Sleep

Question 1

patients with chronic fatigue and chronic pain have what pattern on their sleep study?

Answer 1

alpha intrustion
-alpha appears during NREM (when it should be delta)
-AKA alpha - delta sleep

Question 2

owhen do you see monomorphic spindles?

Answer 2

in patients with head trauma, hypoxic insults, brainstem lesions

Question 3

what is the gold standard for measuring airflow?

Answer 3

pneumotachograph - but cumbersome. not really used clinically

Question 4

what do you use to measure airflow clinically

Answer 4

thermistors or thermocouples
-base measurements on the temp difference of inspired and expired air
-cant measure air volumes and they overestimate the airflow and underestimate abnormalities

Question 5

what stages of sleep does bruxism usually occur?

Answer 5

N1 and N2

Question 6

what is sleep related movement disorder?

Answer 6

repeated forcible banging of head against pillow or mattress
-usually kids
-usualy N2

Question 7

what stages does sleep related movement disorder occur in?

Answer 7

N2, rarely N3 or REM

Question 8

sleep terror sleep stages?

Answer 8

NREM - usually N3

Question 9

N1 sleep characteristics

Answer 9

gradual disappears of alpha
-theta emerges
-slow rolling eye movements
-increase in beta activity
-vertex

Question 10

N2 sleep characteristics

Answer 10

frontocentral spindles and K complexes

Question 11

N3 sleep characteristics

Answer 11

slow wave delta at least 20% of the epoch

Question 12

REM

Answer 12

-no chin EMG artifact
-rapid eye movements
-background has low voltage mixed frequencies similar to wakefulness

Question 13

REM sleep disorder

Answer 13

hyperactive during sleep, REMEMBERS dream

Question 14

N3 delta

Answer 14

high voltage (greater than 75 mV), and slow (0.5-2 Hz) at least 20% of the epoch

Question 15

Sleep onset REM is usually associated with what?

Answer 15

narcolepsy
- but can be seen in sleep deprivation, circadian rhythm disorders, meds and med withdrawal

Question 16

PHB administrations causes leads to decreased ___ sleep?

Answer 16

REM
- not likely to be a culprit of REM onset sleep disorder

Question 17

what is needed to score apneas?

Answer 17

thermistor signal

Question 18

what is the definition of sleep onset REM during MSLT?

Answer 18

-occurrence of REM at ANY sleep stage during nap
-REM typically occurs about 90 mins after sleep onset
-occurrence of 2 SOREMPS with a MSLT of <8 mins is consistent with narcolepsy

Question 19

what are sawtooth waves?

Answer 19

notched, theta frequency waves in the central head regions
-REM sleep

Question 20

what is a respiratory effort related arousal?

Answer 20

airway resistance increases –> increased respiratory effort –> arousal

Question 21

respiratory event is scored as RERA when?

Answer 21

sequence of breaths lasts greater than or equal to 10 seconds
-increasing respiratory effort or by flattening of the inspiratory portion of the nasal pressure
-disturbs sleep

Question 22

what sleep stages is OSA worse in?

Answer 22

REM

Question 23

what stage of sleep walking occur in?

Answer 23

N3

Question 24

what stage do confusional arousal occur in?

Answer 24

NREM

Question 25

how to differentiate RLS and PLMD?

Answer 25

RLS- voluntary response to an uncomfortable feeling in legs PLMD- involuntary, often unaware of the movements

Question 26

criteria for narcolepsy?

Answer 26

2+ SOREMPS with a MSLT of less than 8 mins

Question 27

when do you usually see cheyne stokes breathing?

Answer 27

transition from wake to NREM -prominent durin N1 and N2 -attenuates during SWS and REM -have sleep fragmentation and attenuation of the breathing pattern

Question 28

what is the O2 desat in cheyne stokes usually?

Answer 28

not below 80% -PaC02 less than 45 *how to dif between hypoventilation

Question 29

why is the low frequency filter on the EEG component on sleep studies at 0.3 Hz instead of 1Hz like in regular EEGs?

Answer 29

to maximize recognition of low freq components. if you set it at 1 Hz then the low freq would be attenuated and N3 sleep would be underscored

Question 30

do high or low levels of orexin (hypocretin 1) promote sleep?

Answer 30

low

Question 31

a lesion in the ventrolateral preoptic nucleus of the hypothalamus causes what?

