sleep + obesity Flashcards
recommended TST for young adults is ________-
9+
Increased pain + depleted immune function is associated with sleep deprivation (T/F)
TRUE
Ghrelin is at its highest when ___________ during this time Leptin is ________
Ghrelin is at its highest when you are HUNGRY during this time Leptin is LOW (limited satiety)
Leptin is stored in ___________
Fat cells
Leptin and ghrellin are_______
HORMONES –> not NT’s
Relationship between obesity and the eating hormones is_________
have INCR ghrellin = more hungry
have DECR leptin = less satiated
Relationship b/w sleep and obesity may be due to
incr time awake = more time snacking
less energy expenditure bc been awake longer = tired
hormonal changes
Poor sleep quality ___________ glucose tolerance
REDUCES, become unable to cope with lower amounts bc become INSULIN RESISTANT
Sleep is related to diabetes through _________
Development of insulin resistance
The 2 classes of sleeping disorders are________
Sleep related BREATHING disorders
Sleep relating MOVEMENT disorders
The variants of sleep related BREATHING disorders are
Central sleep apnoea
Obstructive sleep apnoea
Apnoea means_______ the difference between obstructive and central
cessation of breathing.
Obstructive - there is a physiological barrier to regualr breathing, CNS still attempts to breathe
Central - ventilatory depression, CNS stops TRYING to breathe
How is breathing measured for the purposes of sleep apnoea?
measuring PLEURAL PRESSURE - negative air pressure from the chest, indicates ow much the person is TRYING to sleep
in central sleep apnoea, it is expected that the pleural pressure will be ________
0 // absent
The major causes of central sleep apnoea is ________
idiopathic
narcotic induced
Elderly are at a greater risk of developing OSA
(T/F)
False - does not discriminate
The BIGGEST factor for OSA is
Obesity
Which is NOT risk factor for OSA?
a) male gender
b) increasing age
c) stimulant use
d) anatomically different upper airway
e) family history of OSA
C - alcohol + sedatives are assoc with OSA not stimulants
Describe the cycle of OSA aetiology
1) person has predisposition with poor anatomy - narror airway
2) when we are asleep pharyngeal dilators (muscles) relax
3) we have negative compensatory air pressure –> when we are asleep muscles relax = LOSS OF NEG PRESSURE
4) airway collapse
What is the body’s response after airways collapses?
1) Hypoxia + hypocapnia (LOSE O2 + GAIN CO2)
2) ^^^ causes motor arousal, body keeps trying to breathe
3) when this is NOT resolved –> AROUSAL (wake up)
4) arousal of pharyngeal dilators = breathe
What makes OSA harmful?
1) Constant waking + hypoxia/capnia = incr symp NS activity –> strain on cardiovasc system
2) cardiovasc strain - elevated risk of hypertension, arrhthmia, heart failure, stroke, infarct
3) neurocognitive strain - waking hypersomnia (exc day time sleepiness) decr QOL, MDD, incr risk of car accident
Hypercapnia refers to
INCREASE in CO2
Some major traits associated with OSA are_________
Anatomical trait - 44% cases small upper airway
Non-anatomical –> low arousal threshold, poor pharyngeal muscles, oversensitive ventilatory control system
Anatomical trait is a categorical feature
T/F
FALSE - is a dimension.
Stable airway - >5cm
Vulnerable - 2-5cm
Highly collapsible - < 2cm
Those with a stable airway are less likely to have OSA (T/F)
Not necessarily, can have poor non anatomical features
Collapsible airways is a cause of OSA
FALSE - not causal bc can have strong non anatomical features
The key difference in OBESE patients with vs without OSA is that
obese WITH - have collapsible airway, poor phar muscles
obese WITHOUT - less collapsible, better muscles
Obesity causes OSA (T/F)
False
Prior to OSA diagnosis, obese patients often report ____________
Rapid weight gain in the last 12 months
Describe the evidence suggesting that obesity + OSA have a bidirectional relationship
1) patients at risk for OSA have a higher dietary consumption than obese people WITHOUT OSA
- -> OSA may drive obesity
2) OSA causes incr in sleep fragmentation –> leads to hyperphagia
3) Less TST = preference for high energy food (more cal)
4) Less TST = stress,change in eating may cause diff eating behaviours
5) sleep curtialment - change in hormone levels
Hyperphagia refers to
eating a lot more
Describe how Leptin resistance is acquired
gain more weight –> more fat cells –> leptin stored in fat cells –> body gets inflamed –> body not used to this much leptin, brain stops recognising it, acts as though it is low –> incorrect hormonal signalling –> brain sense LOW LEPTIN –> lack of satiety, eat more
What is the HYPOTHETICAL evidence suggesting OSA linked with higher energy expenditure
Constantly fighting against hpyoxia / hypercapnia + resulting sleep fragmentation associated with incr EE and arousal
What may indicate that OSA reduces EE?
