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Respiratory > Sleep disorders > Flashcards

Sleep disorders Flashcards

1
Q

What is sleep?

A 
Nightly
Associated with dreaming
Important for function
Portal of entry is non-REM sleep
Associated with transient jerks
Defined electrically but not sensed
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2
Q

REM sleep

A 
Progress through non-REM sleep
REM cycles every 90-110 minutes
4-6 episodes per night\
Progressively longer
Associated with dreaming if woken
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3
Q

Sleep Duration?

A

6-8 hours/night

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4
Q

Upper airways disorders?

A

Snoring
Upper airway resistance syndrome
Hypopnoea
Apnoea

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5
Q

Snoring?

A 
Vibration of the pharyngeal walls
Noise >60dBA
Classified as Snores/hour
V common 
Increases with increased age, males, obesity and alcohol
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6
Q

Upper airways obstruction

A

Loss of tone in the upper airways which is actively controlled while awake resulting in obstruction of the upper airway

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7
Q

Mechanism of OSA?

A

Sleep onset –> loss of upper airways tone –> apnoea –> decreased O2, increased CO2 and decreased pH –> arousal–> resumption of airflow –> sleep

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8
Q

Predisposing factors?

A 
Drugs - EtOH, Smoking
Sleep deprivation
Large pharynx
Obesity
Tumours and tonsils
Male
Hypothyroidism
Acromegaly
Increased nasal resistance
Asthma
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9
Q

Arousal complications

A 
Sleep fragmentation
Unrefreshing sleep
Excessive somnolence
Personality disorders
Memory loss
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10
Q

Symptoms of OSA?

A 
Snoring
Reported apnoea
Restless sleep
Unrefreshing sleep
Nocturnal choking
Headache
Excessive daytime sleepiness
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11
Q

Assessment of sleepiness?

A

Epsworth sleepiness scale

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12
Q

Complications of OSA

A

Pulmonary vasoconstriction –> pulm HTN and right heart failure

Systemic vasoconstriction –> systemic HTN

Cardiac instability –> bradycardia

Erythropoiesis –> polycythaemia

HPA axis –> reduced sexual function

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13
Q

What does OSA look like on sleep study?

A

No O2 flow

Ongoing abdominal and thoracic movement

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14
Q

Severity of sleep apnoea?

A

Apnoea/hour index = AHI

Mild = AHI <20 = sats >85
Moderate = 20-40 = sats >80
Mod-Severe = 40-60 = sats >70
Severe = >60 = sats <70
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15
Q

What is obesity hypoventilation syndrome?

A

BMI >30 with PaCO2 >45 without other causes found

10-20% of patients with OSA but 90% have OSA

Worse outcomes in hospital

Managed with CPAP +/- BIPAP

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16
Q

Reasons to treat OSA?

A

Improved QOL
Reduced MVAs - improved with CPAP

Associated with:

  • Increased mortality
  • HTN
  • Increased Cardiovascular events
  • Stroke
  • Renal disease
  • Cancer
  • Metabolic syndrome
17
Q

Ways to treat OSA

A

WEIGHT LOSS
Avoid EtOH and sedatives
Treat nasal obstruction and asthma

CPAP
Mandibular splints
? surgical therapies

18
Q

Complications of CPAP

A 
Nasal stuffiness
Conjunctivitis
Bloating
Mask complications
COMPLIANCE
19
Q

Definition of Central sleep apnoea

A

Absence of breathing >10 seconds without abdominal or thoracic effort resulting in a change in O2 sats

20
Q

Pathophysiology of CSA

A

Instability of the respiratory controller
Hypocapnic threshold - PaCO2 below apnoeic threshold

Variants:
Sleep onset CSA
High altitude CSA

21
Q

Secondary CSA

A

Congestive HF –> cheyne strokes respiration
Metabolic disorders - acromegaly, hypothyroidism
Renal failure
Neuromuscular disorders
Long acting opioids esp. methadone

22
Q

Treatment for secondary CSA

A 
Drugs
Oxygen
CPAP
BIPAP
Adaptive servo-ventilation
23
Q

Idiopathic CSA

A

Abnormal central integration of awake and sleep stimuli
Associated with PHOX2B

AHI>5/hr with predominate central apnoeas
Improves during REM sleep

Treatment = diaphragm pacing

24
Q

Periodic limb movements

A

Intermittent repetitive flexion of limbs during sleep
Every 20-30 seconds

Doesn’t need treatment

25
Q

Restless legs syndrome definition

A

Neurological disorder resulting in compelling urge to move which worsens at night

2-15% of the population F>M
Increases with age

26
Q

Causes of RLS

A

Primary
Secondary:
- Iron deficiency
- Neurological disorders - spinal cord, peripheral nerve
- Pregnancy
- Uraemia
- Drug induced - TCAs, SSRI, Li, dopamine agonists, caffeine

27
Q

Treatment of RLS

A

Pregabalin

28
Q

Definition of Narcolepsy and cataplexy

A

0.05% of patients
Sleepiness and muscle weakness due to daytime intrusion of REM

Cataplexy = REM inhibition of muscles. usually emotion induced

29
Q

What happens during sleep in narcolepsy?

A 
Sleepy +++
Sleep paralysis
Increased dreaming
Hypnagogic hallucinations
PLMS 40%
30
Q

Diagnosis of narcolepsy

A

Cataplexy
Sleep latency < 8 minutes
>2 sleep onset REM periods

31
Q

Treatment of Narcolepsy

A

Cataplexy = TCA or SSRI

Sleepiness = dexamethasone, methylphenidate, modafinil

32
Q

Cause of Nacrolepsy and cataplexy?

A

Reduced CSF levels of hypocretin-1/orexin A

33
Q

Genetic association with narcolepsy and cateplexy?

A

HLA DQB1*0602

Respiratory (11 decks)

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