Sleep medicine Flashcards
Components of Epworth sleepiness scale
sleeping while
- sitting/ reading
- sitting after lunch
- sitting talking
- watching TV
- sitting in public
- sitting talking to someone
- car passenger, car stopped in traffic,
rule of thumb for guessing CPAP needed?
10% of body weight
Benefits of CPAP
- 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
Options in OSA if not tolerating CPAP
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
how to tel OSA from CSA (central sleep apnoea)
Not trying to breath in CSA
- put a band around the chest, resistance measured (bucket handle stuff)
Test needed in narcolepsy
PSG, MSLT
Test needed in REM sleep disorder
(Video) PSG
AHI for OSA criteria
<5/hour = normal (for adults);
5–14.9/hour = mild OSA;
15–29.9/hour = moderate OSA;
≥30/hour = severe OSA
Test needed in Nocturnal Hypoventilatioin syndromes
Oximetry, capnography, ABGs
Criteria for OHS
elevated pCO2 (during or immediately after sleep)
PLUS
BMI>35
AND
no other reason for hypercarbia (e.g. COPD, neuromuscular)
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 to ask for restless leg syndrome?
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
Treatments for restless leg syndrome
stop/treat cause massage, stretching, yoga, distraction
Drugs:
PRN Levodopa if rare occurrence;
otherwise gabapentin,
ropinirole,
clonazepam,
tramadol, oxycodone, morphine, methadone
Ix restless leg syndrome
Iron studies, FBC, U&E, B12, folate, glucose, HbA1c, TFTS
Pathophys narcolepsy
Acquired deficiency of orexin (hypocretin) in key hypothalamic neurons
Narcolepsy definition/ types
A rare, incurable condition characterised by excessive daytime sleepiness, and usually cataplexy
Type 1 (Narcolepsy with Cataplexy)
Type 2 (Narcolepsy without Cataplexy)
Cataplexy
cataplexy - the sudden loss of motor power during wakefulness due to REM intrusion;
Treatments for narcolpsy
- 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
Cataplexy specific treatment
- 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;
REM behavious disorder and dementia
can predate dementia by 10+ years
Treatment doesn’t help
REM behavioural disorder pathophys
ssociated with the synucleinopathies (Lewy body dementia, PD, multisystem atrophy)
REM behavioural disorder treatment
Treatment: clonazepam usually highly effective and well tolerated; also melatonin
Sleepwalking name
somnambulism
(associated with HLA DQB1)
What is Klein Levin syndrome
- 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)
