Sleep (Knowles) Flashcards
(28 cards)
1
Q
What are the 3 normal physiologic levels of consciousness?
What is the “reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment” ?
A
- Awake
- NREM sleep
- REM sleep
- the Behavioral definition of sleep
2
Q
What are the 2 independent forces that impact sleep?
A
- Circadian rhythm
- Sleep debt
3
Q
NREM sleep:
- Divided into ___ stages
- During normal sleep onset into NREM sleep -
- _____ in muscle tone
- slow eye movements, possibly ______
- Loss of ______, low voltage mixed frequency
- What are the stages differentiated by?
A
- 4 stages
- Decrease
- asynchronous
- classic alpha rhythm
- Presence of electrographic phenomenon - degree of high voltage slow wave activity
4
Q
REM sleep:
- Electrographic background similar to _____ sleep or ______
- Muscle _____, with intermittent twitches seen
- eyes:
A
- stage 1 NREM, or relaxed awake (loss of posterior dominant rhythm)
- Atonia
- Rapid eye movements
5
Q
Sleep cycle:
- Sleep is entered via the _____
- Cycles between NREM and REM on average are ___ minute cycles
- _____ predominates for the first 2/3 of the night
- _____ predominates for the last 1/3
Classic distribution: 1: 2-5%, 2: 45-55%, 3: 3-8%, 4: 10-15%, REM: 20-25%
A
- NREM sleep
- 90 minutes
- NREM
- REM
N2 is the MAJORITY
6
Q
Apnea:
- _____: no effort to breathe, no air movement
- _____: Effort to breathe, no air movement
- _____: Initially no effort to breathe, but then makes respiratory effort without air movement
A
- Central
- Obstructive
- Mixed
7
Q
What is the difference between adult and child definitions of pbstructive sleep apnea?
A
Both have > 90% decrease in airflow compared to pre-event baseline; associated with continued/increased respiratory effort throughout the entire episode of absent airflow
- Adults: lasts 10 seconds or greater
- Child: Lasts the length of 2 breaths during baseline breathing
8
Q
What are some clinical signs and symptoms of obstructive sleep apnea? (5)
(Observed apneas - by 75% of bed partners)
A
- Loud, disruptive snoring
- Periods of silence with gasps/snorts (snore arousal)
- Restless sleep (50%)
- Nocturia (28%, 4-7 nightly trips to the bathroom)
- Nocturnal GERD
9
Q
OSA:
- Most common complaint is ______
- ___ of reaction time
- Personality changes - including:
- ______ libido - impotence, ED, *** reversible
- ~1/2 report morning/nocturnal _____
- In children, more likely to report poor ____, ____, ____, ____ than daytime sleepiness
A
- Daytime sleepiness/fatigue
- Slowing
- aggressiveness, irritability, anxiety, depression
- Decreased
- Headaches
- attention, impulse control, distractibility, irritability
10
Q
What are some treatment options for OSA?
- Non-surgical
- Behavioral? (3)
- ___/____
- Devices? (3)
- Medications?
A
- Weight loss, smoking cessation, body positioning
- CPAP/BiPAP
- Snore balls, oral appliances, nasal dilators
- Nasal steroids, antidepressants, stimulants
11
Q
What are some surgical treatment options for OSA?
- ?
- ?
- ?
- ?
A
- Tonsillectomy/adenoidectomy
- UPP
- Mandibular advancement
- Tracheostomy
12
Q
Hypersomnolence: is secondary to:
- ______ sleep (OSAS, PLMD)
- ______ sleep
- ______ (recreational, prescription)
- _______ effects - sleep phase disorders
- ____/____ hypersomnolence
- Other systemic disease (hypothyroidism)
A
- Disrupted
- Inadequate
- Drugs
- Chronobiologic
- Narcolepsy/idiopathic
13
Q
Diagnosis:
- Excessive daytime sleepiness with abnormal REM sleep phenomenon
- Presumed 2 hit hypothesis - genetic predisposition with environmental trigger
- Changed classification:
- type 1 - with cataplexy
- type 2 - without cataplexy
A
Narcolepsy
14
Q
What type?
- Criteria A and B must be met:
- A: The patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least 3 months
- B: The present of 1 or both of the following:
- _____ and a mean sleep latency of < or = 8 minutes and 2+ sleep onset REM periods on an MSLT performed according to standard techniques - A SOREMP within 15 min of sleep onset - on the preceding nocturnal polysomnogram may replace one of the SOREMPs on the MSLT
- CSF hypocretin-1 concentration, measured by immunoreactivity is either < or = 100 pg/mL or <1/3 of mean values obtained in normal subjects with the same standardized assay
A
Type 1: Narcolepsy with Cataplexy
- Cataplexy
15
Q
What is defined as more than _____ episode of generally brief (<2 mins) usually ____ symmetrical sudden loss of muscle tone with retained consciousness?
