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Respiratory > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

What are the causes of daytime sleepiness?

A

1) Lack of sleep
2) Conditions disrupting sleep e.g. OSA
3) Drugs
4) Narcolepsy

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2
Q

How can sleepiness and lethargy be distinguished clinically?

A

Ask if after a long day, when sitting down to watch tv, would they fall asleep?

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3
Q

How is sleepiness assessed clinically?

A
  • Epworth sleepiness scale

- Functional e.g. do you doze watching tv, in the car etc.

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4
Q

Briefly outline respiratory control changes at sleep onset.

A
  • Loss of wakefulness drive to breath
  • Downregulation of control mechanisms e.g. respiratory reflexes, chemosensitivity, upper airway and resp muscle pump tone.
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5
Q

What are the cardinal symptoms of sleep apnoea?

A
  • Heavy snoring
  • Excessive daytime sleepiness
  • Witnessed apnoeas
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6
Q

What are the symptoms of sleep apnoea?

A 
Nocturnal: 
-unrefreshed sleep, 
-nocturnal choking,
 -nocturia.
Daytime: 
-morning headaches, 
-cognitive decrease,
-depression, 
-decreased libido, 
-HTN.
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7
Q

What are the RFx for OSA?

A
  • Age
  • Male gender
  • Obesity
  • Alcohol/sedatives
  • Upper airway morphology (inc nasal obstruction)
  • FHx
  • Chronic snoring
  • PCOS
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8
Q

How is OSA diagnosed?

A

-AHI >5 events per hours (events/total sleep time).
5-15 = mild
15-30 = moderate
>30 = severe

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9
Q

What is apnoea?

A

Complete cessation of airflow for 10s of longer regardless of oxygen desaturation

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10
Q

What is hypopnea?

A

30% or more reduction in airflow associated with +/- 3% oxygen desaturation, or alpha wave arousal from sleep

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11
Q

How is OSA managed?

A
  • Conservative Mx
  • CPAP
  • Oral appliances
  • Surgery
  • Other
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12
Q

What is the conservative mx of OSA?

A
  • Weight loss
  • Avoid alcohol/tobacco/sedatives
  • Body position
  • Treat nasal congestion
  • Treat medical disorders (e.g. hypothyroidism)
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13
Q

What are the contraindications to oral appliances for Mx of OSA?

A
  • Dentures or lack of teeth
  • Periodontal problems
  • TMJ disorder
  • severe nasal obstruction
  • severe hypoxia
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14
Q

What are the problems that may result from oral appliances to manage OSA?

A
  • Excessive salivation
  • Discomfort in teeth and jaw
  • Movement of teeth
  • TMJ dysfunction
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15
Q

What is central sleep apnoea?

A

Apnoeas or hypopnoeas caused by reduction in central respiratory drive

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16
Q

What is the aetiology of central sleep apnoea?

A
  • Cardiac failure (cheyne stokes respiration)
  • High altitude
  • CNS disorders e.g. CVA
  • Idiopathic
17
Q

What are the causes of hypoventilation?

A
  • Reduced CNS drive/suppression by drugs
  • NM disease: nerve paralysis (drugs, polio, Guillain-Barre), muscle weakness (drugs, MND, muscular dystrophy)
  • Chest wall deformity
  • Obesity
18
Q

Is hypoventilation worse during day or night?

A

All forms of hypoventilation are worse at night.

19
Q

What is primary insomnia?

A 
Disorder of hyperarousal: increased anxiety/HPA axis/hypertension/ANS activity.
Behaviorual contributions (e.g. anxiety, poor sleep hygiene)
20
Q

Which conditions contribute to insomnia?

A

OSA, circadian disorders, restless legs, psychiatric disorders, substance abuse, pain, urinary problems, meds.

21
Q

How is insomnia treated?

A
  • Manage comorbidities
  • Control stimuli
  • Restrict sleep
  • Relaxation
  • Biofeedback
  • Paradoxical intention
  • Sleep hygiene
  • Short term hypnotics
22
Q

What are the types of pharmacological management of insomnia?

A

-Benzos e.g. temazepam
-Non-benzos e.g. zolpidem
-Other: antidepressnats, valerian, anti-histamines.
Drugs should not be first line Mx.

23
Q

What is the epidemiology of restless legs syndrome?

A

5-15% of population. Increases with age.

24
Q

What are the causes of secondary restless legs syndrome?

A

Fe deficiency, renal failure, peripheral neuropathy, lumbosacral radiculopathy, pregnancy.

25
Q

What is periodic limb movement disorder?

A

Repeptitive movement of the limbs (usually legs) that occur during sleep. May be associated with arousal.
Associated with RLS.

26
Q

What are the treatments of PLM?

A

Non-pharm: Fe replacement, avoid aggravating factors.

Pharm: opioids, benzos, dopamine agonists.

27
Q

What is narcolepsy?

A

Disorder of sleep regulation with intrusion of REM sleep into wakefulness. Due to deficiency in neurotransmitter orexin.
AD with incomplete penetrance.

28
Q

Epidemiology of narcolepsy?

A

0.02% of people in W. Europe and N America.
M=F.
Onset: teens to 20s. May be after 40.

29
Q

What are the lifestyle mx for narcolepsy?

A
  • Avoid sleep schedule shifts
  • Avoid heavy meals and alcohol intake
  • Regular sleep time
  • Strategic naps
  • Career counselling
30
Q

What are the pharmacological treatments of narcolepsy?

A

Stimulants: modafinil, amphetamines

REM Suppression: SSRIs, tricyclis.

31
Q

What is REM behaviour disorder?

A

Predominately elderly men (0.5% prevalence). Dream enactment due to failure of REM atonia.
Acute: injury, CVA, SSRis.
Associated with neurodegenerative disorders also.
Responds to clonazepam.

32
Q

What is OSA?

A

OSA characterised by episodes of airway obstruction during sleep. Usually associated with O2 desat, arousal from sleep. Dx with AHI.

33
Q

What is the major regulator of breathing during sleep?

A

Chemical control is the major regulator of breathing during sleep.

34
Q

Ix of sleep disorders?

A
  • Keep sleep diary every morning for 1-2/52 (bedtime, sleep latency, total sleep time, awakenings, quality of sleep)
  • Exclude medical problems (FBE, TSH)
  • Refer for sleep study
35
Q

What are the RFx for insomnia?

A
  • Female
  • Older age
  • Unemployed / less educated
  • Separated/divorced
  • Medical comorbidities
  • Depression
  • Anxiety
  • Substance abuse
36
Q

What causes snoring?

A

Snoring results from soft tissue vibration at the back of the nose and throat due to turbulent airflow through narrowed nasal passages.

37
Q

What causes apnoea in OSA?

A

apnea results from upper airway obstruction due to collapse at the base of the tongue, soft palate with uvula and epiglottis.

Respiratory (17 decks)

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