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BSM Board Exam > Misc. Topics > Flashcards

Misc. Topics Flashcards

1
Q

What is a hypnic headache?

A

Uncommon and occur exclusively during sleep
Most commonly occur during REM, can also occur in SWS
Onset typically age 50, rare in younger age
Headache is typically bilateral, not assoc w/ autonomic features
Isolated nausea, photophobia and photophobia can be present
Often respond to lithium, Indocin, and/or caffeine

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2
Q

Sleep dysfunction in schizophrenia

A 
Sleep dysfunction is extremely common
Occurs in about 30-80% of patients
Increased SL
Decreased TST
Decreased SE
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3
Q

What is the typical chronotype in ASD patients, children and adults?

A 
Typically present with :
	low SE
	prolonged SL
	insomnia
	irregular sleep-wake patterns
	EDS
	delayed sleep phase
	evening chronotype
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4
Q

Insulin sensitivity and sleep

SWS and HPA axis activity

Testosterone secretion during sleep

A

Insulin response is circadian modulated
Insulin sensitivity in adipose tissue is higher during daytime hrs compared to nighttime.
Sleep deprivation has been shown to induce insulin resistance via variety of pathways

SWS inhibits HPA axis activity
Cortisol is elevated in later portions of sleep period and during REM
Circadian disruption can increase inflammatory cytokines, increase risk for sepsis and cancer

Peak levels of testosterone occur in middle of sleep cycle, around time of REM sleep onset.
Fragmented sleep reduces amount of REM, blocks nocturnal increase in testosterone

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5
Q

What is overlap syndrome?

A

OSA and COPD
5 times more likely to have pulmonary HTN than those with OSA alone
Results in worsened nocturnal desaturations
Severe pulmonary HTN most likely to be seen in patients with daytime hypoxemia in addition to just nocturnal desat.

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6
Q

Impact of Crohn’s disease on RLS

A

Crohn’s can affect the entire GI tract, namely stomach fundus, where gastric acid is secreted, and the duodenum , where the majority of iron is absorbed

Low ferritin and low iron can contribute to RLS

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7
Q

What is the overall frequency of OSA in acromegaly patients?

A

Overall frequency is 40-50%

OSA is more common than central sleep apnea, due to structural changes

Predictive factors for development of sleep apnea include severity of GH excess, duration of disease, obesity, older age and being a male

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8
Q

What are the sleep characteristics with amphetamine abuse?

A

Causes severe fragmentation of sleep-wake cycle

Both insomnia and rebound hypersomnia (if they are unable to find the drug) occur

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9
Q

Prader Willi syndrome and sleep apnea

A

Central sleep apnea is most prominent in infants with PWS and often improves with GH therapy.
GH therapy is associated with worsening of OSA in patients with PWS, most likely due to GH stimulation of lymphoid tissue.
There are reports of deaths in patients with PWS on GH; is recommended that all patients with PWS have PSG prior to starting GH.
AAP recommends repeat PSG also at 6-10 weeks after initiation of GH therapy

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10
Q

What is SSRI eyes?

I.e. patient on lexapro having PSG

A

PSG finding of Rapid eye movements during NonREM sleep
Makes scoring of sleep stages more difficult
No known clinical significance
No need to d/c medication

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11
Q

What is the risk of developing depression in patients with new-onset insomnia

A

Two fold
Based on 2 meta-analysis

Individuals with insomnia were 2.3 times more likely to develop depression

Experimental studies showed that sleep loss may result in cognitive and affective alterations that lead to depression risk.
Sleep difficulties impair emotional regulation and stability

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12
Q

What is chronic paroxysmal hemicrania (CPH) ?

A 
CPH resembles cluster h/a 
	but shorter duration
	occur more frequently
	more common in females
Patients may awaken from sleep w/ h/a (not so common w/ cluster h/a)
Strongly associated with stage REM sleep
Are very responsive to indocin
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13
Q

What are the characteristics of Familial Advanced Sleep Phase syndrome (FASPS)

A

FASPS is inherited abnormal sleep pattern
“Morning lark”
Goes to sleep very early, wakes up very early; ~3-4 hrs ahead of local time
Most affected people carry a single base-pair substitution in the hPer2 gene.
This variant in human sleep behavior is due to a missense mutation in a clock component, hPER2, that alters the circadian period

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14
Q

What are the characteristics of Fatal Familial Insomnia

A

It is a prion neurodegenerative disorder
Severe loss of thalamic nuclei resulting in reduced metabolism seen on PET scan
Is autosomal dominant, occurs equally in men and women
Is 100% fatal
Typical symptoms are:
severe insomnia, no sleep at night, no naps
weight loss
difficulty swallowing
frequent fevers
unsteady gait
tremors
progressive dementia is common presentation
Will die from coma, young age
Is caused by gene mutation of PRNP gene

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15
Q

What is motivational interviewing?

