Lecture 50: Sleep Flashcards Preview

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Flashcards in Lecture 50: Sleep Deck (49):
1

Stage 1 Sleep EEG and corresponding body state

Light sleep, less alpha, theta waves; muscle activity slows, twitching

2

Stage 2 Sleep EEG and corresponding body state

Theta waves, sleep spindles, K complexes; slowed breathing, HR

3

Stage 3 & 4 Sleep EEG and corresponding body state

Delta waves; very limited muscle activity

4

What stage is the most common? %

Stage 2; about 50%

5

Restorative sleep is which stage?

Stages 3 & 4

6

REM Sleep EEG and corresponding body state

Similar to waking state; paralysis, rapid eye movements, dreaming, increased HR, rapid breathing

7

How much time a night do we spend in REM? (% and # cycles)

25%, 5 cycles

8

Sleep cycle. How long does the pattern take?

Awake --> stage 1 --> 2 --> 3 --> 4 --> 3 --> 2 --> REM (like stage 1) --> 2; repeats every 90-120 minutes

9

Sleep latency

Time from lights out to stage 1 (10-20 min)

10

REM latency

Time from sleep onset to first REM (90-100 min)

11

Sleep efficiency

Amount of sleep/total time in bed

12

For infants, how much time do you spend sleeping?

2/3 of the day

13

As we age, what happens to our sleep cycle?

Increased sleep latency, noctural awakenings and stage 1, decreased REM latency, sleep efficiency, and stage 4

14

What are some key pieces of information for a patient with disordered sleep?

Sleep hx, meds, family/psych hx, bed partner hx, physical exam, sleep measurements

15

Scale for measuring sleepiness and structure

Epworth Sleepiness Scale asks likelihood to fall asleep in various situations

16

What does the multiple sleep latency test assess?

Objective daytime sleepiness: sleep/REM latency during day

17

What suggests narcolepsy

REM sleep in 2+ naps

18

Primary sleep disorders (2)

Dyssomnias = too much or too little sleep; Parasomnias = abnormal sleep behaviors

19

Sleep-related breathing disorders are categorized as...

A dyssomnia

20

Define sleep apnea

Repetitive episodes of complete or partial cessation of air flow during sleep that often result in oxygen desaturation and terminate with brief arousals

21

Two types of sleep apnea

Central = reduction in respiratory drive; Obstructive = upper airway obstruction

22

Two causes of obstructive sleep apnea

Obesity or craniofacial abnormalities (leading to soft tissue collapse of airway)

23

Signs of obstructive sleep apnea (3)

Excessive daytime sleepiness, loud/choking snoring, pauses in breathing while sleep

24

Consequences of sleep apnea on all causes of mortality

3-6 x fold in all-causes of mortality

25

Cardio consequences of sleep apnea

CHF, stroke, hypertension

26

Neurocognitive consequences of sleep apnea

Accidents, decreased vigilance, executive functioning

27

Metabolic consequences of sleep apnea

Increased insulin resistance

28

Prevalence of sleep apnea (%)

15%

29

Main sleep apnea treatments (3)

Weight loss, positional therapy, C-pap (positive airway pressure therapy)

30

Central sleep apnea means what? What people get it?

No respiratory effort at time of airflow cessation; patients w/ lower brainstem lesions

31

Clinical feature of narcolepsy

Frequent attacks of irresistible daytime sleepiness; REM sleep INTRUDING when it's not supposed to

32

What is the "classic tetrad" of narcolepsy

"Classic Tetrad" = daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations

33

T/F: Narcoleptics get normal amounts of sleep per 24 hours

True! Also have normal polysomnogram

34

Hypnagogic hallucinations (def)

Vivid hallucinations during transition between wakefulness and sleep

35

Cataplexy (def)

Sudden intrusion of REM sleep into wakefulness resulting in emotionally-triggered, transient muscle weakness

36

Narcolepsy can involve what hormone?

Orexin (reduced or absent)

37

Narcolepsy diagnosis involves...

Clinical assessment, REM latency via polysomnography

38

Pharmacologic narcolepsy treatments (2 categories)

Stimulants and cataplexy modifying agents (sodium oxybate, REM-suppressing antidepressants)

39

Board sleep disorders (2)

Ondine's curse (sleep --> stop in breathing); Kleine-Levin syndrome (daytime somnolence and other hypers-)

40

Circadian rhythm disorders (def)

Recurrent or persistent misalignment between the desired sleep-wake schedule (external physical or social environment) and the endogenous circadian rhythm-related propensity for sleeping and waking

41

Circadian rhythm disorders are often associated with...

Night & early-morning shift schedules

42

Shift work sleep disorder (def)

Excessive sleepiness during work hours that are scheduled during the usual sleep period and insomnia when attempting to sleep during the usual wake period

43

Sleep-related movement disorders include which two disorders with brief description

Restless leg syndrome (urge to move legs) and periodic limb movements of sleep (partner notes this one)

44

RLS and PLMS are primarily; most important secondary cause? One associated disease

Idiopathic; iron deficiency; Parkinson's disease

45

Non-REM Parasomnias (2) and stage. Amnesia? Confusion? Dreaming? Patients?

Sleepwalking and sleep terror disorder; delta sleep (Stage 3 & 4); yes, yes, no, children

46

REM Sleep Parasomnias (2) and stage. Amnesia? Confusion? Dreaming? Patients?

Nightmare disorder, REM behavior disorder (REM); no, no, yes, older men

47

Pathophysiology of non-REM parasomnia

Brief, incomplete awakening during Stage 3 & 4 sleep

48

What's behind/presentation of sleep terror

Waking from Stage 3 & 4 with gasping, panic, and then return to sleep w/out fully waking

49

Pathophysiology of REM behavior disorder and important association

Loss of muscle atonia during REM sleep resulting in acting-out of dreams; early manifestations of neurodegenerative disorders

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