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Respiratory > Sleep > Flashcards

Sleep Flashcards

1
Q

In what way may children differ to adults in their presentation of sleepiness.

A
  • anxious - irritable - impulsive - inattentive - poor concentration - “ADHA like”
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2
Q

What are DIMS?

A

Disorders of initiating and maintaining sleep. - Insomnia’s - Sleep related breathing problems - Circadian rhythm sleep disorders

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3
Q

What are DOES?

A

Disorders of excessive somnolence. - Hypersomnias of central origin - sleep related movement disorders

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4
Q

What are parasomnias?

A

Abnormal occurrences during sleep. - parasomnias - REM behaviour disorder

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5
Q

What percentage of children are affected by sleep problems?

A
  • 10-30%
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6
Q

Describe the screen tool BEARS.

A

screening tool to assess sleep in children B- Bedtime problems E - Excess daytime sleepiness A - Awakenings at night R - Regularity and duration of sleep S - Snoring and Apnoea

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7
Q

Describe the physiological changes seen during sleep.

A
  • BP and body temp changes - Reduced tone: increased upper airway resistance (x2), tidal volume decrease (1/2 in REM) - Impairment of ventilation and worsening of underlying ventilation problems.
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8
Q

What are the functions of sleep?

A

Pre-requisite for learning: consolidates and enhances learning. Hormal and growth function

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9
Q

What are the effects of sleep deprivations?

A
  • tremor - reflex changes - blunted hormone secretion (GH) - elevated pro-inflammatory cytokines - impaired psychomotor performance - behavioural changes (pre-frontal cortex and executive function - obesity
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10
Q

How does sleep deprivation lead to obesity?

A
  • increased secretion of leptin and ghrelin - increased appetite - less physical activity - adolescent boys particularly.
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11
Q

Describe the features of N1 sleep.

A

transition to light sleep, easily aroused

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12
Q

Describe the features of N2 sleep.

A
  • light sleep - k complexes and spindles feature on polysomnography
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13
Q

Describe features of N3 sleep

A
  • “slow wave sleep” - very difficult to rouse - little movement - very regular breathing
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14
Q

Describe the features of REM sleep.

A
  • dream sleep - increased chin tone - rapid eye movements - partial paralysis - irregular breathing - increased upper airway resistance - reduced tidal volume
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15
Q

What are the sleep stages of newborns?

A
  • 50% active sleep (equivalent to REM) - 50% quite sleep (equivalent to N3) - Indeterminate sleep
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16
Q

On a hypnogram, where is REM sleep predominantly located?

A

In the latter half of sleep

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17
Q

On a hypnogram, where is the slow wave sleep (N3) normally located

A

In the early half of sleep

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18
Q

Describe the polysomnograph of an awake person with eyes open.

A

-Chin EMG = Big - EEG: all over the place, EMG interference, eye movements

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19
Q

What do these polysomnograph findings indicate? -Chin EMG = medium - EEG: quiet EEG, frequent arousals, rhythmic alpha in occipital lead.

A

Awake with eyes shut

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20
Q

What do these polysomnograph findings indicate? -Chin EMG = medium - EEG: quiet EEG, K complexes and spindles

A

N2

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21
Q

What do these polysomnograph findings indicate? -Chin EMG = small - EEG: Big slow waves, can have K’s and spindles

A

N3

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22
Q

What do these polysomnograph findings indicate? -Chin EMG = smallest - EEG: quiet EEG, eye movements. No K’s or spindles

A

REM

23
Q

What is the timing per page on a PSG for a breathing questions?

A

1-2mins per page

24
Q

What is the timing per page on a PSG for a sleep stage question?

A

30 secs per page.

25
Q

What would you classify these sleep disorders as.. - Bed-time refusal - Night time waking - Night time fears

A

Difficulties going to sleep. - bed-time refusal is also termed behavioural insomnia of childhood.

26
Q

What could be the causes of night time waking without a sleep association problem (bed-time refusal)?

A
  • GORD - Eczema - Asthma - PLMD - OSA
27
Q

Describe the 3 type of behavioural insomnia.

A
    • sleep association type 2. - limit setting disorder 3. - mixed
28
Q

How do you manage behavioural insomnia?

