Sleep Disorders Flashcards
What is obstructive apnea on a polysomnogram?
What is the presentation?
No flow with effort
Flat lines in flow channels
Activity in abdominal/thoracic
Presentation: 56 yo man with HBP and diabetes who snores/stop breathing in sleep
What are the OSA effects on the cardiac and nervous system?
What does it increase risk for?
Cardiac
Throat closing during OSA closes upper air tract
Right ventricle fills up with blood
Left ventricle underfills
Cardiac output drops by as much as 25%
Nervous system
BP jumps up after event
SNS starts to periodic firing
Eventually this will result in hypertension even during the day
Increase risk for MI, arrhythmias
What is hypopnea?
How is it shown on the polysomnogram?
Shallow breathing episode
Reduced flow in one channel
What is central apnea?
No flow with no effort
How does Cheyne-Stokes present on polysomnogram?
What is its patient presentation?
What is the common clinical correlate?
What is the physiology?
Crescendo-decrescendo
Same presentation as obstructive in terms of patient history
Think of bad heart: Heart failure often cause
Also occurs with bad strokes and attempted hangings
Latency between lung blood carbon dioxide is too long
Restrictive lung problems often resulting in overcompensation
What is the history of narcolepsy?
How does narcolepsy present on sleep study?
On MSLT?
History: sleepy for many years even though gets adequate
Lots of REM during sleep study - REM usually diminished during sleep study due to threatening environment
Mean sleep latency for narcoleptics typically 5 minutes: enters REM
What is the prevalence of narcolepsy?
What are the genetics of narcolepsy?
What are other causes of narcolepsy?
Affects 0.03% to 0.1% of the general population
Most cases of narcolepsy are sporadic
1% to 2% of first degree relatives have narcolepsy-cataplexy (20 to 40 times greater risk than general population)
Familial clustering occurs in about 10% of cases
Monozygotic twins often discordant for narcolepsy
Environmental factors are implicated: unknown antigen binding, head trauma, virus, toxins, sleep deprivation, change in sleep/wake cycle
Hormonal shifts: Aging/puberty
What is the pathophysiology of narcolepsy?
Hypocretin cell loss
Essentially breaking of the physiological switch
Cataplexy – REM intrusion while awake resulting in paralysis, falls, etc.
Dreaming while awake
What is periodic limb movement disorder shown as on sleep study?
What are its causes?
Many limb movements, poor sleep quality, no REM
Causes: iron deficiency, RLS, drug
Actinograph disorder trivia!
What hours do late sleep disorder patients typically sleep?
Who are suceptible to non-24 hour circadian rhythm disorder?
What does insomnia manifest as?
What edoes shift work sleep disorder manifest as?
What is advanced sleep disorder?
3 am to 12 am
The blind (lack 24 hour signaling)
Completely random sleep cycle and also psych patients
Sleep during the day
Sleep earlier than normal
How are parasomnias diagnosed?
What are the non-REM disorders?
What are the REM disorders?
Actigraphy used to diagnosis
NREM
Partial arousal during delta wave sleep
Sleep walking
Sleep talking
Sleep related eating
Confusional arousal
Night Terror
REM
Nightmare
Paralysis
REM Behavioral Disorder
What is REMBD characterized by?
How is it diagnosed?
Non-paralysis during REM
Violent actions/talking during sleep
MSLT not used, polysomography
