Sleep (Knowles) Flashcards
What are the 3 normal physiologic levels of consciousness?
What is the “reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment” ?
- Awake
- NREM sleep
- REM sleep
- the Behavioral definition of sleep
What are the 2 independent forces that impact sleep?
- Circadian rhythm
- Sleep debt
NREM sleep:
- Divided into ___ stages
- During normal sleep onset into NREM sleep -
- _____ in muscle tone
- slow eye movements, possibly ______
- Loss of ______, low voltage mixed frequency
- What are the stages differentiated by?
- 4 stages
- Decrease
- asynchronous
- classic alpha rhythm
- Presence of electrographic phenomenon - degree of high voltage slow wave activity
REM sleep:
- Electrographic background similar to _____ sleep or ______
- Muscle _____, with intermittent twitches seen
- eyes:
- stage 1 NREM, or relaxed awake (loss of posterior dominant rhythm)
- Atonia
- Rapid eye movements
Sleep cycle:
- Sleep is entered via the _____
- Cycles between NREM and REM on average are ___ minute cycles
- _____ predominates for the first 2/3 of the night
- _____ predominates for the last 1/3
Classic distribution: 1: 2-5%, 2: 45-55%, 3: 3-8%, 4: 10-15%, REM: 20-25%
- NREM sleep
- 90 minutes
- NREM
- REM
N2 is the MAJORITY
Apnea:
- _____: no effort to breathe, no air movement
- _____: Effort to breathe, no air movement
- _____: Initially no effort to breathe, but then makes respiratory effort without air movement
- Central
- Obstructive
- Mixed
What is the difference between adult and child definitions of pbstructive sleep apnea?
Both have > 90% decrease in airflow compared to pre-event baseline; associated with continued/increased respiratory effort throughout the entire episode of absent airflow
- Adults: lasts 10 seconds or greater
- Child: Lasts the length of 2 breaths during baseline breathing
What are some clinical signs and symptoms of obstructive sleep apnea? (5)
(Observed apneas - by 75% of bed partners)
- Loud, disruptive snoring
- Periods of silence with gasps/snorts (snore arousal)
- Restless sleep (50%)
- Nocturia (28%, 4-7 nightly trips to the bathroom)
- Nocturnal GERD
OSA:
- Most common complaint is ______
- ___ of reaction time
- Personality changes - including:
- ______ libido - impotence, ED, *** reversible
- ~1/2 report morning/nocturnal _____
- In children, more likely to report poor ____, ____, ____, ____ than daytime sleepiness
- Daytime sleepiness/fatigue
- Slowing
- aggressiveness, irritability, anxiety, depression
- Decreased
- Headaches
- attention, impulse control, distractibility, irritability
What are some treatment options for OSA?
- Non-surgical
- Behavioral? (3)
- ___/____
- Devices? (3)
- Medications?
- Weight loss, smoking cessation, body positioning
- CPAP/BiPAP
- Snore balls, oral appliances, nasal dilators
- Nasal steroids, antidepressants, stimulants
What are some surgical treatment options for OSA?
- ?
- ?
- ?
- ?
- Tonsillectomy/adenoidectomy
- UPP
- Mandibular advancement
- Tracheostomy
Hypersomnolence: is secondary to:
- ______ sleep (OSAS, PLMD)
- ______ sleep
- ______ (recreational, prescription)
- _______ effects - sleep phase disorders
- ____/____ hypersomnolence
- Other systemic disease (hypothyroidism)
- Disrupted
- Inadequate
- Drugs
- Chronobiologic
- Narcolepsy/idiopathic
Diagnosis:
- Excessive daytime sleepiness with abnormal REM sleep phenomenon
- Presumed 2 hit hypothesis - genetic predisposition with environmental trigger
- Changed classification:
- type 1 - with cataplexy
- type 2 - without cataplexy
Narcolepsy
What type?
- Criteria A and B must be met:
- A: The patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least 3 months
- B: The present of 1 or both of the following:
- _____ and a mean sleep latency of < or = 8 minutes and 2+ sleep onset REM periods on an MSLT performed according to standard techniques - A SOREMP within 15 min of sleep onset - on the preceding nocturnal polysomnogram may replace one of the SOREMPs on the MSLT
- CSF hypocretin-1 concentration, measured by immunoreactivity is either < or = 100 pg/mL or <1/3 of mean values obtained in normal subjects with the same standardized assay
Type 1: Narcolepsy with Cataplexy
- Cataplexy
What is defined as more than _____ episode of generally brief (<2 mins) usually ____ symmetrical sudden loss of muscle tone with retained consciousness?
- Precipitated by strong emotions - usually +, some with laughter
- Transient reversible loss of DTRs
- In children: may present close to disease onset as facial hypotonia with droopy eyelids, mouth opening, protruded tongue, gait disturbance, facial/masticatory movements may occur (reward is a common precipitant)
Cataplexy
- one
- bilaterally
