Sleep Disorders Flashcards
(37 cards)
What are the causes of daytime sleepiness?
1) Lack of sleep
2) Conditions disrupting sleep e.g. OSA
3) Drugs
4) Narcolepsy
How can sleepiness and lethargy be distinguished clinically?
Ask if after a long day, when sitting down to watch tv, would they fall asleep?
How is sleepiness assessed clinically?
- Epworth sleepiness scale
- Functional e.g. do you doze watching tv, in the car etc.
Briefly outline respiratory control changes at sleep onset.
- Loss of wakefulness drive to breath
- Downregulation of control mechanisms e.g. respiratory reflexes, chemosensitivity, upper airway and resp muscle pump tone.
What are the cardinal symptoms of sleep apnoea?
- Heavy snoring
- Excessive daytime sleepiness
- Witnessed apnoeas
What are the symptoms of sleep apnoea?
Nocturnal: -unrefreshed sleep, -nocturnal choking, -nocturia. Daytime: -morning headaches, -cognitive decrease, -depression, -decreased libido, -HTN.
What are the RFx for OSA?
- Age
- Male gender
- Obesity
- Alcohol/sedatives
- Upper airway morphology (inc nasal obstruction)
- FHx
- Chronic snoring
- PCOS
How is OSA diagnosed?
-AHI >5 events per hours (events/total sleep time).
5-15 = mild
15-30 = moderate
>30 = severe
What is apnoea?
Complete cessation of airflow for 10s of longer regardless of oxygen desaturation
What is hypopnea?
30% or more reduction in airflow associated with +/- 3% oxygen desaturation, or alpha wave arousal from sleep
How is OSA managed?
- Conservative Mx
- CPAP
- Oral appliances
- Surgery
- Other
What is the conservative mx of OSA?
- Weight loss
- Avoid alcohol/tobacco/sedatives
- Body position
- Treat nasal congestion
- Treat medical disorders (e.g. hypothyroidism)
What are the contraindications to oral appliances for Mx of OSA?
- Dentures or lack of teeth
- Periodontal problems
- TMJ disorder
- severe nasal obstruction
- severe hypoxia
What are the problems that may result from oral appliances to manage OSA?
- Excessive salivation
- Discomfort in teeth and jaw
- Movement of teeth
- TMJ dysfunction
What is central sleep apnoea?
Apnoeas or hypopnoeas caused by reduction in central respiratory drive
What is the aetiology of central sleep apnoea?
- Cardiac failure (cheyne stokes respiration)
- High altitude
- CNS disorders e.g. CVA
- Idiopathic
What are the causes of hypoventilation?
- Reduced CNS drive/suppression by drugs
- NM disease: nerve paralysis (drugs, polio, Guillain-Barre), muscle weakness (drugs, MND, muscular dystrophy)
- Chest wall deformity
- Obesity
Is hypoventilation worse during day or night?
All forms of hypoventilation are worse at night.
What is primary insomnia?
Disorder of hyperarousal: increased anxiety/HPA axis/hypertension/ANS activity. Behaviorual contributions (e.g. anxiety, poor sleep hygiene)
Which conditions contribute to insomnia?
OSA, circadian disorders, restless legs, psychiatric disorders, substance abuse, pain, urinary problems, meds.
How is insomnia treated?
- Manage comorbidities
- Control stimuli
- Restrict sleep
- Relaxation
- Biofeedback
- Paradoxical intention
- Sleep hygiene
- Short term hypnotics
What are the types of pharmacological management of insomnia?
-Benzos e.g. temazepam
-Non-benzos e.g. zolpidem
-Other: antidepressnats, valerian, anti-histamines.
Drugs should not be first line Mx.
What is the epidemiology of restless legs syndrome?
5-15% of population. Increases with age.
What are the causes of secondary restless legs syndrome?
Fe deficiency, renal failure, peripheral neuropathy, lumbosacral radiculopathy, pregnancy.
