sleep + obesity

Question 1

recommended TST for young adults is ________-

Answer 1

9+

Question 2

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

Answer 2

TRUE

Question 3

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

Answer 3

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

Question 4

Leptin is stored in ___________

Answer 4

Fat cells

Question 5

Leptin and ghrellin are_______

Answer 5

HORMONES –> not NT’s

Question 6

Relationship between obesity and the eating hormones is_________

Answer 6

have INCR ghrellin = more hungry

have DECR leptin = less satiated

Question 7

Relationship b/w sleep and obesity may be due to

Answer 7

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

Question 8

Poor sleep quality ___________ glucose tolerance

Answer 8

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

Question 9

Sleep is related to diabetes through _________

Answer 9

Development of insulin resistance

Question 10

The 2 classes of sleeping disorders are________

Answer 10

Sleep related BREATHING disorders

Sleep relating MOVEMENT disorders

Question 11

The variants of sleep related BREATHING disorders are

Answer 11

Central sleep apnoea

Obstructive sleep apnoea

Question 12

Apnoea means_______ the difference between obstructive and central

Answer 12

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

Question 13

How is breathing measured for the purposes of sleep apnoea?

Answer 13

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

Question 14

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

Answer 14

0 // absent

Question 15

The major causes of central sleep apnoea is ________

Answer 15

idiopathic

narcotic induced

Question 16

Elderly are at a greater risk of developing OSA

(T/F)

Answer 16

False - does not discriminate

Question 17

The BIGGEST factor for OSA is

Answer 17

Obesity

Question 18

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

Answer 18

C - alcohol + sedatives are assoc with OSA not stimulants

Question 19

Describe the cycle of OSA aetiology

Answer 19

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

Question 20

What is the body’s response after airways collapses?

Answer 20

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

Question 21

What makes OSA harmful?

Answer 21

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

Question 22

Hypercapnia refers to

Answer 22

INCREASE in CO2

Question 23

Some major traits associated with OSA are_________

Answer 23

Anatomical trait - 44% cases small upper airway

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

Question 24

Anatomical trait is a categorical feature

T/F

Answer 24

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

Question 25

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

Answer 25

Not necessarily, can have poor non anatomical features

Question 26

Collapsible airways is a cause of OSA

Answer 26

FALSE - not causal bc can have strong non anatomical features

Question 27

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

Answer 27

obese WITH - have collapsible airway, poor phar muscles | obese WITHOUT - less collapsible, better muscles

Question 28

Obesity causes OSA (T/F)

Answer 28

False

Question 29

Prior to OSA diagnosis, obese patients often report ____________

Answer 29

Rapid weight gain in the last 12 months

Question 30

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

Answer 30

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

Question 31

Hyperphagia refers to

Answer 31

eating a lot more

Question 32

Describe how Leptin resistance is acquired

Answer 32

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

Question 33

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

Answer 33

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

Question 34

What may indicate that OSA reduces EE?

Answer 34

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

Question 35

The typical tmt for OSA is

Answer 35

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

Question 36

What is a side effect of CPAP machien use?

Answer 36

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

Question 37

Ventilation in the body is maintained by regulating___________

Answer 37

negative feedback loop of O2 + CO2

Question 38

In central sleep apnoea, the controller and plant refer to

Answer 38

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

Question 39

Describe how 'the loop' regulates O2/CO2

Answer 39

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

Question 40

loop gain refers to

Answer 40

the RATIO of response : disruption | i.e. if ratio >1 dvpt of CSA, if ratio <1 , resume normal breathing

Question 41

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

Answer 41

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)

Question 42

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

Answer 42

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

Question 43

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

Answer 43

- Decreased 02/CO2 sensitivity --> heart failure | - longer timing (delay) --> longer to reach plant and restore breathing bc depleted ability to pump blood

Question 44

CPAP targets which loop factor?

Answer 44

lung volume --> increases O2 available to lungs

Question 45

Timing delays can be corrected for with

Answer 45

increased cardiac output

Question 46

The 3 major sleep movement disorders are__________

Answer 46

Parasomnias Restless leg syndrome Periodic limb movement disorder

Question 47

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

Answer 47

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

Question 48

Some distinctions between restless leg syndrome and periodic limb movement is

Answer 48

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

Question 49

RLS is often comorbid with

Answer 49

iron deficiency, pregnancy, kidney faily, antidepressants, antihistamines

Question 50

TMT for RLS is

Answer 50

meds, iron supplement

Question 51

RLS is worst at ________ time of day

Answer 51

evening --> night

Question 52

Parasomnias are associated with ________ sleep stage

Answer 52

ALL of them --> onset, during, offset

Question 53

Paasomnias, both REM // NREM are caused by_________

Answer 53

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

Question 54

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

Answer 54

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

Question 55

Waking client with somnambulism ________ recommended

Answer 55

IS recommended or else may hurt self or others

Question 56

Doctor may offer ________to reduce sleep walking

Answer 56

Incr sleep hygiene bc exacerbated by sleep deprivation

Question 57

REM sleep behaviour disorder is likely assoc with______ sex

Answer 57

MEN aged 60-65

Question 58

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

Answer 58

failed muscle atonia in REM sleep

Question 59

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

Answer 59

removing dangerous objects to incr safety