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Flashcards in Sleep disorders Deck (18):
1

What conditions must be ruled out with insomnia?

restless leg syndrome and disordered breathing

2

What do maintenance difficulties indicated?

intrinsic sleep disorder that requires sleep study

3

What causes psychophysiologic insomnia?

learned sleep-preventing associations
paradoxical improvement in sleeping lab

4

What causes fatal familial insomnia?

prion protein
autonomic dysfunction
rare neurodegenerative process

5

What is the prevalence sleep apnea?

2-4% of population
rising due to rising obesity

6

What are some clinical aspects of obstructive sleep apnea?

17" neck circumfrence
obesity
excessive daytime sleepiness, pseudodepression
morning headache
crowded oropharynx, nasal disorders
positionally worse, and aggravated by sedatives or alcohol
common in neuromuscular disorders
polychythemia (increased rbc) and hypothyroidism

7

Define apnea vs. hypopnea

Apnea: absent airflow for 10 seocnds
hypopnea: reduced airflow for 10 seconds

8

What are the types of apnea/hypopnea?

Obstructive
central
Mixed: starts central, becomes obstructive

9

What is the cutoff for apnea/hypopnea index/ Respiratory disturbance index?

<5 (events/hour sleep)

10

How is apnea/hypopnea treated?

conservative measures and cpap (contineous positive airway pressure), dental devices, sometimes surgery

11

What are possible causes of central apnea?

Lateral medullary syndrome
atlantoaxial sublaxation
myotonic dystrophy
heart failure
syringobulbia

12

Define restless leg syndrome

urge to move
begins or worsens with rest
partially/totally relived by moving
worse at night/evening

13

What is the difference between restless leg syndrome and periodic limb movement disorder?

RLS: sensation
PLMD: manifestation 0.5-10 s, at 5-90 s intervals
90% of RLS have PLMD
50% of PLMD have RLS

14

What are common causes of RLP/PLMD?

Central (spastisity) or peripheral (radiculopathies, and neuropathies)
pregnancy
ferritin deficiency

15

How is RLS/PLMD treated

underlying cause ex. iron folate def
Firs line role for dopaminergic agonists an hour or two before bed
Sinemet (carba-levo dopa)
clonazepam may cause tachyphylaxis (reduced response)
opioids in some circumstances

16

What is the classic tetrad for narcolepsy?

1- excessive daytime sleepiness
2- cataplexy (full muscle weakness while awake)
3- hypnagogic hallucinations
4- sleep paralysis

17

How is narcolepsy treated?

strategic napping
alerting agents: modafininl, methylphenidate, other amphetamines
anticataplectic: anticholinergic agents (TCA)
SSRI
Methlphenidate
sodium oxybate/GHB

18

Where is hypocretin/orexin synthesized? where does it project to?

Synthesized in the lateral and posterior hypothalamus
projects diffusely to anterior projecting systems important for maintaing wakefulness
explains a series of symptomatic narcolepsies