sleep disorders (see DM)

Question 1

what hormone is released during sleep and pathway does it act on

Answer 1

melatoninc - secreted from the pineal gland in response to darkness; acts on the reticular activating system (RAS) which projects to the hypothalamus

Question 2

what are the 5 sleep stages and what are the waves associated

Answer 2

1. wake - alpha waves
2. N1 - theta waves
3. N2 - theta waves w spindles and K complexes
4. N3 (deep sleep) - delta waves
5. REM - theta waves

Question 3

what are the 4 main breathing-related sleep disorders

Answer 3

obstructive sleep apnoea; obesity hypoventilation syndrome; central sleep apnoea; mixed obstructive/central apnoea

Question 4

what score is usually used for a measure of excessive day time sleepiness

Answer 4

epworth sleepiness scale - scores of 11+ is considered significant

Question 5

what conditions are assoicated with sleep apnoea (causative)

Answer 5

obesity; enlarged tonsils; acromegaly; hypothyroidism; cushing’s syndrome; micrognathia (small jaw); retrognathia (severe overbite)

Question 6

what is the mallampati score

Answer 6

an assessment to describe the relative size of the base of the tongue compared to the oropharyngeal opening in hopes of predicting the difficult airway
class 1- complete visualisation of the sofe palate
class 2 - complete visulation of the uvula
class 3 - visualisation of only the base of the uvula
class 4 - soft plate not visable at all

Question 7

what is apnoea

Answer 7

the cessation of breathing for 10s or more (Sp02 desaturation >4%)

Question 8

what is hypopnoea

Answer 8

reduction in airflow (nasal flow) by 50% or more - may not cause O2 desaturations

Question 9

how many hours of recorded apnoea/hypopneoa is abnormal

Answer 9

5+ hrs

Question 10

obstructive sleep apnoea classifications

Answer 10

mild: 5-15hrs
moderate: 15-30hrs
severe: >30hrs

Question 11

4 types of sleep aponoea monitoring

Answer 11

1. in lab, technician attended;
2. potable PSG;
   3.home sleep testing - only breathing recorded not actual sleep stages or disruption;
3. nocturnal oximetry -single/two variables (O2, HR, snoring etc.);

Question 12

6 main treatments for sleep apnoea

Answer 12

lifestyle modifications; weight reduciton; sleep hygiene; positional training; CPAP machine (must be used for minimum of 4hrs a night); mandibular advanement devices (not NHS liscenced yet)

Question 13

who does sleep apnoea have to be declared to

Answer 13

DVLA -> must show they are on treatment

Question 14

signs of obesity hypoventilation syndrome

Answer 14

morbid obesity; mean Sp02 <90% in sleep study; daytime CO2 retention/elevated HCO3

Question 15

what are 4 consquences of sleep disturbed breathing

Answer 15

systemic hypertension; atrial fibrillation; MI; pulmonary arterial hypertension

Question 16

why is there increased risk of MI/AF/PH with sleep apnoea

Answer 16

increased sympathetic stimulation

Question 17

the loss of tone in what muscles results in sleep apnoea

Answer 17

phayrnx and genioglossus muscle -> loss of tone results in narrowing of airway