Special Procedures F12-F26

Question 1

What is MWT?

When is it indicated? (x2)

Answer 1

Maintenance of Wakefulness Test
To determine response to treatment for excessive sleepiness and to determine the alertness of an individual during the day.

Question 2

How is an MWT done?

How many trials are done and how long is each trial?

Answer 2

Patient is asked to stay awake for 40 min while seated.

4 trials are done, 40 min periods

Question 3

When should the first MWT be done?

Answer 3

1.5-3 hrs after awakening

Question 4

Is a nocturnal PSG required prior to the MWT?

Answer 4

No, a PSG is not required.

Question 5

How long is the break between trials?

Answer 5

2 hours.

Question 6

What are two factors for terminating a nap during an MWT?

Answer 6

Greater than 15 seconds of cumulative sleep
3 epochs of N1
1 epoch of any other stage of sleep

Question 7

After the MWT, what do you have to calculate, and what is considered abnormal?

Answer 7

Calculate mean sleep latency.

Less than 8 min is abnormal.

Question 8

What is Actigraphy?

Answer 8

It is a non-invasive method for monitoring rest/activity cycles by recording movement using a device worn on the wrist.

Question 9

What are the indications for actigraphy? (x6)

Answer 9

All indications have to do with circadian rhythm disorders.
Evaluation of Advanced Sleep Phase Synd. (ASPD)
Evaluation of Delayed Sleep Phase Synd. (DSPD)
Estimate sleep time in patients with OSA when PSG is not available
Evaluate treatment for insomnia
Monitor Restless Leg Synd. or PLMD. (Unit is worn on the ankle.)

Question 10

What is the name of the device worn on the wrist during an actigraphy?

Answer 10

Piezoelectric accelerometer

Question 11

Who fits an oral appliance to a patient?

Answer 11

A qualified dentist.

Question 12

What are two worn devices that are used to treat OSA? (These devices work by advancing the jaw.)

Answer 12

Oral appliance therapy

Mandibular advancement devices

Question 13

What is the most common surgical procedure for treating OSA?

What does it entail?

Answer 13

Uvulopalatopharyngoplasty (UP3)

Removal of soft tissue at the back of the throat.

Question 14

What are the indications for treating OSA surgically?

Answer 14

Unresponsive to CPAP

Excessive soft tissue in mouth

Question 15

During surgery to treat OSA, what structures may be removed or modified? (x6)

Answer 15

Uvula
Soft Palate
Tonsils
Adenoids
Pharynx
Mandibular advancement
(Success rate for this surgery is low.)

Question 16

Name five SABAs that can make it hard to go to sleep.

Answer 16

Albuterol, Atrovent, Duoneb, Levalbuterol, Terbutaline

Question 17

Name a LABA that can make it hard to go to sleep.

Answer 17

Salmeterol

Question 18

Name 2 xanthines that can make it hard to go to sleep.

Answer 18

Theophylline, Aminophyllin

Question 19

Name three corticosteroids that can make it hard to go to sleep.

Answer 19

Fluticasone, Budesonide, Prednisone

Question 20

Name two cardiac drugs that can make it hard to go to sleep.

Answer 20

Digitalis and digoxin

Question 21

Name two vasoactive drugs that can make it hard to go to sleep.

Answer 21

Dopamine and Dobutamine

Question 22

Name two diuretics that can make it hard to go to sleep.

Answer 22

Furosemide and mannitol

Question 23

What effect do opioids (analgesics) have on sleep?

Answer 23

Decreases stage N3 and R sleep.
Decreases sleep efficiency, increases wakefulness
Increases N1 sleep

Question 24

What effect do hypnotics / sedatives have on sleep?

Answer 24

Increases TST and N2, decreases REM, may increase or decrease delta waves.

Question 25

What effect do benzodiazapines have on sleep?

Answer 25

Increases TST, decreases WASO.

Increases N2, increases sleep spindles, decreases delta waves

Question 26

What effect do non-benzo hypnotics (sleep aids) have on sleep?

Answer 26

Increases TST

No change in REM