A

Developed by Miller and Rollnick
Client centered and directive in nature
Purpose of MI is to help people resolve their natural ambivalence about health behavior change in order for the behavior change to occur

4 principles of MI:

  1. Express empathy
  2. Develop discrepancy (eliciting/reflecting inconsistencies between patient’s current behavior and his or her stated goals/values)
  3. Roll with resistance
  4. Support self-efficacy

What are 4 key strategies used to build rapport?

  1. Reflective listening (warm, non-judgemental restatement, clarification, enhancement)
  2. Open-ended questions (encourage patient to talk about thoughts and feelings, prompt to elaborate)
  3. Affirmations (express appreciation)
  4. Summaries (brings together thoughts or feelings patient has shared)
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16
Q

What is the duration of an epoch on a PSG?

A

1 epoch = 30 seconds

Total # of epochs/2= minutes
# of minutes x2 = epochs
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17
Q

How do you count on MSLT if there is no sleep onset in one of the nap periods?

A

If no sleep onset, Sleep latency is counted as 20 minutes or 40 epochs

18
Q

Newborn sleep

Sleep by 6 months of age

A

Newborns have 2 stages of sleep: REM and NREM

Distinct NREM stages (1,2,3) develop during 1st 6 months of life, typically present by 6 mos of age

19
Q

Sleep terrors, other info

A

More accurate term than night terrors
These events can occur during naps or other bouts of daytime sleep (i.e., not during the night)
Events tend to occur during first 1/3 of the night when SWS is at its highest
Children typically have no recall of the event
Peak prevalence during preschool years

20
Q

More information on treatment of Delayed Sleep phase disorder

A

CBTmin occurs ~2-3 hrs prior to habitual wake time
Light administered prior to CBTmin results in phase delay (moves it later)
Light given after the CBTmin results in phase advance of the clock (moves it earlier)
DLMO occurs ~2 hrs prior to habitual sleep onset
Giving low dose melatonin 5 hrs prior to DLMO or 7 hrs prior to habitual sleep onset will give a consistent phase advance.
Light “pushes” the rhythm and melatonin “pulls” the rhythm
Strict scheduling is recommended, but difficult
Pharmacotherapy not recommended as first line therapy

21
Q

What are side effects of dopaminergic agents for RLS (pramipexole) ?

A 
Nausea
Nightmares
Fatigue
Sleepiness
Up to 9% of patients experience impulse control disorders (ICDs) such as inappropriate shopping, gambling, and sexual activities. Patients on these drugs should be routinely asked about ICDs on clinic visits
22
Q

Augmentation with dopamine agonists

A

Patients report worsening sx and sx start to occur earlier in the day.
Augmentation has been reported for all dopaminergic medications and for tramadol, but not for Alpha 2 ligands.
Tx for augmentation is to decrease dose of dopamine agonist.
Alpha 2 ligands are now considered the 1st line medications because of side effect of augmentation with dopamine agonists.
Ferritin level in RLS patients should be maintained >75 ng/ml.

23
Q

Differences between Narcolepsy and Idiopathic hypersomnia

A

Both Narcolepsy Type 1 and IH are disorders of EDS, but differ in typical sleep durations.

Narcolepsy Type 1 typically sleep normal amounts in 24 hr period, similar to non-sleepy controls.
They may have more daytime naps, their nocturnal sleep is fragmented, so 24 hr sleep duration
is often close to 8 hrs
Naps are typically refreshing

Patients with IH may have normal sleep durations, but often have very prolonged sleep durations, which contribute to functional limitations created by this disorder. Naps are typically not refreshing.

24
Q

Melatonin synthesis pathway includes?

A 
L-tryptophan
5-hydroxytryptophan (5HTP)
Serotonin
N-acetylserotonin
Hydroxindol-0-methyltransferase (HIOMT, enzyme)
Melatonin

Dopamine is NOT in the melatonin synthesis pathway

25
Q

About what proportion of population reports habitual sleep duration of 6 hrs or less

A

20-35% (1/3)

26
Q

The biological basis of sleep-wake regulation is best represented by functions managed by?

