Sleep Disorders Flashcards
What is restless leg syndrome?
Idiopathic - Affects younger people - At rest - Feels like electricity going through legs Secondary - Most common in lumbosacral disease - Burning sensation in legs - Happens later on in night
What are the changes in respiratory control at sleep onset?
Loss of wakeful drive to breathe and behavioural influences
Down-regulation of
- Respiratory reflexes
- Chemosensitivity
- Upper airway and respiratory pump muscle tone
What are the cardinal symptoms of sleep apnoea?
Heavy snoring
Excessive daytime somnolence
Witnessed apnoea
What are other nocturnal symptoms of sleep apnoea?
Disrupted/restless/un-refreshed sleep
Nocturnal choking and/or gasping
Nocturia
What are the daytime symptoms of sleep apnoea?
Headaches Memory/cognitive/concentration deficit Mood change - Depression - Irritability Sexual dysfunction - Decreased libido - Impotence
What is the most common cause of secondary hypertension?
Obstructive sleep apnoea
What are the risk factors for obstructive sleep apnoea?
Age Male Obesity Alcohol/sedatives Upper airway morphology, including nasal obstruction
How is obstructive sleep apnoea diagnosed?
Full polysomnography
>5 events/hour
How is apnoea defined when obstructive sleep apnoea is diagnosed?
Complete cessation of airflow for 10 sec/longer, regardless of O2 desaturation
How is hypopnoea defined when obstructive sleep apnoea is diagnosed?
30+% reduction in airflow associated with 3% O2 desaturation/alpha wave arousal from sleep
What is the management for obstructive sleep apnoea?
Conservative treatment
CPAP
Oral appliances
Surgery - major facial reconstruction
What is conservative treatment for obstructive sleep apnoea?
Weight loss Avoid - Alcohol - Tobacco - Sedatives Sleep on side Treat nasal congestion Treat medical disorders; eg: hypothyroidism
When is the use of oral appliances for the treatment of obstructive sleep apnoea indicated?
Snoring
Mild-moderate disease
Failed CPAP treatment
What are the contraindications for the use of oral appliances in the treatment of obstructive sleep apnoea?
Dentures/lack of teeth Periodontal problems TMJ disorder Severe nasal obstruction Severe hypoxia
What problems can oral appliances cause?
Excessive salivation
Discomfort in teeth and jaw
Movement of teeth
TMJ dysfunction
What is central sleep apnoea?
Apnoeas/hypopnoeas caused by reduction in central respiratory drive
What are the causes of central sleep apnoea?
Cardia failure > Cheyne-Stokes respiration
High altitude
CNS disorders
Idiopathic
How is central sleep apnoea due to heart failure managed?
Treat heart failure
CPAP
?O2
How is idiopathic central sleep apnoea treated?
?O2
?Non-invasive ventilation
What is chronic insomnia?
Subjective dissatisfaction with sleep quality/duration
Difficulty falling asleep at bedtime
Waking up in middle of night/too early in morning
Non-restorative/poor quality sleep
Associated daytime symptoms
Functional impairments
What disorders can contribute to insomnia?
Obstructive sleep apnoea Circadian disorders Restless legs Psychiatric disorders Substance abuse Pain Urinary problems Medications
What are some treatment strategies for insomnia?
Treat comorbid disorders Stimulus control therapy Sleep restriction Relaxation Biofeedback Paradoxical intention Sleep hygiene Short-term hypnotics
What are pharmacological options for the treatment of insomnia?
Benzodiazepines
Non-benzodiazepines
Others; eg: antidepressants
What is narcolepsy?
Disorder of sleep regulation
Deficiency in neurotransmitter orexin
Autosomal dominant with incomplete penetrance