OSA causes disruptions to sleep –> more day time hypersomnia / fatigue
The typical tmt for OSA is
Continuous Positive Air Pressure machine –> mechanically blowing air into lungs to prevent airway from collapsing
What is a side effect of CPAP machien use?
Weight gain –> better sleep means less arousal= less EE, so weight loss must be recommended ALONGSIDE CPAP machine
Ventilation in the body is maintained by regulating___________
negative feedback loop of O2 + CO2
In central sleep apnoea, the controller and plant refer to
controller - chemoreceptors in the neck controlling o2/co2 in the blood
Plant - mechanics of respiration = lung volume
Describe how ‘the loop’ regulates O2/CO2
1) disturbance to normal breathing i.e. deep sigh = incr O2, LESS co2
2) signal goes to chemoreceptors (controller) that CO2 low
3) controller sends signal to lungs (plant) to lower breathing amplitude to normalise CO2
loop gain refers to
the RATIO of response : disruption
i.e. if ratio >1 dvpt of CSA, if ratio <1 , resume normal breathing
Cheyne stokes respiration is caused by __________ whereas idiopathic central SA cased by_________
seen in HEART FAILURE patients –> inability to pump sufficient blood around body
idiopathic - no known cause, just have periods of breathing then PERIODS of apnoea (not continuous)
Central sleep apnoea is related to loop gain, which factors affect this
O2/CO2 sensitivity
lung volume
timing
inspiration some (breath size)
Patients with chayne stokes respiration are likely to have it caused by _______ loop factors
- Decreased 02/CO2 sensitivity –> heart failure
- longer timing (delay) –> longer to reach plant and restore breathing bc depleted ability to pump blood
CPAP targets which loop factor?
lung volume –> increases O2 available to lungs
Timing delays can be corrected for with
increased cardiac output
The 3 major sleep movement disorders are__________
Parasomnias
Restless leg syndrome
Periodic limb movement disorder
Which is INCORRECT regarding periodic limb movement a) occur every 20-40 sec
b) are distressing to the patients
c) usually it does not cause arousal to patient
d) often related to leg movements
B - patient usually doesn’t realise its a problem = no diagnosis
Some distinctions between restless leg syndrome and periodic limb movement is
RLS - more in WOMEN
RLS - is DISTRESSING
RLS - occurs during waking hours+ night, PLM at night
RLS is often comorbid with
iron deficiency, pregnancy, kidney faily, antidepressants, antihistamines
TMT for RLS is
meds, iron supplement
RLS is worst at ________ time of day
evening –> night
Parasomnias are associated with ________ sleep stage
ALL of them –> onset, during, offset
Paasomnias, both REM // NREM are caused by_________
Erroneous activation of muscle tone + autonomic NS –> fight/flight response
Sleep walking relates to _______ sleep and is most common in _____ population
NREM, SWS –> childen, may grow out of it
Waking client with somnambulism ________ recommended
IS recommended or else may hurt self or others
Doctor may offer ________to reduce sleep walking
Incr sleep hygiene bc exacerbated by sleep deprivation
REM sleep behaviour disorder is likely assoc with______ sex
MEN aged 60-65
REM sleep invovles acting out dramatic/dangerous dreams, this is due to failed _________
failed muscle atonia in REM sleep
wife asks for help bc 58yo husband has violent movement during sleep, what is recommended?
removing dangerous objects to incr safety
