Sleep in Other Disorders

Question 1

What is another name for nocturnal frontal lobe epilepsy?

Answer 1

Nocturnal paroxysmal dystonia

Question 2

EDS is found in what % of myotonic dystrophy Type I (DM1) patients?

Answer 2

Approximately 30% - 40%

Question 3

Does the degree of sleepiness in DM1 correlate with the number of CTG repeats?

Answer 3

No, although it can with other parts of the disorder

Question 4

What can the MSLT look like in DM1?

Answer 4

It can look like narcolepsy

Reduced mean sleep latency

SOREMs

Question 5

Pediatric RBD can herald the onset of what disorder?

Answer 5

Narcolepsy. In adults it can preceed PD.

Question 6

What 2 sleep disorders lead to an increased risk for stroke?

Answer 6

Habitual snoring and severe OSA

Question 7

What % of acute stroke patients develop SDB and does it improve?

Answer 7

50% and it does improve some (central improves more than obstructive)

Question 8

What is Peduncular hallucinosis of Llhermitte?

Answer 8

Hallucinations seen with some strokes involving the midbrain or pons

Question 9

What is Charcot-Wilbrand syndrome?

Answer 9

Reduction or cessation of dreaming in some strokes that affect the cerebral cortex, especially the deep frontal white matter

Question 10

What % of patients with generalized myasthenia gravis develop sleep apnea?

Answer 10

Approximately 60% with obstructive the most common

Question 11

Tumors in what ventricle can cause narcolepsy?

Answer 11

3rd ventricle

Question 12

What are common sleep findings in patients with narcolepsy?

Answer 12

• Severe insomnia
• Impaired sleep efficiency
• Decreased SWS
• Decreased REM latency

Question 13

A schizophrenic in remission has worsening insomnia. Why is this concerning?

Answer 13

Worsening insomnia can indicate an impending relapse

Question 14

Short REM latency can be seen in what psychiatric disorders?

Answer 14

• Borderline personality disorder
• Anxiety
• Depression
• Schizophrenia
• Anorexia nervosa
• Panic disorders

Question 15

Name 2 atypical antipsychotics that increase SWS

Answer 15

• Risperidone
• Olanzapine

Question 16

What is the best treatment for patients with hypothyroidism?

Answer 16

CPAP and low dose thyroxine

Question 17

What adverse reaction can patients with hypothyroidism and OSA have with thyroid replacement alone?

Answer 17

Cardiovascular complications including nocturnal angina and cardiac arrhythmias

Question 18

In patients with heart failure and CSB, when is an arousal most likely to occur?

Answer 18

During the peak of hyperpnea

Question 19

3 causes of CSB related to heart failure

Answer 19

1. Long circulation time
2. Increased drive to breath
3. Hypoxemia related to pulmonary edema

Question 20

3 causes for nocturnal diarrhea

Answer 20

1. Diabetic neuropathy affecting G.I. tract
2. Neoplasia in G.I. tract
3. Inflammatory bowel disease

Question 21

G.I. changes that occur during sleep (4)

Answer 21

• Delayed gastric emptying
• Decreased upper esophageal sphincter pressure
• Decreased esophageal peristalsis
• Decreased salivary secretion

Question 22

What will be seen on PSG in patients with insufficient sleep syndrome?

Answer 22

• Shortened sleep latency
• Improved sleep efficiency > 90%
• Increased total sleep
• Increased N3 and REM sleep

Question 23

Bruxism is typically seen in what stages of sleep?

Answer 23

N1 & N2,

Can be seen less in REM

Question 24

What medication is recommended for PTSD patients with nightmares?

Answer 24

Sertraline. In the past prazosin was recommended but it didn’t show any benefit in the VA cooperative study

Question 25

The presence of RBD in parkinson’s disease can predict what symptom?

Answer 25

Cognitive dysfunction