A
  1. Assume all are type 3 (mixed) 2. Exclude physiological cause 3. Look at day time behaviour and sleep hygiene 4. Then use either an extinction or graduated technique.
29
Q

What sleep problems are found with ADHA?

A
  • prolonged sleep latency - more observed restless sleep - more night time wakings - longer total sleep time. - difficulty waking/irritability - daytime sleepiness - ?OSA ?secondary to stimulant medications.
30
Q

What are the sleep problems associated with Autism?

A

44-83% of people with Autism have sleep problems. - waking for hours in the middle of the night - early morning waking

31
Q

How would you manage Autism associated sleep problems?

A
  1. Behavioural therapy: PPP model (50% of parents find this helpful 2. Melatonin ( however because the half life is only 4 hours may ned to consider a second dose or a long acting version. (also remember the side effects of potentially causing oestrous. in animal studies.
32
Q

How would you manage sleep problems in ADHD?

A
  • consider atomoxetine, clonidine or melatonin - behavioural therapy can be effective.
33
Q

What is delayed sleep phase?

A

Onset of sleepiness delayed by several hours. - tend to go to be hours later and if possible, wake hours later. Common in adolescents due to delayed melatonin peak. Promoted by late night homework and screen time. Can be seen on actigraphy.

34
Q

From which sleep stage do people with parasomnia’s awake from?

A

N3 - slow wave sleep - usually 60-90mins in to sleep - 1-2 per night but can be multiple - often have a family history - consider OSA/PLMDs

35
Q

Night terror vs nightmare

A

-child cannot be comforted - go straight back to sleep following (usually 20 mins with nightmare) - no recall in the morning

36
Q

What are the features of a frontal lobe seizure

A

-stereotypical -may have features such as pointing or thrusting -more likely to be standing -sudden offset -post-ictal state can look like a parasomnia

37
Q

Management of night terrors?

A

(affect 39% children, 3% have them frequently) - trying to wake them will prolong the event - clonazepam or zopiclone can be used in extreme cases

38
Q

Management of sleepwalking?

A

(15% occasionally, 3-4% frequently) - consider safety: locking doors, remove plate glass - redirect to bed - can trial clonazepam or anticipatory awakening

39
Q

What are non- sleep stage specific disorders

A
  • rhythmic movement disorder: head banging, occurs just before sleep onset, normal variant in young children - periodic limb movement disorder: part of restless legs spectrum, related to low iron stores in the CNS. Rx - keep ferritin above 50.
40
Q

How do we stay awake?

A

nuclei in the thalamus, hypothalamus and pons send neurotransmitter (including monoamines, hypocretin 1, histamine) to the cortex. when this stops, we fall asleep. (In narcolepsy hypocretin 1 is not secreted)

41
Q

What is sleepiness?

A

falling asleep when one would normally be awake or constantly fighting sleep.

42
Q

List secondary hypersomnias

A
  • hypothalamic tumors (obesity and OSA) - psychiatric disorders - lack of sleep - caffeine
43
Q

List constant primary hypersomnias

A
  • Narcolepsy: is constant sleepiness - primary idiopathic hypersomnia with long or normal sleep time
44
Q

What is the most common cause of sleepiness?

A

Not sleeping enough!

45
Q

List periodis primary hypersomnias

A
  • Klein-levin syndrom - menstrual related hypersomnia are periodic hypersomnia’s
46
Q

What is a multiple sleep latency test (MSLT)?

A

Given five opportunities to fall asleep through the day. Able to sleep for a max of 20 mins. If sleep latency is <8 minutes, it is considered abnormal.

47
Q

What would indicate narcolepsy on MSLT?

A

Short latency with SOREM

48
Q

What would indicate hypersomnia on MSLT?

A

Short latency with no SOREM

49
Q

When would an MRI be indicated in hypersomnia

A

Any neurological features.

50
Q

What are the features of narcolepsy?

A
  • cataplexy - sleep paralysis hypnagogic hallucinations
51
Q

What is the treatment for narcolepsy?

A
  • routine: regular, good quality sleep - scheduled naps - stimulants: methylphenidate or dexamphetamine, modafinil
52
Q

treatment for cataplexy?

A

sodium oxybate tricyclics, SSRI’s venlafaxine

53
Q
A
54
Q

Describe the features of this PSG and what sleep stage it represents.

A

REM sleep

Respiratory (3 decks)

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