Sleep

Question 1

Three physiological changes during sleep that contribute to ventilatory instability

Answer 1

1. Alterations in ventilatory control - decrease responses to hypoxemia and hypercapnia
2. FRC reduced by 200-300 ml - decreased tidal volume with increased rate
3. Increased upper airway resistance

Question 2

Home sleep apnea test

Answer 2

Used to rule in OSA >5 AHI/hour
If less and high suspicion, do full study
Treatment of apnea:
- CPAP in moderate to severe (AHI >15) or mild (>5) with symptoms

Question 3

Narcolepsy

Answer 3

• Defined as excessive daytime sleepiness for > 3 months with a mean sleep latency of < 8 minutes on a MSLT and 2 or more sleep onset REM periods (SOREMs)
• SOREM - TEM onset within 15 minutes of sleep in 1 of 5 naps or PSG
• Type 1
• Type 2 - absence of cataplexy and normal hypocretin-1 levels in CSF

Treatment: armodafinil or modafinil for initial treatment

Question 4

Cataplexy

Answer 4

Weakness of muscles or paralysis associated with a strong emotion or laughter during wakefulness

Question 5

REM Behavior Disorder

Answer 5

• REM sleep without muscle atonia
• Patients act out dreams
• Associated with Parkinson’s, Levy body
• Can be presenting signs of degenerative disease
• Treated with benzos (clonazepam) or melatonin
• benzos contraindindicated in glaucoma

Question 6

Treatment-Emergent Central Sleep Apnea

Answer 6

Occurs in 10% of titration studies
Spontaneously resolves
Should never be treated with bilevel with backup rate
Not associated with benzos
Is associated with opioids

Question 7

Hypoglossal Nerve Stimulation

Answer 7

• AHI 20-65
• BMI < 32
• Age > 22
• Anterior/posterior collapse of soft palate
• second line after CPAP

Question 8

Definitions

Answer 8

• Apnea - > 90% drop in flow for 10 seconds
• Hypopnea - > 30% drop in flow with 4% or more drop in saturation
• Mild AHI 5-15
• Moderate 16-30
• Severe > 30

Question 9

CPAP

Answer 9

• set pressure to achieve 90% percentile improvement in AHI

Question 10

Biots Breathing Pattern

Answer 10

• abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea.