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Respiratory Part 2 > Sleep disorders and treatment > Flashcards

Sleep disorders and treatment Flashcards

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1
Q

Define sleep disorder

A

any medical disorder which has a negative effect on sleep patterns

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2
Q

What do we do when investigating sleep disorders?

A

-medication
-day time symptoms
-sleep hygiene
-evening symptons
-does the patient have difficulty falling or staying asleep
-quality of sleep

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3
Q

What is epworth sleepiness scale?

A

-self reported questionare, 8 questions to assess daytime sleepiness

-big limitations- some questions not applicable
-no legal standing-DVLA

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4
Q

What is the Berlin questionaire?

A

-11 questions divided into 3 categories to classify the patient as high or low risk for OSA

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5
Q

What is the STOP-BANG questionnaire?

A

an OSA screening tool, 4 easy questions and 4 clinical attributes

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6
Q

What does STOP-BANG stand for?

A

Snore
Tired
Observed events
Pressure ( blood)

BMI
Aged older than 50
Neck size more than 16cm
Gender male?

<3 low risk >5 high risk for OSA

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7
Q

Name some sleep studies

A

-actigraphy
-overnight pulse oximetry
-polygraphy (limited multichannel sleep study)
-detailed polygraphy ( additional EMG video)
-polysomnography( EEG and EOG)

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8
Q

What is actigraphy?

A

-worn on wrist or ankle
-contains accelerometer to record movement
-worn for days/weeks
-more accurate than a sleep diary

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9
Q

What does oxygen saturation do in overnight pulse oximetry?

A

-after long apnoea or hyponoea, arterial blood passing theough lungs picks up less o2, leading to desaturation

-when airflow returns to normal, o2 sats normally respond by returning to the original level

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10
Q

What does pulse rate do during overnight pulse oximetry?

A

-spikes in pulse rate seen with: PLMD ( periodic limb movement disorders) or sleep related breathing disorders

flat pulse rates seen in patients with diabetic cardiac autonomic neuropathy (CAN) or those of beta blockers

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11
Q

What is polygraphy?

A

nasal flow-can identify apnoeas that don’t cause significant desaturation, identify oximetry artefacts

chest and abdomen bands- differentiate between central and obstructive events and mixed events. if flow fails then it can act as a back up and often is of diagnostic quality

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12
Q

What is a detailed polygraphy?

A

-Leg EMG​ for PLMD

-Microphone​ -identifys snoring and determine obstructed apnoes vs central​

-Camera -Helps to remove periods of wakefulness (reduced false negatives)​
Helps to support diagnosis of ​- Periodic leg movement disorder (PLMD). Special bed sheets. Sleep parasomnias: Night terrors etc​

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13
Q

What is an electroencephalogram - EEG?

A

-only technique to categorically measure actual sleep
-reduces false negatives
-sleep staging can produce a hypnogram to diagnose non-resp sleep disorders

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14
Q

What is an electrooculography- EOG?

A

-identifys REM sleep
-determines other stages of sleep based on pattern of eye movement

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15
Q

What is an electromyography - EMG?

A

-Submental EMG- identify’s REM sleep

Limb EMG- identify’s PLMD

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16
Q

Name 6 sleep disorders

A

1-insomnias
2-circadian rhythm sleep disorders
3-parasomnias
4-sleep related movement disorders
5-excessive sleepiness(hypersolnolence and narcolepsy
6-sleep related breathing disorders

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17
Q

Define parasomnias

A

abnormal or innappropriate behaviour and or movement/ emotion/ perception of dreams which take place at any time during sleep.

-occurs furing transitions between sleep stages

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18
Q

Name some parasomnias

A

-hypnogogic-occurs during transition from wake to sleep

-hypnopompic-occurs during the transion from sleep to wake

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19
Q

What are the 2 groups parasomnias fall under?

A

-NREM
-REM

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20
Q

What is the ICSD diagnostic criteria?

A

-recurrrent episodes of incomplete awakening from sleep

-limited or no associated cognition of dream imagery

-Inappropriate or absent responsiveness to efforts of others to intervene or redirect the person during the episode​

-The disturbance is not explained more clearly by another sleep disorder, mental disorder, medical condition, medication of substance use​

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21
Q

Name some NREM parasomnias

Study These Flashcards
A

-Bruixsm (teeth grinding)​
-Exploding head syndrome​
-Confusional arousals​
-Night terrors​
-Sleepwalking​
-Sexsomnia​
-Enuresis (bed wetting) ​
-Sleep related eating disorder​

22
Q

Describe confusional arousals

Study These Flashcards
A

-appears awake, confused and diorientated for 1-40 mins

-carry out normal behaviours, not concious of them/ effectively perform them

-known as sleep inertia

-slow speech is common feature

-ranges from simple vocalization by occas aggressive or violent

-may occur at night or morning

-most common in toddlers and early age school children

23
Q

Describe sleep walking/ somnuambulism

Study These Flashcards
A

-large motor control, not fine motor skills
-can endanger patients
-can occas result in violent behaviour
-usually occurs in NREM3
-can lead to insomnia -somniliquy can occur at any sleep stage ( sleep talking)

24
Q

Describe night terrors/pavor nocturnus

Study These Flashcards
A

-experienced on waking in NREM3
-starts with vocalization
-often sit up and look very frightened with eyes open
-feeling of intense fear but little memory of the event
-inc ANS- tachycardia, tachypnoea, sweating, dilated pupils, muscle tone
-different to nightmares that occur during REM sleep
-may be violent movement

