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Flashcards in Sleep Medicine Deck (26):
1

SLeep

Reversible behavioral state of prceptual disengagement from and unresponsiveness to environemnt

2

Stage 2 and 3

2 - sleep spindles and K complexes

Delta - lower frequencyc and bigger WL

3

Sleep structure

More REM towards the end of sleep

4

NREM vs. REM sleep

HR
Resp rate
BP
Muscle tone
Brain O2
Ventilatroy
Temp
Sexual changes

HR, RR, and BP regulr in NREM, irregular in REM

No muscle tone in REm

More O2 in REM

Norma vent and temp in NREM, decreased response and poikilothermic in REM

Rare in NREM

5

Age and sleep architecture

WASO increases while SWS decreases

6

2 process model

Homeostatic pressure to sleep and circadian pressure to be awake

7

Circadian rhythm

Zerigebers entrained

Light, photic, meal times

Retinohypothalamic tract to suprachiasmatic nucleus which affects melatonin production from pineal gland

8

When to give melatonin

4-6 hours BEFORE bedtime

9

Sleep and endocrinology

Decrease leptin and increase ghrelin

10

Delayed sleep phase

Think teenagers

Confused with hypersominia and insomina

Lgiht exposure in AM, melatonin in PM

Later sleep onset and wake time

11

Advanced sleep phase

Earlier sleep and wake times

Confused wit hexcessive daytime sleepiness, depresison and insomnia

12

Ireegular sleep rhythm disorder

Disorganized

Occurs in several periods througout 24 hour cycles

13

Narcolepsty

Excessive daytime sleepiness

Hallucinations

Sleep paralysis

Under 25 onset

Naps ARE refrehsing (oppositve of OSA)

Sleep attacks

14

Narcolepsy type 1 and 2

Type 1 - With cataplexy...bilateral loss of muscle control mainting consciousness...HLA DQB-0602

Loss of hypothalamic hypocretin/orexin secreting neurons

Low CSF hypocretin-1 levels



Type 2 - without cataplexy, normal CSH hypocretin

15

Keline Levin

Recurrent hypersomnia

Young man

Head injury or febrile illness

Periods of hypersomnia followed by normal periods

Hyperphagia and hypersexuality

16

Dx of narcolepsy

Overnight polysomnography

MSLT - sleep latency less than 8 minutes and 2 sleep onset REM periods

17

Insomina

Difficulty falling and staying asleep

Not associated with daytime sleepiness

Tx NEVER a hyponotic agent

18

REM beahvior disorder

Acting out a dream content

Remember*** dream content

Late in night/early morning

Loss of REM aotnia

Tx with melatonin or benzos

Association with Pakrinsons and MSA

19

RLS

Abnormal sensation in legs close to bedtime alleviated by movement and interferes with falling asleeo

Similar to perioidc limb movement disordrr over 15/hr

Exclude Fe def, remove benadryl, SSRIs

Tx is dopaminergic agents

Beware of augmentation

20

Obstructive vs central sleep apnea

Obstructive- trying to breath

Central - not trying to breath

21

Risk factors for OSA

Post menopausal, age,

In children, tonsils and adenoids

22

Sx of OSA

SNoring

Witnessed apneas

Frwquent night time awakenings

Nocturia

Non restorative sleepp

Morning headaches

Execssive daytime sleepiness

23

Dx of OSA

Polysomnography and home sleep study

24

Tx of OSA

CPAP

Oral appliances have better compliacne

25

Central sleep apnea

Seen in children

CNS disorders

Most common cause is CHF

Tx is tx of underlying cause

26

Hypoventilation

CO2 retnetion

Congenital central hypoventilation - PHOX 2 B gene

ETCO2>50 for >10 minutes