- Precipitated by strong emotions - usually +, some with laughter
- Transient reversible loss of DTRs
- In children: may present close to disease onset as facial hypotonia with droopy eyelids, mouth opening, protruded tongue, gait disturbance, facial/masticatory movements may occur (reward is a common precipitant)
A
Cataplexy
- one
- bilaterally
16
Q
What type?
- Criteria A-E must be met:
- A: daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least _____
- B: Mean sleep latency of = 8 minutes and 2 or more sleep onset REM periods found on MSLT; a SOREMP on the preceding nocturnal polysomnogram may replase one of the SOREMPs on the MSLT
- C: Cataplexy is absent
- D: Either CSF hypocretin-1 concentration has not been measured or CSF hypocretin-1 concentration measured by immunoreactivity is either > 110 pg/mL or >1/3 of mean values obtained in normal subjects with the same standardized assay
- E: Not better explained by other causes - insufficient sleep, OSA, delayed sleep phase disorder, effect of meds/substances/withdrawal
A
Type 2 - Narcolepsy
- 3 months
17
Q
Hypocretin/Orexin:
- 2 highly homologous neuropeptides - hypocretin 1 & 2
- Found in only a few _____ cells, all in the _____ area of the ________
- Extensive projections thoughout CNS, including?
- Central administration of hypocretin-1 stimulates _____ and _____ REM sleep
A
- thousand cells, perifornical, posterior hypothalamus
- Limbic system
- Monoaminegic cell groups
- Intrahypothalamic nuclei
- Cerebral cortex
- Spinal cord
- Thalamus
- wakefullness, suppresses
18
Q
Hypocretin/Orexin:
In animal models, levels fluctuate over 24 hour cycle, suggest driven by ______ influences and indirectly by _______
A
Circadian, increased sleep debt
19
Q
What is the TETRAD of symptoms of Narcolepsy?
*** The last 3 are all REM phenomenon intruding into wakefulness
- Other associated features - disrupted sleep, obesity, anxiety/panic attacks
Diagnostic evaluations: requires _____ to evaluate nightime sleep and document adequate sleep/mean sleep latency
A
- Sleep attacks
- Hypnogogic/hypnopompic hallucinations
- Sleep paralysis
- Cataplexy
- Eval: overnight polysomnogram
20
Q
Treatment for narcolepsy?
- Behavioral
- ?
- ?
- ?
- Medications
- ?
- ?
A
- Behavioral
- Adequate daytime sleep
- Daytime naps
- Keeping physically active
- Medications
- Sleepiness - modafanil, amphetamines, atomoxetine
- Cataplexy - sodium oxybate, SSRIs
21
Q
What parasomnias occur during:
- REM sleep
- Non-REM sleep
- Other parasomnias without regard
A
- REM
- REM behavior disorder
- Painful erections
- Non-REM
- Confusional arousals
- Sleep walking
- Sleep terrors
- Other
- Bruxism
- Sleep groaning/moaning
- Rhythmic mvmt disorder
- Enuresis
- Sleep talking
22
Q
Diagnosis:
- Loss of REM atonia, patient “acts out” dreams
- Acute and Chronic forms
- Acute - toxic/metabolic (EtOH/BZD withdrawal, biperiden intoxication)
- Chronic - Idiopathic, neurologic disease (narcolepsy, EP disease, NPH, mitochondrial disease)
A
REM Behavior Disorder
23
Q
Diagnosis?
- Tends to arise from slow wave sleep (N3-4)
- Most common in 1st third of the night
- Common in childhood, decreases with age
- Frequently + family history
- Medication induced cases reported
- Arousals can provoke episodes
- Increased tiredness, sleeping in unfamiliar place may increase likelihood of episode
A
Non-REM parasomnias
- Confusional arousals
- Sleep walking
- Sleep terrors
24
Q
Sleep is entered via?
- Slow wave sleep
- REM sleep
- NREM sleep
- Varies
A
NREM sleep
25
The majority of normal sleep is spent in stage...
* 1
* 2
* 3
* 4
* R
2
26
Most common complaint of OSAs Patients...
* Snoring
* Impotence
* Daytime sleepiness
* Headaches
Daytime sleepiness
27
The narcolepsy tetras does NOT include:
* Sleep paralysis
* Confusional arousals
* Sleep attacks
* Cataplexy
* Hypnogogic/hypnopompic hallucinations
Confusional arousals
28
Which is not true of non-REM parasomnias...
* More common in last 1/3 of the night
* More common in children
* Frequently a + family history
* Can be a medication side effect
More common in last 1/3 of the night
