Obstructive Sleep Apnea (Breathing stops during sleep)

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Obstructive Sleep Apnea (Breathing stops during sleep)

  1. 1. Sleep Disorders ←Obstructive Sleep Apnea (Breathing stops during sleep) • Prevalence 4-8% • What is it? o Apneas o Hypopneas (difficulty breathing or slow breathing) o EDS (excessive daytime sleepiness) • Risk Factors o Obesity  Look at neck circumference and upper airway o Male gender o Family history • Symptoms o Night  Snoring  Apneic episodes  Restlessness o Daytime  EDS  Clumsiness  Dry mouth
  2. 2.  HA??? (?) • Complications o Systemic and pulmonary HTN (hypertension) o Arrhythmias o Congestive heart failure • Treatment o Behavioral o nCPAP (nasal continuous positive airway pressure) o Oral Appliance o Suregery  UPPP (Uvulopalatopharyngoplast)  Removal of the uvula and soft tissue in the back of the mouth  Tonsillectomry/adenoidectomy  Tracheostomy ← ←Restless Legs Syndrome • Leg discomfort with desire to move leg o Causes motor restlessness o Worsen sensorimotor symptoms when inactive (repose)  Also evening and early night • Can cause insomnia and EDS
  3. 3. • Signs o PLMS – periodic limb movements in sleep  Different entity • 2ndary cases o iron deficiency o uremia – excess urea in blood – can be due to kidney failure o neuropathy • Treatment o Treat underlying disorder if present o Time does to symptoms o Recommended agents  Dopaminergic  Benzodiazepines  Opioids  AEDs o Sleep Hygiene tips Sleep when sleepy Get up and do something if you cant fall asleep No naps Get up at the sametime ←NREM Arousal Parasomnias – see in children a lot
  4. 4. • Sleep terrors o Signs  Sitting  Scream w/ facial expression of acute terror  Tachycardia  Tachypnea  Diaphoresis – sweating o Can evolve into walking o They have poor recall o Last less than 5 minutes o What to do  Reassure parents  DO NOT forcefully interfere  Medicine: Benzos or TCAs • Confusional arousals o Confusion with partial awakening  NO signs of acute fear or walking behaviors o DO NOT INTERFERE • Sleep walking o Sits, blank facial expression, gestural automatisms, moves around (gets out of bed), complex or purposeless behavior, injuries o Poor recall
  5. 5. o Last less than 15 minutes o Concerns  Environmental safety  Avoid forceful interference o Treat  Benzos  TCAs ←REM Sleep Parasomnias • Nightmares o Frightening dreams that usually awaken the sleeper o Late night o No screaming or walking o Recall • REM Sleep Behavior Disorder o Vigorous sleep behaviors usually accompanying vivid dreams o Injure self frequently o Associated with neurological disorders o Treatment  Environmental safety  Protect against injury  Clonazepam++
  6. 6.  90% effective ←Narcolepsy • Signs o 100% have  EDS & sleep attacks o 70% have  cataplexy – go to sleep when sudden stimulus occurs o sleep paralysis o hypnagogic hallucinations  hypnagogic = transitional state or when entering sleep o full tetrad – or have all the above  15% • Treatment o Modafinil or indirect sympathomimetic drugs (stimulate dopamine relase and inhibit reuptake)  Treats EDS o Antidepressent drugs – inhibit adrenergic reuptake  Treats cataplexy ←Nocturnal Seizures • 15-30% of epilepsy patients have night seizues only • what stage of sleep do they occur in o NREM
  7. 7. NOTE TO SELF – probably b/c you are “paralyzed” in REM sleep • Stereotyped, may cluster • Diagnostic Evaluation o Polysomnography (PSG), MSLT (multiple sleep latency test) o Video EEG o Polysomnography with video ←So what is a PSG • Measure multiple physiologic parameters during sleep o EEG o EOG o Submental EMG (remember from Rill lecture slides) o ECG o Respiration o Blood oxygneation o Body and limb movement o Audiovisual monitoring and behavioral observation • Indications – what can you diagnosis with it? o OSA: RDI > 5 (respiratory distress index with 0-5 normal) o RLS o NREM parasomnias  Repeated sudden SWS (slow wave sleep) awakenings o RBD (REM sleep Behavior Disorders)  Persistence or increase in EMG during REM  Under chin monitoring – they are active when they should be paralyzed ←What is the MSLT (multiple sleep latency test) • Take a series of naps (4-5) every 2 hours over a day o Usually then do a PSG overnight • Calculate o mean sleep latency o # of SOREM periods (sleep onset REM) • SO what Well if MSL < 5 mins/ 2 or more SOREMS there is pathology ←
  8. 8. 28/04/2005 15:15:00 ←
  9. 9. 28/04/2005 15:15:00 ←

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