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110 Cards in this Set
- Front
- Back
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More slow wave sleep in early life explains higher prevalance of ... |
Parasomnias |
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N3 |
More parasomnias |
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Posterior dominant rhythm |
Alpha 12-15 hz |
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Scn location |
Anterior hypothalamus |
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Decreased latency to R sleep, increased R sleep, increased # and density of rapid eye movements seen in.... |
Depression |
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Huntington disease sleep complaints |
Insomnia (initiation and maintenance) comorbid depression. Also with circadian rhythm problems(delay in melatonin rise in evening) - decreased stage R sleep, decreased N3, increased sleep spindles |
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Etiology of non 24 hr |
Loss of ipRGCs |
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Benzo effect on eeg |
Excessive beta acticivity- more prominent in frontal leads |
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What do you do about this high frequency finding? |
Apply a notch filter |
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What is this? |
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Labs in narcolepsy |
Hla dqb1 0602, low CSF hypocretin |
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What is this found with at higher rate? |
Nrem parasomnias- represents cyclic alternating pattern, when rate is high indicates that non-rem sleep is more unstable |
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Criteria for PLM |
Leg movement last 0.5 to 10 seconds, was at least an 8 micro voltage increase in EMG above the resting baseline, plms requires minimum of four consecutive movements with a period Length of 5 to 90 seconds |
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Growing pains is associated with |
Restless legs are periodic limb movement syndrome |
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Hirschsprung disease and neural crest tumors are associated with what condition |
Congenital Central hypoventilation syndrome |
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Gerd is more commonly associated with increased risk for_____ during infancy |
Central sleep apnea |
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Sleep-related seizures occur during what sleep stages? |
Stage N1 and n2 |
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At what time should low-dose melatonin be given for delayed sleep phase syndrome |
5 to 5.5 hours prior to desired time of sleep onset |
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PCOS is associated with increased prevalence of... |
Obstructive sleep apnea |
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Hi iPAP to epap differential has a potential worsen____ |
CSA by lowering paco2 below the apnea threshold |
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Nocturnal oxygen improves oxygen saturation in patients with obstructive sleep apnea but it also results in an.... |
Increase in duration of respiratory events |
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Sudden cardiac death and sleep apnea is most commonly seen during.... |
Duration of sleep *whereas in general population without obstructive sleep apnea most commonly cardiac events occur between 6 to 10 in the morning |
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Cycle length in periodic breathing is inversely proportional to cardiac output and is usually greater than.... |
45 seconds *In high altitude short cycle periodic breathing is seen lasting less than 45 seconds |
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Mechanism of chain Stokes respiration |
Heightwned Central and peripheral respiratory chemoreflexes with the hyperventilatory state resulting in hypocapnia and both sleep and wake |
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What is the role of supplemental oxygen in central sleep |
It eliminates sleep hypoxemia and lowers the ahi |
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How does oxygen reduce ahi in central sleep apnea |
Oxygen May decrease chemoreceptor sensitivity or increase cerebral partial CO2 level |
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What is indicative of poor prognosis and clinical deterioration in heart failure |
The presence of chain Stokes respiration during wakefulness |
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Bp dipping is a normal phenomenon in sleep... When this does not happen it is associated with? |
Sleep apnea, diabetes, stroke and heart attack, obesity |
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In what sleep state is glucose utilization in metabolic rate the lowest? |
Nrem |
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What are risk factors for Central sleep apnea? |
Atrial fibrillation and diabetes Heart failure |
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What are the most common arrhythmias associated with sleep apnea? |
Bradycardia and asystole, NSVT, 2nd degree av block, PVC |
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What bicarbonate level is predictive of obesity hypoventilation syndrome? |
>27 |
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What predicts better outcomes with use of oral appliance therapy? |
Younger age, lower BMI and positional osa |
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Most common contraindication of oral appliance therapy... |
Temporal mandibular joint disease |
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What is use of an oral nasal mask associated with? |
Higher rate of non-adherence by delivering increased pressure to the oral cavity may lead to posterior displacement of the tongue. residual ahi is often higher when using a oral nasal mask and some patients may need higher CPAP pressures |
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Which sleep aid can improve sleep apnea severity? |
Trazadone |
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If residual apnea-hypopnea index is less than 10 and patient is without residual symptoms, should a change be made to their PaP setting |
No |
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Medications that can induce restless leg syndrome |
Mirtazapine Lower rates with serotonin reuptake inhibitors like paroxetine or sertraline |
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Frequent slow movements during stage 2 sleep is seen with what class of medications |
Ssris |
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Causes of non rem parasomnias |
Sleep deprivation, obstructive sleep apnea, fever, periodic limb movement, restless leg syndrome, GERD - obstructive sleep apnea and restless leg syndrome should be treated when they are triggering non-rem parasomnias |
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Common sleep-wake transition disorders include... |
Hypnic jerks and rhythmic movement disorder (in kids manifest as headbanging, head rolling, or body rocking) |
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Rem eye movement duration... |
Less than o.5 seconds |
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Filter types |
High frequency Low frequency Notch filter(blocks specific frequency) |
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Impedance on EEG must be less than... |
5 kom |
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Notch filter is typically set at |
60hz |
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Polarity of the eye |
The cornea is + Retina is - |
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During what sleep stages does rhythmic movement disorder occur? |
Drowsy wakefulness and light sleep, very rarely from deep slow-wave or active REM sleep. The rhythmic pattern occurs at a frequency of 0.5 to 2 Hertz |
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At what age does rhythmic movement disorder typically stop? |
Age 4 |
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What is this? What is it associated with? |
Bruxism Associated with higher rate of cyclic alternating pattern with higher micro arousals |
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What can produce or worsen bruxism in sleep? |
Ssris and anti dopaminergic medications |
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Nocturnal leg cramps occur in what stages of sleep? What can they be due to? |
All stages Low calcium, neuropathy, peripheral artery disease, older age |
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Treatment for sleep-related leg cramps |
Strenuous stretching- daily Vitamin e and quinine Verapamil may possibly be effective |
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What is this and what is it associated with? |
Floppy eyelid syndrome - eyelids are rubbery floppy and easily everted, on questioning patients recall that they may raise their eyebrows for photographs Associated with obstructive sleep apnea can lead to reduced peripheral vision, propensity for eye irritation, foreign body sensation |
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What neurotransmitters are suppressed in slow-wave sleep and what neurotransmitters promote it? |
Norepinephrine and serotonin are suppressed Acetylcholine is released from the PPT and the lateral dorsal tegmentum |
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What is the treatment of recurrent isolated sleep paralysis? |
Antidepressants |
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Peak age for nightmares |
6 to 10 years of age |
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What medications can lead to nightmares? |
Antidepressants that react with dopamine, norepinephrine, and serotonin. Also beta blockers amphetamines and sedatives |
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What is the mechanism of action of prazosin |
Block Central alpha-1 adrenoreceptors |
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Medications that decrease nightmares |
Prazosin, fluvoxamine, trazodone and ciproheptadine |
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When to use BiPAP in COPD with suspected hypoventilation |
Typically fev1 will be less than 1 liter. oxygen use can help with pulmonary hypertension however will actually increase hypercapnia during sleep and those patients with hypoventilation |
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Diagnostic criteria for chronic insomnia |
Symptoms should be present for at least 3 days per week and must have been there for at least three months |
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What is a diagnostic criteria for short-term |
Duration of less than three months there is no weekly frequency requirement |
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What is true of patients with insomnia with regards to sleep latency and Total sleep Time |
They tend to overestimate their sleep latency and under estimate their Total sleep Time |
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What is involved in stimulus control? |
Patient should attempt to maintain a regular sleep-wake schedule and avoid napping, use the bed only for sleep and sexual relations and attempt to fall asleep only want sleepy. Leave the bed to pursue relaxing activities if unable to fall asleep within 20 minutes. The latter step should be repeated as necessary |
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What is the focus of cognitive therapy as part of having a behavioral therapy for insomnia? |
Focuses on identifying and addressing distorted beliefs and attitudes and maladaptive behaviors related to sleep and insomnia |
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What are the side effects of quinine *Due to these side effects as well as limited-benefit the FDA has published strong advisory against its use |
Ocular toxicity, rare thrombocytopenia, and fatal hypersensitivity reactions |
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When are lambda waves seen? What leads are they in? |
Seen during scanning activities specifically reading Occipital leads |
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And what time does the lowest body temperature occur? |
Sometime between 3 and 4 in the morning |
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Vulnerability of bronchioles to respiratory failure occurs at what time |
2 to 4 a.m. |
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Arousals at the zenith of respiratory effort are seen in |
Centra apnea |
