Sleep Disorders Flashcards
What are the stages of sleep?
4 stages of non-rapid eye movement
Rem Sleep
How long does each cycle of sleep last?
100 mins
where non-rem predominates the earlier in the night
Rem sleep later
What is S in stopbang?
Snoring loudly?
What is T in stopbang?
Tired during day?
What is O in stopbang?
Observed apnea?
What is P in stop bang?
Pressure (elevated blood pressure)?
What is B in stop bang?
BMI more than 35
What is A in stop bang?
A Age more than 50
What is N in stop bang?
Neck circumference > 40cm
What is G in stopbang?
G for Gender male
What are cardiopulmonary consequences of OSA?
Nocturnal arrhythmia Systemic and pulmonary Hypertension R or L ventricular failure Myocardial infarction, Stroke Elevated levels of C-reactive protein, homosteine and proinflammatory cytokines
What are neurological consequences of OSA?
Excessive daytime sleepiness Diminished quality of life Adverse personality changes MVAs Stroke Memory
What can happen if a patient with COPD also has OSA?
Significant hypercapnea, hypoxemia
Exacerbate underlying condition
Pts have worse prognosis than COPD w/o OSA
What is Central Sleep Apnea?
Apnea during sleep due to a loss of ventilatory drive
Pathophysiology poorly understood
What kind of breathing pattern would you observe in central Sleep apnea?
Often, patients have periodic breathing – episodes of hyperventilation followed apnea
Cheyne Stokes respiration is the extreme of this
How can you treat central sleep apnea?
use treatments that treat heart failure
this can reduce heart failure
CPAP
Oxygen
What group of patients is likely to have central sleep apnea?
CHF
What are types of sleep disorders?
Apnea – Obstructive or Central Insomnia (psychophysiologic/perimenopausal ) Circadian rhythm disorders Sleep walking, nightmares Sleep paralysis
What happens to our body in normal sleep?
Marked reduction in muscle tone
-Loss of accessory muscle use
The bodies metabolic rate slows
A decreased amount of CO2 is produced
Brainstem input to respiratory muscle drive is diminished
Chemoreceptor response is reduced
-Hypercapnic response is reduced by 20-50%
What happens to our Ve in normal sleep?
Hypoventilation and hypercarbia in normal sleep
In Non-REM sleep, our minute ventilation is 0.5 – 1.5L lower
In REM sleep, minute ventilation is ~1.5L lower
What is defined as apnea period?
complete cessation of flow for more than 10 seconds
How do you diagnose OSA or CSA?
Medical History and Sleep questionnaires
Polysomnography (PSG) - Gold Standard
-in home (portable) or in LAB
Nocturnal Pulse Oximetry Screening
What are the main sensors for a PSG?
Electroencephalogram –EEG - BRAIN
Electro-oculogram - EOG, - EYES
Chin electromyogram – EMG - CHIN
EKG - HEART
What is the AHI and its ranges?
Total number of apneas and hypopneas divided by the number of hours of sleep
Diagnosis: more than 5 with symptoms, or more than 15 with or without symptoms
Mild: 5-20 / hr
Mod: 20-40 / hr
Severe:>40 / hr
What is RERA?
The average number of episodes of apnea, hypopnea, and respiratory event-related arousals (RERA) per hour of sleep
Mild: 5-15 / hr
Moderate: 15-30 / hr
Severe: >40 / hr
What are the Types of sleep study?
Type 1 - PSG
Type 2 - COMP - portable PSG
Type 3 - modified portable psg
Type 4 - least - only 2 monitors
What are non-medical treatments to OSA?
Loss of weight
Avoidance of alcohol, sedatives and sleep deprivation
-Alcohol decreases the threshold for arousal, thus episodes are longer and worse
Positional therapy
- The tennis ball cure
- Side positioning
What are pressures for CPAP with OSA?
7-12 commonly used
Determined by a CPAP titration study.
