Sleep medicine

Question 1

Components of Epworth sleepiness scale

Answer 1

sleeping while
- sitting/ reading
- sitting after lunch
- sitting talking
- watching TV
- sitting in public
- sitting talking to someone
- car passenger, car stopped in traffic,

Question 2

rule of thumb for guessing CPAP needed?

Answer 2

10% of body weight

Question 3

Benefits of CPAP

Answer 3

• reduced respiratory events during sleep
• decrease in daytime sleepiness
• small improvements in BP
• decreased erectile dysfunction
• reduced risk of MVA
• improved QoL scores - if tolerate

Question 4

Options in OSA if not tolerating CPAP

Answer 4

Mandibular advancement devices

Tongue stabilising devices

enerally in males

Positional devices
- stop lying on your back

Hypoglossal pacing
- pacemaker that works of pleural pressure sensor, makes tongue move forwards

Tracheostomy

Bimandibular osteotomy
- just break their jaw

Question 5

how to tel OSA from CSA (central sleep apnoea)

Answer 5

Not trying to breath in CSA
- put a band around the chest, resistance measured (bucket handle stuff)

Question 6

Test needed in narcolepsy

Answer 6

PSG, MSLT

Question 7

Test needed in REM sleep disorder

Answer 7

(Video) PSG

Question 8

AHI for OSA criteria

Answer 8

<5/hour = normal (for adults);
5–14.9/hour = mild OSA;
15–29.9/hour = moderate OSA;
≥30/hour = severe OSA

Question 9

Test needed in Nocturnal Hypoventilatioin syndromes

Answer 9

Oximetry, capnography, ABGs

Question 10

Criteria for OHS

Answer 10

elevated pCO2 (during or immediately after sleep)

PLUS

BMI>35

AND
no other reason for hypercarbia (e.g. COPD, neuromuscular)

Question 11

Answer 11

REM associated hypoventilation

Here they are overweight and normally using non Resp muscles.
When paralysed in REM sleep they can’t use these and hypoventilate

Question 12

Question to ask for restless leg syndrome?

Answer 12

IRLSSG Consensus question: “When you try to relax in the evening or sleep at night, do you ever have unpleasant, restless feelings your legs that can be relieved by walking or movement?”

100% sensitivity, 96.8% specificity

Question 13

Treatments for restless leg syndrome

Answer 13

stop/treat cause massage, stretching, yoga, distraction

Drugs:
PRN Levodopa if rare occurrence;
otherwise gabapentin,
ropinirole,
clonazepam,
tramadol, oxycodone, morphine, methadone

Question 14

Ix restless leg syndrome

Answer 14

Iron studies, FBC, U&E, B12, folate, glucose, HbA1c, TFTS

Question 15

Pathophys narcolepsy

Answer 15

Acquired deficiency of orexin (hypocretin) in key hypothalamic neurons

Question 16

Narcolepsy definition/ types

Answer 16

A rare, incurable condition characterised by excessive daytime sleepiness, and usually cataplexy

Type 1 (Narcolepsy with Cataplexy)

Type 2 (Narcolepsy without Cataplexy)

Question 17

Cataplexy

Answer 17

cataplexy - the sudden loss of motor power during wakefulness due to REM intrusion;

Question 18

Treatments for narcolpsy

Answer 18

• dose limiting side effects inevitably occur before maximal potential treatment (dexamphetamine, methylphenidate, modafinil, solriamfetol, gamma hydroxybutyrate where available - good for cataplexy too; pitolisant - but prolongs QTc)
• Strategic napping and sleep hygiene can reduce sleep pressure

Question 19

Cataplexy specific treatment

Answer 19

• methylphenidate, gamma hydroxybutyrate and dexamphetamine both help with anrcolepsy/ cataplexy
• Anti-cataplectics include venlafaxine, clomipramine
• Sodium oxybate (sodium gamma hydroxybutyrate a.k.a. GHB) effective and well tolerated but tightly controlled - US, Aus but not NZ;

Modafinil treats narcolepsy but not cataplexy;

Question 20

REM behavious disorder and dementia

Answer 20

can predate dementia by 10+ years

Treatment doesn’t help

Question 21

REM behavioural disorder pathophys

Answer 21

ssociated with the synucleinopathies (Lewy body dementia, PD, multisystem atrophy)

Question 22

REM behavioural disorder treatment

Answer 22

Treatment: clonazepam usually highly effective and well tolerated; also melatonin

Question 23

Sleepwalking name

Answer 23

somnambulism

(associated with HLA DQB1)

Question 24

What is Klein Levin syndrome

Answer 24

• Periodic Hypersomnia
• Eating Disorder (excessive cravings)
• Hypersexuality (often males) and depression (often females) in an episodic manner
• Some data to suggest crossover with bipolar disorder (but limited response to lithium or carbamazepine)