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50 Cards in this Set
- Front
- Back
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What is the definition of hypopnea?
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irregular resp event reduced airflow/reduction of thoraci movement from 30 % baseline with 4% desaturation; 50% reduction in flow with 3% desaturation, lasting more than 10 seconds in adults (more than 2 resp cycles, 5 seconds in kids)
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What is central apnea?
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cessation in respiratory effort, airflow, thoracic/abdominal movement, 4% decrease in O2 sat or <4% with EEG arousal, lasting >10 seconds (children 3% O2 desat, 25% decrease in heart rate)
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What is obstructive apnea?
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cessation or near cessation of airflow with reduced thoracic/abdominal movements with >3# oxyygen desat, or EEG arousal
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What is the calculation for effective minute ventilation?
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5*Wt(kg*respiratory rate, event length >90 seconds, reduction of airflow to a less than effective tial volume and minute ventilation or end tidal CO2 >50 torr
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What is the definition of a transient arousal?
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abrupt shift in EEG frequency for at least 3 seconds but not enough to be awake, (arousal during REM if accompanied by increased submental EMG)
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What is the definition of PLM series?
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series of 4 movements separated by 5-90 seconds, duration of 0.5-5 seconds with 8 microvolt increase in leg EMG
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What are 9 symptoms of narcolepsY?
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1. misery 2. lethargy 3. excessive daytime sleepiness 4. cataplexy provoked by laughter, emotion, athletic 5. daytime naps with partial relief of EDS 6. sleep attacks 7)hyponogogic hallucinations 8)sleep paralysis 9 episodic paroxysmal muscular weakness
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What is characteristic of narcolpesy on NPSG?
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short sleep latency, short REM latency, increased awakenings, nomral state, periodic leg movements, mild sleep apnea
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What 3 medicatins are used in the US to treat narcolepsy?
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Provigil, Ritalin, Dexedrine
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What 4 meds are used to treat cataplexy, sleep paralysis, hypnagogic hallucations?
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GHB, protriptyline, imipramine, fluoxetine
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What are 6 management strategies for PLMS?
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1. Pramipexole
2. Ropinorole 3. Pergolide 4. L-dopa 5. Klonopin 6. Avoid caffeine, tea, TCAs, SSRIs |
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What 4 criteria are used to diagnose RLS?
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urge to move the leg
at least partial relief with leg movement worse at night worse with recumbency |
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What treatmetns are used for RLS?
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pramipexole, ropinorole, pergolide, l-dopa, clonazepam, vitamin E, narcotics, opioids, cbz
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What is idopathic hypersomnia?
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recurrent daytime sleepiness, no attacks, naps not refreshing
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What si the differential for idiopathic hypersomnia?
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communicating hydrocephalus, post-traumatic hypersomnolence
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What is normal age or onset and remission in Kleine-Levin syndrome?
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10-21 onset, remission by 40
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What are the 3 characteristics of Kleine Levin?
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voracious eating, loss of sexual inhibition, long periods of sleep
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What is episodic nocturnal wandering?
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indistinguishable from somnambulian and night terrors, responds to anticonvulsants
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What are some examples of diencephalic or autonomic sz?
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apnea, stridor, cough, laryngospasm, local hyperhidrosis, flushing arrhythmias, chest pain
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What headaches may be associated with REM onset?
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chronic paroxysmal hemicrania, cluster headaches
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When should one score a respirtaory effort-related arousal?
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>10 seconds, increasing resp effort, flattening of nasal pressure waveform, arousal of sleep but does not meet criteria for apnea or hypopnea
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What is the definition of hypoventilation?
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Increase in PaCo2 by more than 10 mmg HG
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What is the definition for Cheyne Stokes breathing?
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at least 3 consecutive cycles of cyclical crescendo and decrescendo change in breathing amplitude with 1 of the following: 5 or more central a/h per hour or duratin of 10 consecutive minutes
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What is the definition of asystole?
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interuption of cardiac rhthym lasting more than 3 seconds
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What is excessive fragmentary myoclonus?
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limb emg activity specific freq and duration unassoc with visible movement, not defined disorder
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What is the normal frequency of ye movements?
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0.5 to 2 HZ
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What are the 2 possible definition for hypoventilation?
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PaCO2 > 50 mm HG or rise by >10 mm Hg
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What percentage of TST is required to have high CO2 to be considered hypoventilation
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>25%
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What is the definition of periodic breathign?
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>3 episodes of central apnea lasting >3 seconds separated by no more than 20 seconds
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What are the differences in pediatric hypopnea compared to adult?
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>50% fall nasal pressure, 2 missed breaths, the falls must last >90% of the entire respiratory event assoc. with arousal or >3% desaturation
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How long should EFM last?
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maximum EMG burst duratino 150 msec, at least 20 minutes of NREM sleep with EFM, 5 emg potentials per minute
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What is the minimum number of bursts to make a train in hypnagogic foot tremor?
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4 bursts
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What is the min-max frequency of EMG in HFT?
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0.3-4 HZ
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How is bruxism definied in EMG ?
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0.25-2 seconds, 3 elevations in regular sequence, sustained more than 2 seconds or audibly
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What is the definiton of RM BD?
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Sustained muscle activity in REM sleep >50% of the muscle activity is transietn muscle activity with bursts 0.1-5 sec, 4X higher in amplitude
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What is the difference between respiratory related arousal and apnea/hypopnea?
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>10 seconds, flattening, nasal pressure signal , -20 cm H20 esophageal pressure, terminating with arousal
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What is duration of PLMS?
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0.5 to 5 sec
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What is PLMs change in amplitude minimum?
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8 microvolts
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What is the correction factor for carboxyhb?
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COHb-2%
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What is the definition of esophageal reflux?
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pH<4, >4% of TST
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What are 4 causes of noctunral hypoven?
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primary alveolar, central, high upper airway resistance, COPD
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What are 5 aspects of Pickwickian syndrome?
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1. obesity
2. alv hypovent 3. eds 4. sleep apnea 5. corpulmonale, cyanosis |
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What is primary alveolar hypovent?
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no thoracic/pulmonary/neuro cuase, normal PFTs, reduced response to CO2, pul hypertension, Na and H2O retention
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What are 5 causes of central hypovent (neuro)?
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WEE, bulbar polio, encephalitis, lethargia, PD, injury to reticulospinal tract
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acute pontine dysfunction
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central neurogenic hypervent
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lower pontine & medullary
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ataxic breathing
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lower pontine or upper medullary
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periodic hypercapnic
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hemispheric or diencephalic/
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hypocapnic cheyne stokes
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What are 9 ways to treat central sleep apnea?
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progresterone, medroxyprogesterone, diaphragm pacing, rocking bed, oxygen, mechanical ventilation, diamox, theophylline, doxapram
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What are 12 diseases associated with OSA?
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micrognathia, LS, hypertrophied tonsils, stroke, deviated nasal septum, renal disease, retrognathia, myxedema, acromegaly, allergic rhinitis, prader willi, obesity, lymphoma, acromegaly
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