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SLEEP 3320 > sleep + obesity > Flashcards

sleep + obesity Flashcards

1
Q

recommended TST for young adults is ________-

A

9+

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2
Q

Increased pain + depleted immune function is associated with sleep deprivation (T/F)

A

TRUE

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3
Q

Ghrelin is at its highest when ___________ during this time Leptin is ________

A

Ghrelin is at its highest when you are HUNGRY during this time Leptin is LOW (limited satiety)

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4
Q

Leptin is stored in ___________

A

Fat cells

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5
Q

Leptin and ghrellin are_______

A

HORMONES –> not NT’s

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6
Q

Relationship between obesity and the eating hormones is_________

A

have INCR ghrellin = more hungry

have DECR leptin = less satiated

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7
Q

Relationship b/w sleep and obesity may be due to

A

incr time awake = more time snacking
less energy expenditure bc been awake longer = tired
hormonal changes

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8
Q

Poor sleep quality ___________ glucose tolerance

A

REDUCES, become unable to cope with lower amounts bc become INSULIN RESISTANT

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9
Q

Sleep is related to diabetes through _________

A

Development of insulin resistance

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10
Q

The 2 classes of sleeping disorders are________

A

Sleep related BREATHING disorders

Sleep relating MOVEMENT disorders

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11
Q

The variants of sleep related BREATHING disorders are

A

Central sleep apnoea

Obstructive sleep apnoea

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12
Q

Apnoea means_______ the difference between obstructive and central

A

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

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13
Q

How is breathing measured for the purposes of sleep apnoea?

A

measuring PLEURAL PRESSURE - negative air pressure from the chest, indicates ow much the person is TRYING to sleep

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14
Q

in central sleep apnoea, it is expected that the pleural pressure will be ________

A

0 // absent

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15
Q

The major causes of central sleep apnoea is ________

A

idiopathic

narcotic induced

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16
Q

Elderly are at a greater risk of developing OSA

(T/F)

A

False - does not discriminate

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17
Q

The BIGGEST factor for OSA is

A

Obesity

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18
Q

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

A

C - alcohol + sedatives are assoc with OSA not stimulants

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19
Q

Describe the cycle of OSA aetiology

A

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

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20
Q

What is the body’s response after airways collapses?

A

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

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21
Q

What makes OSA harmful?

A

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

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22
Q

Hypercapnia refers to

A

INCREASE in CO2

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23
Q

Some major traits associated with OSA are_________

A

Anatomical trait - 44% cases small upper airway

Non-anatomical –> low arousal threshold, poor pharyngeal muscles, oversensitive ventilatory control system

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24
Q

Anatomical trait is a categorical feature

T/F

A

FALSE - is a dimension.
Stable airway - >5cm
Vulnerable - 2-5cm
Highly collapsible - < 2cm

25
Q

Those with a stable airway are less likely to have OSA (T/F)

A

Not necessarily, can have poor non anatomical features

26
Q

Collapsible airways is a cause of OSA

A

FALSE - not causal bc can have strong non anatomical features

27
Q

The key difference in OBESE patients with vs without OSA is that

A

obese WITH - have collapsible airway, poor phar muscles

obese WITHOUT - less collapsible, better muscles

28
Q

Obesity causes OSA (T/F)

A

False

29
Q

Prior to OSA diagnosis, obese patients often report ____________

A

Rapid weight gain in the last 12 months

30
Q

Describe the evidence suggesting that obesity + OSA have a bidirectional relationship

A

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

31
Q

Hyperphagia refers to

A

eating a lot more

32
Q

Describe how Leptin resistance is acquired

A

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

33
Q

What is the HYPOTHETICAL evidence suggesting OSA linked with higher energy expenditure

A

Constantly fighting against hpyoxia / hypercapnia + resulting sleep fragmentation associated with incr EE and arousal

34
Q

What may indicate that OSA reduces EE?

A

OSA causes disruptions to sleep –> more day time hypersomnia / fatigue

35
Q

The typical tmt for OSA is

A

Continuous Positive Air Pressure machine –> mechanically blowing air into lungs to prevent airway from collapsing

36
Q

What is a side effect of CPAP machien use?

A

Weight gain –> better sleep means less arousal= less EE, so weight loss must be recommended ALONGSIDE CPAP machine

37
Q

Ventilation in the body is maintained by regulating___________

A

negative feedback loop of O2 + CO2

38
Q

In central sleep apnoea, the controller and plant refer to

A

controller - chemoreceptors in the neck controlling o2/co2 in the blood
Plant - mechanics of respiration = lung volume

39
Q

Describe how ‘the loop’ regulates O2/CO2

A

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

40
Q

loop gain refers to

A

the RATIO of response : disruption

i.e. if ratio >1 dvpt of CSA, if ratio <1 , resume normal breathing

41
Q

Cheyne stokes respiration is caused by __________ whereas idiopathic central SA cased by_________

A

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)

42
Q

Central sleep apnoea is related to loop gain, which factors affect this

A

O2/CO2 sensitivity
lung volume
timing
inspiration some (breath size)

43
Q

Patients with chayne stokes respiration are likely to have it caused by _______ loop factors

A
  • Decreased 02/CO2 sensitivity –> heart failure

- longer timing (delay) –> longer to reach plant and restore breathing bc depleted ability to pump blood

44
Q

CPAP targets which loop factor?

A

lung volume –> increases O2 available to lungs

45
Q

Timing delays can be corrected for with

A

increased cardiac output

46
Q

The 3 major sleep movement disorders are__________

A

Parasomnias
Restless leg syndrome
Periodic limb movement disorder

47
Q

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

A

B - patient usually doesn’t realise its a problem = no diagnosis

48
Q

Some distinctions between restless leg syndrome and periodic limb movement is

A

RLS - more in WOMEN
RLS - is DISTRESSING
RLS - occurs during waking hours+ night, PLM at night

49
Q

RLS is often comorbid with

A

iron deficiency, pregnancy, kidney faily, antidepressants, antihistamines

50
Q

TMT for RLS is

A

meds, iron supplement

51
Q

RLS is worst at ________ time of day

A

evening –> night

52
Q

Parasomnias are associated with ________ sleep stage

A

ALL of them –> onset, during, offset

53
Q

Paasomnias, both REM // NREM are caused by_________

A

Erroneous activation of muscle tone + autonomic NS –> fight/flight response

54
Q

Sleep walking relates to _______ sleep and is most common in _____ population

A

NREM, SWS –> childen, may grow out of it

55
Q

Waking client with somnambulism ________ recommended

A

IS recommended or else may hurt self or others

56
Q

Doctor may offer ________to reduce sleep walking

A

Incr sleep hygiene bc exacerbated by sleep deprivation

57
Q

REM sleep behaviour disorder is likely assoc with______ sex

A

MEN aged 60-65

58
Q

REM sleep invovles acting out dramatic/dangerous dreams, this is due to failed _________

A

failed muscle atonia in REM sleep

59
Q

wife asks for help bc 58yo husband has violent movement during sleep, what is recommended?

A

removing dangerous objects to incr safety

SLEEP 3320 (8 decks)

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