Ent Review Sleep Medicine And Sleep Apnea Surgery

Front 1

LY- Sleep wake cycle definitions
1) Homeostatic drive
2) Circadian Rhythm, peaks?
3) Sleep inertia
4) Zeitgeber
5) Entrainment

Back 1

1) promotes sleep, increases while awake decreases with NREM
2) promotes wakefullness. 2 peaks- late morning and early evening
3) reduction in alertness after awakening (Groggy)
4) Recurrent cue (Light/dark)
5) coupling of cue to rhythm

Front 2

LY- Core body temp and sleep

Back 2

Warming = wake up (Coolest in the early morning --> Increase temp --> wake up

Cooling = Sleep
Hottest in evening --> Cooling --> Sleep

Front 3

LY- Sleep and brain nuclei
1) Locus ceruleus
2) Substantia Nigra
3) Leterodorsal tegmental
4) Dorsal raphe

Back 3

1) NE release --> Wakeful
2) Dopamine --> Wakeful (Parkinson's insomnia)
3) Ach--> Regulates REM
4) Seritonin--> NREM > REM

Front 4

Best sensor to measure
1) Apnea
2) Hypopnea

Back 4

1) oronasal thermosensor
2) nasal air pressure transducer

Front 5

Stages of Sleep (5)

Back 5

Stage W- Wakeful/drowsy --> Alpha waves
Stage N1- LAMF waves slow eye movements
Stage N2- K complexs, 50% of sleep
Stage N3- slow wave activity, 20% of sleep
REM- LAMF, phasic (Rapid EM), and tonic (Non-Rapid EM), 25% of sleep

Front 6

Scoring definitions
1) Apnea
2) hypopnea
3) Respiratory effort-related arousal (RERA)
4) RDI
5) Arousal

Back 6

1) >10s with drop in Oronasal temp sensor >90%
2) 30% drop with 4% desat OR 50% drop with 3% desat
3) Arousal preceded by 10s respiratory event that does not meet criteria for A or H
4) Measures A, H and RERA
5) Increase EED > 3s, must be proceeded by 10s of sleep

Front 7

Leg Movement definitions
1) Leg movement
2) PLM
3) PLMI, abnormal number

Back 7

1) Ant. Tibialis EMG 0.5-10s
2) 4 LM's within 90 seconds
3) PLMS x60/total hours sleep, abnormal >15

Front 8

Pediatric Scoring
1) Apneic event
2) Central apneic event
3) Hypopneic Event

Back 8

1) Duration of 2 breaths (NOT TIME)
2) Two ways
a) >20 seconds
b) 2 missed breaths with Arousal OR >3% desat

Front 9

MLST
1) Method
2) Measures
3) Narcolepsy

Back 9

1) 5 naps for 20 minutes at 2 hours intervals
2) sleep latency and REM latency
3) 2 REM episodes with sleep latency <8 minutes

Front 10

MWT
1) Why
2) How

Back 10

1) Maintain wakefullness in pilots/drivers
2) 4 trials of 40 minutes in 2 hours

Front 11

MC site of collapse

Back 11

Velopharynx

Front 12

Fujita Classifiations

Back 12

I- Retropalatal collapse
II- Retropalatal and retrolingual (MC)
III- Retrolingual

Front 13

Mallampati Score
vs.
Friedman

Back 13

I:Normal
II: Uvula at BOT
III: Uvula not visible
IV: soft palate not visible

Friedman: Don't stick tongue out

Front 14

Most predictive indicator of OSAS

Back 14

Neck circumfrence
Male > 17 inches
Female > 15.5 inches

Front 15

OSA: Mild, Moderate, severe

Back 15

Mild >5
Moderate 15-30
Severe > 30

Front 16

Mortality of OSA

Back 16

- 2.5 x risk of accident
- 5 x risk of cardiovascular death
- 5 x risk of sudden death at night

Front 17

MC cardiovascular effect of OSA, MC arrhythmia

Back 17

HTN, sinus arrhythmia

Front 18

Upper Airway Resistance Syndrome (UARS)

Back 18

Symptoms due to RERA without apneas/hypopneas

Front 19

Hypopharyngeal Surgery

Back 19

1) Tongue base reduction
2) Genioglossal advancement: Advance mandible segment with genioglossus attached
3) Genioglossal suspension: suspend tongue base to mandible
4) Hyoid myotomy and suspension: Hyoid released form infrahyoid muscles, suspended to lingual surface of mandible
5) Epiglottoplasty- Debulk epiglottis

Front 20

Cheyne-stokes breathing pattern, association

Back 20

Waxing and waning tidal volue, may be asymptomatic
- CHF, CV, renal failure

Front 21

Hypoventilation syndrome
- Physio
- Causes
- PSG findings
- 2 types

Back 21

- Abnormal increase in PaCO2 --> hypoxia without apneas/hypopneas
- Lung disease, pulm HTN, hypothyroid
- Long desaturation (<90% for 5 minutes) without A/H
- Types: lower airway (Lung), Upper airway obstruction (NM, chest wall)

Front 22

Restless Leg Syndrome
- Possible deficiency
- Cells that die
- Classic symptom
- Gene
- Most sensitive test
- Treatment

Back 22

- Iron
- dopminergic cells in substantia nigra
- Urge to move, relieved with movement
- CSF tranferrin level (crazy)
- Iron, Dopamine agonists (Pramipexole and Ropinirole), levodopa

Front 23

Types of insomnia
- Adjustment
- Psychophysiological
- Idiopathic
- Paradoxic
- Insomina due to.....

Back 23

- <3 months
- Anxiety, relieved with sleeping in a different place
- Lifetime, naps unrefreshing
- Overestimate sleep loss
- ...Mental disorder, medical condition, drug, poor sleep hygeine

Front 24

Childhood Insomnia
- Fatal familial insomnia
- Behavior Insomnia of childhood- Limit setting type
- Behavior insomnia of childhood- Sleep onset type

Back 24

- AD, autonomic hyperactivity, infections, oneiric stupor, death
- Parents can't set schedule, use transitional object (teddy bear)
- NO self soothing Trx: cry out

Front 25

Hypersomnia
- MC Cause

Back 25

- Chronic sleep deprivation

Front 26

Narcolepsy
- Symptoms
- Possible cause
- Cataplexy
- DX lab test
- Dx PSG
- Dx MSLT

Back 26

- Tetrad: sleepy, cataplexy, sleep paralysis, hypnagogic hallucinations (awake hallucinations)
- Decreased hypocretin NP
- Laughing --> loss of bilateral muscle tone , + consciousness
- CSF hypocretin-1 (Crazy!)
- Sleep onset REM <20-30 minutes
- 2/5 sleep onset REM, sleep latency < 8 minutes

Front 27

Narcolepsy Meds
- Long acting
- Short acting

Back 27

- Modafinil, Armodafinil
- Methyphenidate

Front 28

Klein-Levin Syndrome
- typical patient
- Symptoms

Back 28

- adolescent male
- recurrent insonmia, hypersexuality, aggressive, hyperphagia