Sleep-Wake Disorders

Question 1

What is a polysomnography?

Answer 1

EEG, EOG, and EMG along with several other measurements such as snore, nasal pressure, oximetry, EKG etc etc.

Question 2

What is a multiple sleep latency test?

Answer 2

Standardized test to evaluate the degree of daytime sleepiness, with four or five PSG studies during a day

Question 3

What is actigraphy?

Answer 3

Measurement of rest/activity patterns throughout body movements, which are strongly correlated with sleep-wake states

Question 4

What is narcolepsy?

Answer 4

Episodes of extreme daytime sleepiness. Also presents with cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations

Question 5

What is the difference between narcolepsy type 1 and 2?

Answer 5

Type 1 is characterized by cataplexy or by lower CSF hypocretin-1. Type 2 has no cataplexy or low CSF hypocretin-1

Question 6

What are 2 key PSG findings in narcolepsy patients?

Answer 6

Short sleep latency on PSG/MSLT and sleep onset REM

Question 7

What is a key pathophysiology of narcolepsy?

Answer 7

Is due to reduction in hypocretin producing neurons and gliosis in the lateral hypothalamus; may be an autoimmune role (if you knock out the wake promoting system, you get sleep attacks)

Question 8

What are treatments for narcolepsy (the sleepiness)?

Answer 8

Sodium oxybate treats both sleepiness and cataplexy, but also stimulants can be used such as methylphenidate, dextroamphetamine, modafinil etc)

Question 9

What is Kleine-Levin syndrome?

Answer 9

Recurrent hypersomnia with hyperphagia and hypersexual personality changes, sleep for 18-20 hours a day.

Question 10

What is obstructive sleep apnea?

Answer 10

Sleep disruption related to repeated airway closures during sleep

Question 11

What is the difference between obstructive sleep apnea and central apneas?

Answer 11

Obstructive apnea has evidence of continued efforts to breath during apneic spell. Central apneas have no apparent breathing effort during spell. Central may be due to Cheyne stokes breathing pattern, drug use, high altitude.

Question 12

What is insomnia?

Answer 12

Persistent difficulty with sleep initiation, duration, consolidation, or quality.

Question 13

What are treatments for insomnia?

Answer 13

Education on sleep hygiene, cognitive behavioral therapy, benzodiazepines, non-benzodiazepine benzodiazepine receptor agonists such as Ambien, Sonata, Lunesta

Question 14

What is circadian rhythm sleep-wake disorders?

Answer 14

Mismatch between desired schedule and internal clock. Treatment is phototherapy

Question 15

What is DSPD and ASPD?

Answer 15

Delayed sleep phase disorder = late sleep schedule

Advanced sleep phase disorder = early sleep schedule

Question 16

What is restless leg syndrome?

Answer 16

Motor disorder characterized by unpleasant sensations in the legs that prevent sleep onset

Question 17

What are risk factors for restless leg syndrome?

Answer 17

Iron deficiency, pregnancy, psych meds

Question 18

What treatments are used for restless leg syndrome?

Answer 18

Dopaminergic agonists such as pramipexole or ropinirole, or L-dopa.

Question 19

What are non-REM parasomnias?

Answer 19

Sleepwalking and sleep terrors are abnormal behaviors arising from deep non-REM sleep.

Question 20

What is REM sleep behavioral disorder?

Answer 20

Acting out dreams, often violently, that occurs during REM sleep.

Question 21

What neurodegenerative disease is associated with REM behavioral disorder?

Answer 21

Synucleinopathies, such as Lewy Body dementia, Parkinson’s disease, and Multiple Systems atrophy

Question 22

Who is most likely to be affected with RBD?

Answer 22

Males, typically arises in middle age patients.