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Hugh's MD2 Intersession 3 > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

What is the function of hypocretin?

A

Controls junction between sleep and wake and non-REM and REM sleep

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2
Q

When do you have most of your REM sleep?

A

Later in the sleep

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3
Q

What proportion of sleep is REM in adults?

A

15%

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4
Q

What is the Epworth sleepiness scale?

A

Subjective measure of a patient’s propensity to sleep

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5
Q

How does sleepiness and tiredness/lethargy differ?

A

Sleepiness is the ability to fall asleep very easily cf. general fatigue

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6
Q

What is the most common cause of daytime sleepiness?

A

Lifestyle - not enough sleep

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7
Q

What are some DDx for daytime sleepiness?

A

Lifestyle

Drugs/Alcohol

Sleep breathing disorder

Restless leg syndrome

Insomnia

Narcolepsy

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8
Q

What is an elevated Epworth sleepiness scale source? What is the most common cause?

A

>10

Depression

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9
Q

What is the major control of breathing during sleep?

A

Chemical control

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10
Q

What are the causes of central sleep apnoea?

A

Cardiac failure (Cheynes Stokes respiration)

High altitude

CNS disorder

Idiopathic

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11
Q

What is the prevalence of OSA in males and females respectively?

A

24% of males

8% of females

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12
Q

What are the cardinal symptoms of OSA?

A

Heavy snoring

Daytime somnolence

Witnessed apnoea

Unrefreshed sleep

Nocturia

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13
Q

What are some consequences of OSA?

A

Neuro

  • Excessive sleepiness
  • Psychologic problems
  • Stroke
  • Dementia
  • ADHD

Cardio-Respiratory

  • HTN
  • Cor pulmonale
  • MI
  • Arrhythmias/sudden death
  • Polycythaemia
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14
Q

What are some risk factors for OSA?

A

Age

Male

Obesity

Alcohol/Sedatives

Upper airway morphology

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15
Q

What is a significant desaturation during an apnoea?

A

>4%

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16
Q

How is OSA diagnosed?

A

Number of events per hour (apnoea hypopnoea index)

5-15: mild

15-30: moderate

>30: severe

17
Q

What is the definition of an apnoea?

A

Complete cessation of airflow for 10s or longer

18
Q

What is an hypopnoea?

A

30% or more reduction in airflow associated with >3% O2 desaturation or an alpha wave arousal from sleep

19
Q

How do you assess whether some with diagnosed OSA needs treatment?

A

Change of long term adverse complications

Clinical picture

Social factors

20
Q

When is surgery used in OSA?

A

Children mainly

Rarely adults

21
Q

What are some conservative management options for OSA?

A

Weight loss

Avoid alcohol

Body position

Relieve nasal congestion

22
Q

How does CPAP work?

A

Continuous positive pressure to open up airways

23
Q

What is the most common second line therapy for OSA?

A

Mandibular advancement splint

24
Q

Why does Cheynes stokes breathing develop in cardiac failure?

A

It’s more efficient

25
Q

What some causes of insomnia?

A

OSA

Disordered circadian rhythms

Restless leg syndrome

Psychiatric disorders

Substance abuse

Drugs

Pain

Urinary problems

26
Q

What are the best interventions for insomnia?

A

Cognitive-Behavioural therapies

27
Q

What is the treatment for restless syndrome?

A

Dopamine agonists

28
Q

What causes narcoplepsy?

A

Deficiency in orexin or hypocretin

29
Q

How is narcolepsy diagnosed?

A

Multiple sleep latency test

30
Q

How is narcolepsy treated?

A

Behavioural changes

Modafinil

Dexamphetamine

31
Q

What are some causes of hypoventilation?

A

Reduced central respiratory activity

Neuromuscular disorder

Obesity

Chest wall deformity

Increased demand

32
Q

What pharmacological therapies are used in insomnia?

A

Benzodiazepines

Antidepressant

Anti-histamines

33
Q

What is restless syndrome? What causes it?

A

Neurological movement disorder with almost an irresistible urge to move the legs, that are not painful but are distinctly bothersome

Primary

Secondary - Fe deficiency, peripheral neuropathy, Parkinson’s, renal failure, lumbosacral reticulopathy, pregnancy

34
Q

How are narcolepsy treated?

A

Lifestyle - consistent sleep pattern

  • Avoid big meals/alcohol
  • Naps

Stimulants - modafinal, amphetamines

REM suppressing drugs - SSRI’s, tricyclics

Hugh's MD2 Intersession 3 (8 decks)

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