Answer 31

insomnia

Question 32

caffeine antagonizes what?

Answer 32

adenosine- promotes wakefulness

Question 33

What HLA type is almost always positive in narcolepsy?

Answer 33

HLA DQB1 *0602

Question 34

adults have how many REM cycles / night?

Answer 34

4-6

Question 35

sleep terror occurs when?

Answer 35

NREM- N3

Question 36

sleep terror

Answer 36

wake up confused, scared and don't remember

Question 37

in contrast to the typical EEG set up for PSG, what does a MSLT require?

Answer 37

additional occipital electrodes to look at the attenuation of the PDR at sleep onset

Question 38

a standard MSLT consists of what?

Answer 38

5 nap opportunities offered at 2 hr intervals

Question 39

when do you stop sleep meds prior to study?

Answer 39

at least 5 half lives of the longest metabolite

Question 40

how to score a leg movement for PLMS?

Answer 40

-after sleep onset -duration of 0.5-10 seconds -amplitude increase of at least 8 `microvolt above the resting EMG baseline -leg movements on 2 dif legs separated by less than 5 secs between movement onsets are counted as a single leg movement

Question 41

absent airflow and absent effort ?

Answer 41

central sleep apnea

Question 42

med used to treat central sleep apnea?

Answer 42

acetazolamide

Question 43

which EEG channels are routinely placed for PSG?

Answer 43

C4-A1 and C3-A2

Question 44

Does n1 increase or decrease with age?

Answer 44

increase - older adults are light sleepers

Question 45

infants and children spend the majority of time in what stage sleep?

Answer 45

N3 which declines in early adulthood

Question 46

REM increases or decreases with age?

Answer 46

decreases

Question 47

sleep latency in adults?

Answer 47

longer- takes longer to fall asleep compared to children

Question 48

barbiturates do what to sleep?

Answer 48

decrease SWS and REM - but also increase spindle activity

Question 49

Carbamazepine does what to REM?

Answer 49

decreases

Question 50

MWT

Answer 50

-assess the ability to stay awake during multiple daytime naps -room is lit -4 trials lasting up to 40 mins each done at 2 hr interals

Question 51

what is delta range is sleep terminiology

Answer 51

2 Hz or less, greater than 75 microvolt

Question 52

phenobarb leads to increase or decrease REM

Answer 52

decreased *withdrawal of phenobarb an cause SOREMP

Question 53

what is the definition of SOREMP

Answer 53

REM onset at any onset during the nap during MSLT

Question 54

idiopathic hypersomnia MSLT

Answer 54

MSLT < 8 mins and LESS than 2 SOREMPl

Question 55

phasic vs tonic REM

Answer 55

phasic -rapid eye movements, low voltage mixed frequency EEG, bursts of EM in chin and leg tonic -atonia, eye movements, dreams, irregular HR and respirations

Question 56

PSLM index to be positive?

Answer 56

>15/hr

Question 57

homeostatic sleep drive

Answer 57

increases with wakefulness

Question 58

circadian rhythm

Answer 58

modulated by suprachiasmatic nucleus of the hypothalamus

Question 59

what classifies as an arousal

Answer 59

abrupt shift of EEG frequency that lasts 3 seconds with at least 10 seconds of stable sleep preceeding the change *if during REM, requires a concurrent increase in chin EMG lasting at least 1 second

Question 60

during NREM what hormone is secreted

Answer 60

growth hormone

Question 61

during NREM what happens to BP, HRR, CO

Answer 61

decrease

Question 62

does obstruction cause tachy or brady

Answer 62

brady

Question 63

apnea definition

Answer 63

drop in oronasal breathing by at least 90% for at least 10 seconds

Question 64

hypopnea definition

Answer 64

drop in oronasal breathing by 30% for at least 10 seconds AND drop in O2 sat by at least 3% or an associated arousal

Question 65

central apnea thoraco-abd movements

Answer 65

no paradoxical movements no snoring!!!

Question 66

cheyne strokes breathing criteria

Answer 66

-min of 3 consecutive central hypopnea/apnea events --> crescendo/descrendo-- > 45 - 90 sec

Question 67

how do you calculate arousal index

Answer 67

number of arousals / total sleep time

Question 68

how many minutes in 24 hr period needs to be sleep to be IH?

Answer 68

>660 min