Sleep Disorders

Question 1

What is restless leg syndrome?

Answer 1

Idiopathic
- Affects younger people
- At rest
- Feels like electricity going through legs
Secondary
- Most common in lumbosacral disease
- Burning sensation in legs
- Happens later on in night

Question 2

What are the changes in respiratory control at sleep onset?

Answer 2

Loss of wakeful drive to breathe and behavioural influences
Down-regulation of
- Respiratory reflexes
- Chemosensitivity
- Upper airway and respiratory pump muscle tone

Question 3

What are the cardinal symptoms of sleep apnoea?

Answer 3

Heavy snoring
Excessive daytime somnolence
Witnessed apnoea

Question 4

What are other nocturnal symptoms of sleep apnoea?

Answer 4

Disrupted/restless/un-refreshed sleep
Nocturnal choking and/or gasping
Nocturia

Question 5

What are the daytime symptoms of sleep apnoea?

Answer 5

Headaches
Memory/cognitive/concentration deficit
Mood change
- Depression
- Irritability
Sexual dysfunction
- Decreased libido
- Impotence

Question 6

What is the most common cause of secondary hypertension?

Answer 6

Obstructive sleep apnoea

Question 7

What are the risk factors for obstructive sleep apnoea?

Answer 7

Age
Male
Obesity
Alcohol/sedatives
Upper airway morphology, including nasal obstruction

Question 8

How is obstructive sleep apnoea diagnosed?

Answer 8

Full polysomnography

>5 events/hour

Question 9

How is apnoea defined when obstructive sleep apnoea is diagnosed?

Answer 9

Complete cessation of airflow for 10 sec/longer, regardless of O2 desaturation

Question 10

How is hypopnoea defined when obstructive sleep apnoea is diagnosed?

Answer 10

30+% reduction in airflow associated with 3% O2 desaturation/alpha wave arousal from sleep

Question 11

What is the management for obstructive sleep apnoea?

Answer 11

Conservative treatment
CPAP
Oral appliances
Surgery - major facial reconstruction

Question 12

What is conservative treatment for obstructive sleep apnoea?

Answer 12

Weight loss
Avoid
- Alcohol
- Tobacco
- Sedatives
Sleep on side
Treat nasal congestion
Treat medical disorders; eg: hypothyroidism

Question 13

When is the use of oral appliances for the treatment of obstructive sleep apnoea indicated?

Answer 13

Snoring
Mild-moderate disease
Failed CPAP treatment

Question 14

What are the contraindications for the use of oral appliances in the treatment of obstructive sleep apnoea?

Answer 14

Dentures/lack of teeth
Periodontal problems
TMJ disorder
Severe nasal obstruction
Severe hypoxia

Question 15

What problems can oral appliances cause?

Answer 15

Excessive salivation
Discomfort in teeth and jaw
Movement of teeth
TMJ dysfunction

Question 16

What is central sleep apnoea?

Answer 16

Apnoeas/hypopnoeas caused by reduction in central respiratory drive

Question 17

What are the causes of central sleep apnoea?

Answer 17

Cardia failure > Cheyne-Stokes respiration
High altitude
CNS disorders
Idiopathic

Question 18

How is central sleep apnoea due to heart failure managed?

Answer 18

Treat heart failure
CPAP
?O2

Question 19

How is idiopathic central sleep apnoea treated?

Answer 19

?O2

?Non-invasive ventilation

Question 20

What is chronic insomnia?

Answer 20

Subjective dissatisfaction with sleep quality/duration
Difficulty falling asleep at bedtime
Waking up in middle of night/too early in morning
Non-restorative/poor quality sleep
Associated daytime symptoms
Functional impairments

Question 21

What disorders can contribute to insomnia?

Answer 21

Obstructive sleep apnoea
Circadian disorders
Restless legs
Psychiatric disorders
Substance abuse
Pain
Urinary problems
Medications

Question 22

What are some treatment strategies for insomnia?

Answer 22

Treat comorbid disorders
Stimulus control therapy
Sleep restriction
Relaxation
Biofeedback
Paradoxical intention
Sleep hygiene
Short-term hypnotics

Question 23

What are pharmacological options for the treatment of insomnia?

Answer 23

Benzodiazepines
Non-benzodiazepines
Others; eg: antidepressants

Question 24

What is narcolepsy?

Answer 24

Disorder of sleep regulation
Deficiency in neurotransmitter orexin
Autosomal dominant with incomplete penetrance