with fam hx of sleep walking

Question 21

environmental factors in narcolepsy

Answer 21

antigen binding HLA DQB1*0602

head trauma, virus, toxins

sleep changes

Question 22

causal factors in periodic limb movement disorder

sleep pattern

Answer 22

iron deficiency

nerve damage (low back injury)

diabetic neuropathy

restless leg syndrome

little delta sleep, little/no REM sleep