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Pathophysiology > Sleep Studies > Flashcards

Sleep Studies Flashcards

1
Q

Symptoms related to tiredness?

A
  • Morning headaches
  • low Libido,mood and concentration
  • Noctouria
  • Sleep onset and walking
  • Snoring history
  • Marital disharmony
  • RTA’s car crash
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2
Q

Physical exam?

A
  • Height
  • Weight
  • BMI
  • Neck circumpherence
  • BP
  • Cardiothoracic examination
  • ENT examination
  • Neurological examination
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3
Q

Meds causing fatigue or sleepiness?

A
  • Alcohol
  • Opiates
  • Beta-blockers
  • Antipsychotics
  • Anti-histamines
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4
Q

OSAHS

What is an Apnoea

What is a hypopnea

A

Apnoea = cessation of breathing for at least 10 seconds AND decrease in oxygen saturation <4%

Hypopnea = 50% reduction In tidal volume for at least 10s and decrease in oxygen saturation

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5
Q

What is OSA?

A
  • Cessation of airflow during sleep preventing air entering lungs
  • Needs to be longer than 10s to be significant
  • Leads to disrupted sleep
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6
Q

How do we assess?

A
  • Subjective sensation
  • ESS
  • Sleep diary
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7
Q

Risk factors?

A
  • Male
  • Elevated BMI
  • Smoker
  • Alcohol
  • Sedatives
  • Retrognathia
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8
Q

What occurs in normal individuals?

A
  • On inspiration negative pharyngeal pressure is generated
  • Potential for pharyngeal collapse and obstruction
  • Despite sleep-induced hypotonia increased contractility of pharyngeal muscles successfully counteracts this
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9
Q

What occurs in sleep apnoea?

A

Negative pressure generated on inspiration leads to airway collapse

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10
Q

Reasons for referral?

A
  • Snoring –> usually partner complaining
  • Excessive daytime somnolence
  • Fatigue and tired all the time
  • Work-related issues
  • FAQ come from ENT/bariatric/cardiology services
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11
Q

Consequences of OSAHS?

A

Pharyngeal narrowing

–>

Negative Intrathoracic Pressure

–>

Arousal

–>

  • Sleep disruption -> Sleepiness and Reduced QoL and RTA’s

OR

  • Blood pressure surge -> Stroke-> Heart attacks
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12
Q

Diagnostic criteria for OSAHS

A
  • Based on full poly
  • Mild 5-15 events
  • Moderate 16-30
  • Severe 30+
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13
Q

Conservative measures for OSA

A
  • Weight reduction
  • Stop Smoking
  • Avoidance of alcohol and sedatives
  • Treat nasal symptoms (eg nasal sprays)
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14
Q

Treatment of OSA

A
  • CPAP (5-10cm H2O)
  • Gold standard
  • Mandibular Advancement Splint (MAS)
  • Mild can use CPAP as second line therapy
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15
Q

Surgical treatment?

A
  • Tonsillectomy, polypectomy and septoplasty
  • UPPP
  • Bariatric Surgery
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16
Q

Define Narcolepsy

A

-Tetrad of symptoms

–> Excessive daytime somnolence

–> Cataplexy

–> Hypnagogic hallucinations

–> Sleep Paralysis

17
Q

What are the 3 types of Epidemiology?

A
  • With Cataplexy
  • Without Cataplexy (10-50%)
  • Due to medical condition (very rare)
18
Q

Clinical features of Narcolepsy?

A
  • Excessive daytime sleepiness and disturbed night-time sleep
  • Cataplexy is a sudden weakening of the muscles triggered by emotions
  • Hypnagogic hallucinations
  • Insomnia
19
Q

Two theories of narcolepsy:

A
  • Genetic

- Neurochemical (including orexin)

20
Q

Genetic link with Narcolepsy?

A
  • Increased risk in first degree relatives
  • Rare autosomal dominate inheritance
  • 90-100% of patients with narcolepsy and cataplexy have HLA gene
21
Q

What is HLA?

A

Human Leukocyte Antigens and they keep the immune system in check

22
Q

What investigations are there for narcolepsy?

A
  • Polysomnography

- MWT maintenance of wakefulness test

23
Q

What is the MSLT

A

Multiple Sleep Latency Test

Normal REM sleep latency is greater than 90mins

but in narcolepsy its 20 minutes

24
Q

Non pharmacological strategies for narcolepsy?

A
  • exercise to reduce obesity
  • Keeping a regular sleep wake cycle
  • Supportive social and psychological measures
  • timing of mealtimes and avoiding certain foods
  • strategic naps
25
Q

Pharmacological treatment for narcolepsy?

A
  • for Excessive daytime somnolence stimulants can be used such as modafinil
  • for cataplexy (REM suppression) SSRIS can be used
26
Q

Future treatments for Narcolepsy:

A
  • Hypocretin replacement
  • TNF replacement
  • Gene therapy

Pathophysiology (16 decks)

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