A

The brainstem and midbrain

27
Q

What is an important brain region for generating human sleep

A

Ventrolateral preoptic area (VLPO)

28
Q

Adenosine

A

Neurochemical positively associated with sleep, not wakefulness

29
Q

What decreases with age in adults?

A

SE
% SWS
% REM sleep
Melatonin secretion

WASO increases w/ age, doesn’t decrease

30
Q

What is True re: relationships between self-reported characteristics of sleep and age?
Older adults

A

Older adults report greater satisfaction w/ sleep overall
Older adults show a weaker relationship between short TST and cardio metabolic disease risk
Older adults show greater resilience to neurobehavioral performance effects of sleep loss
Older adults report less insufficient sleep overall
Older adults are less likely to report that their social schedules interfere w/ ability to get more sleep

31
Q

What can be used to assess for circadian rhythm disorders?

A

Actigraphy

Not MSLT, PSG, MWT

32
Q

Non 24 hr sleep-wake disorder, characterized by?

A

Misalignment of circadian rhythms that presents as relatively steady and continual delay in sleep-wake timing
May present as periods of insomnia, EDS, or asymptomatic
Most often found in individuals who are blind

33
Q

What is treatment for Non-24 hr Sleep-wake-disorder?

A

Melatonin receptor agonist or melatonin

You would NOT use: hypnotics, benzos or modafanil

34
Q

9 month old nursed in rocking chair in her bedroom
Put into rocking chair in her bedroom and put into crib after falling asleep
Has normal awakening at night, cries for mother so she can repeat way she is used to falling asleep.
This informant associates the behavioral cues of being nursed and rocked with sleep onset.
This is an example of?

A

Negative sleep-onset associations- parent centered

Classical conditioning

35
Q

What is the treatment for the 9 month old on previous flash card?

A

Ask mother to nurse infant in rocking chair and put into crib when drowsy but awake and leave the room.
Nurse infant earlier in evening outside the bedroom

36
Q

2 year old has transitioned out of crib, falling asleep w/ mother laying next to him in his twin bed
Playing w/her hair, cuddling right before falling asleep
Lullaby music playing for 30 min. And shutting off
After getting his core sleep (3-4 hrs later) Max screams for his mother so he can reenact how he is used to falling asleep. This toddler associates his mother’s presence, cuddling with her, playing with her hair, listening to lullabies w/ falling asleep

The behavioral treatment to use includes?

A

Establishing short bedtime routine that involved parent initially, then allows Max to be independent at initial sleep onset
Use white noise machine throughout the night rather than playing music
Encourage hugging favorite stuffed animal while waiting to fall asleep

37
Q

Extinction is a behavioral treatment used with pediatric patients to?

A

“Extinguish” infant crying at bedtime by discontinuing the reinforcement of child crying via parental attention/presence
May be graduated or the reinforcement of desired behaviors occurs over time
May include parental presence in the child’s room w/o actively attending to child while crying

38
Q

Bedtime pass uses these principles for child resistance to bedtime:

A

Positive reinforcement

Limit setting

39
Q

Arzin’s dry bed training protocol for enuresis includes:

1974

A

Fluid intake before bedtime
Scheduled awakenings
Positive practice

Protocol actually involves increasing fluid intake before bed
Positive practice on hr before bed
Urine alarm
Scheduled awakenings
Cleanliness training if child wet the bed, morning praise for dry bed

40
Q

2 year old with PSG
Hx snoring, apnea
AHI = 7.5

What is appropriate options for f/u care?

A

Adenotonsillectomy

In children w/AHI >5, considered moderate OSA and intervention is warranted
Adenotonsillectomy is considered 1st line treatment in children

41
Q

Parent discontinues extinction early, picking up her infant son because she finds it too difficult to tolerate his prolonged crying. From the perspective of the parent, what behavioral contingency has occurred?

A

Negative reinforcement

The parental behavior of picking up the child is reinforcing to the parent because it results in removal of an aversive stimulus (infant crying)

42
Q

Compare sleep terrors vs nightmares

A 
Sleep terrors:
First 1/3 of night
Sleep stage SWS
High to extreme agitation
High arousal threshold (agitated if awakened)
No associated daytime sleepiness
No recall or fragmentary recall of event
Nightmares:
Last 1/3 of night
Sleep stage REM
Mild to high agitation
Low arousal threshold (awake and agitated after event)
Associated daytime sleepiness if prolonged awakening
Frequent and vivid recall of event
Prevalence: very common

BSM Board Exam (9 decks)

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