25
What is bruxism?
-teeth grinding -only considered a problem if it results in damage to teeth, jaw, tooth pain, headache or wakes partner
26
How do we diagnose NREM parasomnias
-significant delay to diagnosis -clinical history and PSG often necessary but tricky
27
How do we treat NREM parasomnias
-good sleep hygiene -limit anything causing sleep fragmentation -avoid sleep deprivation -safety assess sleep environment -education and reassurance -treatment for enuresis-limit fluid intake, alarms and medication -drug therapy such as benzodiazepines
28
Name some types of REM parasomnias
-REM sleep behaviour disorder -sleep paralysis -nightmares
29
Describe REM sleep behaviour disorder (RSBD)
-muscle atonia not maintain leading to dream enactment -enacting violent behaviours often from unpleasant and aggressive dreams -may be accompanied by vocalisation -tend to occur during latter part of night -sleep deprivation leads to REM rebound and inc risk of RSBD -progressive over time
30
What is the treatment of RSBD?
-Limit sleep deprivation to prevent excessive REM rebound -safe sleep environment -drug therapy (benzodiazepines, melatonin, clonazepam, antidepressants)
31
What does clonazepam do for RSBD?
reduces dream intensity and acting-out behaviours
32
What is the association between RSBD and neurodegeneration?
50% of patients with RSBD will have developed Parkinsons, Dementia with lewy body or multiple system atrophy by 5 years
33
Describe nightmares
-subjects can usually recall the nightmares -increased ANS activity -occurs during REM sleep
34
Name some sleep related movement disorders
Restless leg syndrome -Periodic limb movement disorder- PLMD
35
Describe RLS
-irrestible urge to move legs and symptoms only relived by movement -has a circadian pattern (night only) -often familial and progressive over years -can lead to difficulties going to sleep -increased prevelance in pregnancy, iron def dialysis, antidepressants antipsychotics
36
What is the diagnosis for RLS?
-self-reported by patient -no specific objective diagnostic test
37
What is the treatment for RLS?
-Good sleep hygiene -avoid sleep deprivation -avoid medication or behaviours that aggrevate ( alcohol,nicotine) -iron replacement helps if patients are anaemic -in severe cases consider drug therapy
38
What drugs can we use to treat RLS?
-dopamine agonists(levodopa and ropinirole -benzodiazepines -opiates -gabapentin/pregabalin NOT amitriptyline or melatonin
39
What is PLMD?
-repetitive, involuntary movements during NREM sleep -(EMG of tibialis anterior is used to detect movements) -movements last 0.5-5 s and occur in a repetitive pattern every 20-40s for mins or hours -complete arousal -patients may be asymptomatic or complain of excessive daytime sleepiness -CVD risk -incidence increases with age
40
How do we diagnose PLMD?
level 1- patients present with HX of disturbed sleep and daytime sleepiness and other causes are ruled out level 2- bed partner has witnessed movements level 3- actigraphy level 4a-PG study with limb EMG level 4B- PG study with limb EMG and camera Level 5 - PSG that has additional EEG to show arousals
41
How do we treat PLMD?
-good sleep hygiene -treat underlying cause -optimise kidney function -drug withdrawal-neurological, anti dopaminergic agent -pharmacological treatment
42
What are some underlying causes of PLMD?
-iron def -B12 -DM -OSA
43
What are some pharmacological treatments of PLMD?
-sedatives ( clonazepam/benzodiazepines) -dopamine agonists ( ropinirole, levodopa, pergolide( regulate muscle movements -anticonvulsants (gabapentin) reduce muscle contraction -GABA agonists ( Baclofen) relaxation of contractions Tricyclic antidepressants (cyclozine) can make it worse
44
Describe hypersolmnolence including narcolepsy
-increased effort to stay awake in low stimulus or inactive situations -increased tendency to fall asleep -sleep onset can occur during active situations such as during a conversation or eating a meal -patients experience problems with memory and conc and are often irritable
45
Describe hypersolmnolence not including narcolepsy
-often associated with psychiatric disorders -high incidence of hypersomnia in patients with mood disorders
46
Name some treatments for hypersomnolence
-good sleep hygiene -avoid sleep deprivation -treatment of underlying conditions -behavioural strategies such as planning naps to reduce the homeostatic pressure for sleep -patients with hypersomnia not related to insufficient sleep benefit from stimulants such as caffeine
47
Name some treatments for narcolepsy
-modafinil- increases dopamine levels -Amphetamines- increases noradrenaline and dopamine level
48
What are some common causes of hypersomnolence?
-medical disorders -neurological/degenerative disorders -psychiatric disorders -medications/substances -sleep disorders -insufficient sleep, sleep related breathing disorders, sleep related movement disorders, circadian rhythm disorders
49
what is Narcolepsy?
-unable to regulate sleep-wake switch ( defic in orexin/hypocretin measured in CSF) excessive daytime sleepiness- chronic and persistent -sleep attacks occur during low stimulus situations -associated with cataplexy, sleep paralysis and hypnogogic hallucinations
50
What is cataplexy?
-loss of muscle tone occurring in response to strong emotions -patients feel weak, clumsy, slurred speech -attacks last from secs to mins -patient aware of what's happening but can't move -loss of muscle tone due to inability to regulate the sleep/wake status so that there are overlapping elements, REM insertion into wakefulness -75% of patients with narcolepsy have cataplexy
51
What is the diagnosis for cataplexy?
-clinical and sleep history -epworth sleepiness scale -PSG -multiple sleep latency test < 5 mins in most narcoleptics evidence of REM -maintenance of wakefulness test -lumber puncture- defic in orexin in CSF

Respiratory Part 2 (15 decks)

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