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What sleep stage is seen predominant after 1st night of SD? |
N3 |
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Patients with x have more theta and delta waves during wake |
Sleep deprivation |
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Gain weight Gastric cells Ginormous Ghrelin is high in what sleep condition ? |
Sleep deprivation |
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Infant |
2months to 1 year |
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Percentage of rem sleep in infants ? |
50% |
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Nrem-rem cycle length in infants? |
50-60 min |
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Sleep spindles develop at..... Delta waves develop at.... K complexes develop at.... |
1 month 3 months 6 months |
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Trace alternant- 25uV alternating with 100-200uV seen at how many weeks gestation? |
34 weeks to term in quiet sleep |
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Trace discontinu- earliest EEG activity that appears in viable neonate. Slow and fast rhythm interspersed against a flat or quiescent background. Seen at what gestational age? |
32 weeks |
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TST for 1m TST for<1 yr TST 1-3 yrs TST 3-5 yrs >5 yrs |
19 hours 15 hours 12 hours 10 hours 9 hours |
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Women are generally >or< symptomatic then man at same AHI |
More symptomatic *Also tend to manifest with more insomnia as well as mood disorders rather than snoring and apnea |
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True or False Women have < supine position dependancy than men |
True |
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True or False Women have less significant oxygen drops than men |
True |
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Ahi of 25 who is at higher risk of MI man or woman? |
Women- studies show worse survival and increased endothelial dysfunction *Lower risk of stroke than men |
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AC amplifiers are used for ... |
EEG, EMG, EOG,ECG these are high frequency fast variables |
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DC amplifiers are used for? |
Sao2, CPAP levels - low frequency or slow variables |
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What direction is the eye moving? |
Negative deflection is the direction of movement so in this case the right eye lead |
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What direction is the eye moving? |
Negative deflection is the direction of movement so in this case the right eye lead |
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Electrode placement- how would this be put in numeric terms? |
E1M2 E2M2 |
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Placement of chin leads? |
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What is this rhythm? |
Vtach |
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What is this rhythm? |
Vtach |
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Scoring hypoventilation in pediatrics? |
>50 mmHg for >25Percent of TST |
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Criteria for scoring PLMS? |
1. Greater than or equal to 4 consecutive leg movements 2. Each is 0.5-10seconds in duration 3. 5-90 sec between consecutive leg movements 4. Greater than or equal to 8 microvolts above resting EMG |
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What is this? How do you fix it? |
Fix electrode placement or change lead, apply more electrode gel |
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What is this? What is it synchronous with? |
Sweat artifact , synchronous with respiration Alteration in electrode potentials by salt in sweat Fix it by lowering temp in room |
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What medications decrease N3 and REM? |
Benzos, stimulants, opioids |
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What medications increase N3, decrease R and increase R sleep latency? |
Antidepressants |
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What medications increase N3, decrease R and increase R sleep latency? |
Antidepressants |
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What effect do benzos have on the EEG? |
Increase spindle density |
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Can lead to slow eye movements during NREM sleep? Can induce RBD? |
SSRIs |
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Medications that can induce or worsen RLS and PLMD? WHAT IS THE EXCEPTION? |
Antidepressants Exception- buproprion |
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Affects of acute alcohol ingestion on sleep? First part SOL...WASO...N3....REM SL...R... |
Dec, Dec, inc, inc, dec |
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Affect of acute alcohol ingestion on 2nd part of sleep period? WASO...N3...REM |
Inc, Dec, inc |
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Rhythmic movement disorder |
Occurs in infants and remits by age 5 in most cases. Occurs during transitions into and from sleep(drowsiness). May lead to daytime symptoms, injury. Stopped by waking up the child. Ddx seizure other movement disorder |
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Medications for isolated sleep paralysis(recurrent) |
TCAS and SSRIS Clomipramine and fluoxetine |
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What else do those with recurrent isolated sleep paralysis experience? |
Hallucinations Episodes last a few seconds to 20 min Thought to be behind extraterrestrial abductions/paranormal activity Higher prevelnace in women and psychiatric disease |
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What is the cause of floppy eye lid syndrome? |
Systemic inflammation due to OSA |
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Why you should use lower dose of melatonin for delayed sleep wake? |
Higher dose may lead to residual affect in the morning and may further delay pt. Some evidence to use melatonin low dose right before desired bedtime as melatonin production is suppressed by light (affect on retina) |
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What gene is associated with dswpd? |
Hper3 |
