Sleep

Front 1

What stage of sleep reduced with aging?

Back 1

N3

More N1 sleep

Front 2

what does tidal volume do during sleep?

Back 2

Reduced tidal volume, RR stay the same

Front 3

What define hyponea?

Back 3

decreased in nasal pressure by >30% x 10 sec with >4% SpO2 drop.

Front 4

True/False:

Home sleep apnea testing is the stardard method for diagnosing uncomplicated OSA (no comorbities)

Back 4

True

Front 5

What defines apnea?

Back 5

90% reduction of peak thermal sensor amplitude x 10 secs and no inspiratory effort

Front 6

What is biot's breathing pattern?

Back 6

small bouts of central apneas.

central apnea on long acting narcotic

doe not go away when discontinue narcotics

Front 7

Which neurotransmitter s release from the pineal gland to regular circadian rhythms in humans?

Back 7

Melatonin

Front 8

What gene is involved in advance sleep syndrome?

Back 8

Per2 Gene

Early risers

Front 9

What is free-running circadian disorder?

Back 9

Non 24hr sleep

Usually occur in blind patients

Front 10

Which hypersomina disorder is due to lack of hypocretin?

Back 10

Narcolepsy type I

Front 11

What HLA typing is seen in narcolepsy with cataplexy?

Back 11

DQB1 type

Front 12

WHich med use to treat narcolepsy reduces the effective of the OCP?

Back 12

Modafinil

Front 13

What's is difference between IH and narcolepsy?

Back 13

IH doesn't get refreshed after napping

Front 14

Which hypnotic medication effect the melatonin?

Back 14

Ramelteon

Has no respiratory depression symptoms

Front 15

Which hypnotics are orexin antagonist?

Back 15

Suvorexin

Front 16

REM sleep behavior is a risk factor of type of dementia?

Back 16

Lewy body dementia

Front 17

Which population has the lowest prevalence of OSA?

A. Premenopausal females

B. Postmenopausal females

C. Adult males < age 50

D. Adult males > age 50

Back 17

Premenopausal females

Front 18

When is home sleep apnea (HSAT) indicated?

Back 18

simple OSA

w/o significant medical disorder:

-CHF

-COPD

-Stroke

-Hypoventiliation syndrome

W/o other sleep disorders: RLS, narcolepsy, insomnia

Front 19

True/False:

Continual use of CPAP following bariatric surgery will help maintaining long-term weight loss

Back 19

True

Front 20

True/False:

Patient with cheyne stokes has decreased chemoreceptor responsives to CO2

Back 20

False,

hyper-responsive to CO2. The problem is in decreased circulatory time.

Front 21

True/False:

Patient with cheyne stokes has increased ventilatory drive

Back 21

True.

Front 22

What's the finding of the SERVE-HF study 2015?

Back 22

ASV is associated with increase all-cause mortality in HF patients. (HR 1.28)

studied patients: Ef < 45% with central AHI >15.

Front 23

What structure in the brain acts as the master cicadian rhythm generator in mammals?

Back 23

Suprchiasmatic nucleus in the anterior hypothalamus

Front 24

When is the two circadian peaks of alertness?

Back 24

Late morning

Early evenining

Front 25

When is the two circadian troughs of alertness?

Back 25

Early morning

Early afternoon

Front 26

How does caffeine work?

Back 26

It increases wakefulness by blocking adenosine receptor (CNS neurotransmitter)

Front 27

Which neurotransmitter is responsible for REM?

Back 27

Acetylcholine

Front 28

What does the HR, cardiac output, and BP do during NREM sleep?

Back 28

HR decrease

CO decrease

BP decrease

Front 29

What does the HR, cardiac output, and BP do during REM sleep?

Back 29

HR increase

CO increase

BP increase

Front 30

What are the effect of REM sleep compared to NREM on the autonomic nervous system?

Back 30

Brief sympathetic surge during REM sleep.

Front 31

Which sleep stage do see K complex and spindles?

Back 31

N2

Front 32

Which sleep stage do you see delta waves?

Back 32

N3

Front 33

Which sleep stage do you see slow eye rolling and diminished alpha waves?

Back 33

N1

Front 34

Which sleep stage do you see Beta waves?

Back 34

AWAKE

Front 35

Which neurotransmitter is affected in narcolepsy type I?

Back 35

Lack of hypocretin

Front 36

Aside from clinical criteria, which lab is also diagnostic for narcolepsy type I?

Back 36

Low CSF hypocretin/orexin level, <110pg/ml

Front 37

True/False:

Modafinil reduces the effectiveness of OCP

Back 37

True

Front 38

What are the REM suppressing drugs?

this can be used for cataplexy

Back 38

SSRI

TCA

MAOI

Venlafaxine (SNRI)

Sodium oxybate

Front 39

What is Ramelteon?

Back 39

Melatonin agonist

short half-life, used for sleep onset insomnia

Contraindication: liver dysfunction, fluvoxamine use

Front 40

What are the nonbenzo benzodiazepine agonist?

Back 40

eszopiclone (Lunesta)

zaleplon (Sonata)

zolpidem (Ambien)

Front 41

What is suvorexant?

Back 41

Orexin receptor antagonist

side effect: cataplexy

Front 42

What are the two short half life hyponotics use for sleep onset insomnia?

Back 42

Ramelteon

Zaleplon

Front 43

What are the NREM parasomnias?

Back 43

Confusional arousals

Sleep terrors

Sleepwalking

Front 44

What are the REM parasomnias?

Back 44

Nightmares

REM sleep behavior disorder

Front 45

What pharmacologic therapy can be used for minimize parasomnia?

Back 45

First line: clonazepam

Then try melatonin

Front 46

What is diagnostic of PML?

Back 46

PML index > 15/hr. But no need to treat if not symptomatic.