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Neuro Clerkship > Sleep Disorders > Flashcards

Sleep Disorders Flashcards

1
Q

What are the three normal physiologic levels of consciousness?

A
  • Awake
  • NREM
  • REM
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2
Q

What two independent forces impact sleep?

A
  • Circadian rhythm

- Sleep debt

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3
Q

Sleep is normally entered via which stage of sleep?

What are three characteristics of this stage? (3)

A

NREM sleep:

  • Decrease muscle tone
  • Slow eye movements (+/- asynchronous)
  • Lose alpha rhythm; low voltage, mixed Hz
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4
Q

What does REM sleep look like on EEG?

What are two features of this stage of sleep?

A
  • EEG mimics Stage 1 NREM/ relaxed awake
  • Muscle Atonia w/ intermittent twitching
  • Rapid eye movement
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5
Q

How long is the typical sleep cycle?
How many stages are there?
What is the distribution of the stages?

A
  • Typical sleep cycle = 90 min
  • There are 4 stages + REM
  • NREM (slow wave sleep) predominates first 2/3 of the night; REM predominates last 1/3 of the night
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6
Q

Most of the night is spent in what stage of sleep?

A

Stage 2; may enter directly here if sleep deprived

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7
Q

With age, how does the distribution of sleep stages change?

A

Less delta (slow wave) sleep, especially in men; waves have decreased amplitude

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8
Q

K complexes and sleep spindles are more frequent in…

A

Children; adults have these but not as frequently

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9
Q

What are the three types of sleep apnea?

Describe each one.

A
  • Obstructive (effort to breathe, no air mvmt)
  • Central (no effort to breathe or air mvmt)
  • Mixed (initially NO effort to breathe; later effort without air mvmt)
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10
Q

How does the definition of obstructive sleep apnea differ between children and adults?
How is it the same?

A

BOTH: Greater than 90% DECREASE in airflow compared to baseline; associated with respiratory effort throughout entire period of decreased flow

Adults: Obstruction lasts 10 seconds or more
Kids: Obstruction lasts length of 2 breaths during baseline breathing

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11
Q

What are two common comorbidities associated with obstructive sleep apnea?

A
  • Nocturea (4-7 nightly trips to the bathroom)

- Nocturnal GERD

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12
Q

Describe the sleep of a patient with obstructive sleep apnea; what are some characteristic features (4)

A
  • Snoring loudly and disruptively
  • Periods of silence w gasps/ snorts between
  • Observed apneas in 75% of bed partners
  • Restless sleep in 50% patients
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13
Q

What are the daytime clinical sings and sx of obstructive sleep apnea? (5)

A
  • Daytime sleepiness/ fatigue
  • Slow reaction time
  • Personality changes (mood disorders)
  • Decreased sexual fxn
  • MORNING HA’s
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14
Q

How might obstructive sleep apnea present in a kid during the day?

A

Mimics ADHD; poor attention, impulse control, distractibility, irritability, daytime sleepiness

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15
Q

What are three behavioral treatments for obstructive sleep apnea?

A
  • Weight loss
  • Smoking cessation
  • Body positioning (use snore ball)
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16
Q

What are some devices used to treat obstructive sleep apnea? (3)

A
  • CPAP/BIPAP (continuous vs. bilevel air pressure)
  • Snore balls
  • Oral and nasal appliances
17
Q

One common complaint with the CPAP/BIPAP

A

Patients complain that at higher levels of pressure, they feel smothered because they can’t exhale

18
Q

List three types of meds that might be helpful in treating obstructive sleep apnea:

A
  • Nasal steroids (allergic patients)
  • Antidepressants
  • Stimulants to relieve daytime sleepiness (avoid this as long as possible)
19
Q

List 4 surgical treatments for obstructive sleep apnea:

A
  • Tonsillectomy/ Adenoidectomy (kids)
  • Uvuolopalatalpharyngioplasty
  • Mandibular advancement
  • Trachiostomy
20
Q

What type of prescription drugs can cause hypersomnolence?

A

Antiepileptics and Antipsychotics (DA inhibitors)

21
Q

Define Narcolepsy Type I (3)

A

Daily periods of irrepressible need to sleep/ daytime lapses for @ least THREE MONTHS

  • *PLUS one or both or the following:
    1. Cataplexy, mean sleep latency of under 8 min, 2+ SOREMPs (REM in 15 min)
    2. CSF hypocretin-1 LESS THAN 110 pg/mL
22
Q

Define cataplexy

A

Multiple episodes of brief BL, symmetrical loss of muscle tone w/ retained consciousness; typically associated with excitement, laughter, strong positive emotions

23
Q

Define Narcolepsy Type II (4)

A

Narcolepsy sans cataplexy:

  • Daily periods of irrepressible need to sleep/ daytime lapses for @ least THREE MONTHS
  • Mean sleep latency of under 8 min, 2+ SOREMPs (REM in 15 min)
  • Unmeasured hypocretin 1 or MORE than 110pg/mL
  • No other explanation for hypersomnolence etc.
24
Q

What are hypocretin/ orexin 1 and 2?
What is the function of hypocretin 1?
What two factors influence its production?

A

Homologous neuropeptides produced by cells in perifornical area of posterior hypothalamus

Hypocretin 1 stimulates wakefulness and suppresses REM sleep; levels fluctuate over 24 hour period in response to circadian rhythm and increased sleep debt

25
Q

What is the narcoleptic tetrad?

A
  • Sleep attacks
  • Sleep paralysis
  • Hypnagogic/hypnopompic hallucinations
  • Cataplexy
    (Last 3 are REM associated pathology)
26
Q

List 3 other associated features with narcolepsy:

A
  • Disrupted sleep
  • Obesity
  • Anxiety/ panic attacks
27
Q

How do we evaluate for narcolepsy dx?

A

Overnight polysomogram w/ MSLT and SOREMPs

**Will document adequate sleep or sleep latency

28
Q

What are some behavioral modifications to treat narcolepsy (3)?

A
  • Adequate nighttime sleep
  • Daily naps (decrease need for meds)
  • Physical activity
29
Q

Which meds treat daytime sleepiness associated with narcolepsy?

Cataplexy?

A

Sleepiness: stimulants; modafanil, amphetamines, atomoxetine

Cataplexy: sodium oxybate and SSRIs

30
Q

REM sleep behavior disorder is more common in what age group?

Describe the difference between acute and chronic.

A

More common in elderly; patients act out their dreams

Acute: Toxic/ metabolic (i.e. ETOH or BDZ withdrawal)

Chronic: Idiopathic or associated with neurological disease (EPS, narcolepsy, NPH, mitochondrial disorder)

31
Q

During which stages of sleep are the non-rem parasomnias most common?

Which age group gets them?
Is there a familial component?

What are some triggers (4)?

A
  • Occur during slow wave (stages 3, 4) sleep; more common during first 1/3 of night
  • Kids get them more than adults; strong family hx

Triggers: ^ tiredness, arousals, unfamiliar places, ETOH

32
Q

Majority of normal sleep is spent in stage…

A

2

33
Q

Most common complaint of obstructive sleep apnea patients is…

A

Daytime sleepiness

Neuro Clerkship (13 decks)

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