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Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
Sleep disorders
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Sleep disorders

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Sleep disorders

Sleep disorders

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  • 1. Sleep, sleep disorders Professor Yasser Metwally
  • 2.
    • Each of us will spend about 27 years of our lifetime sleeping…..
    • … ..And 1/3 part of the population has sleep disorder
    About the sleep…
  • 3. „ Why we sleep remains one of nature’s greatest mysteries”
    • (MG Frank, The function of sleep, 2006)
    • Somatic theories of sleep function
    • Neural metabolic theories: detoxification and regeneration
    • Cognitive theories of sleep function: learning and brain development
  • 4. Regulation of sleep
    • Cirkadian timing: lasts about 24 hours
    • Hypothalamus
        • Suprachiasmatic nucleus
    • Pituitary gland: melatonin
    • Ultradian timing : lasts less than 24 hours
    • Prepontin nuclei
    • Raphe nuclei
    • L. coeruleus
  • 5. Normal human sleep
    • Sleep cycle – occurs about every 90 minutes,
    • approximately 4-6 cycles occur per major sleep episode
    • Microarousal
    • NREM (70-80%)
        • slow wave sleep
        • heart rate, BP, breathing ↓
        • body temperature, muscle tone ↓
    • REM (20-25%)
        • rapid eye movement, paradox, fast wave sleep
        • heart rate, BP, breathing ↑ , metabolic rate ↑
        • dreaming, erection
        • muscleatonia, BUT: myoclonus!
  • 6. NREM
    • stage (3-8%) ~ drowsiness, sleepiness EEG: α -activity, muscle tone, eye movement ↓, myoclonus!
    • stage (45-55%) ~ EEG: K-complexes, sleep spindles, no eye movement
    • stage (5-10%) EEG: delta waves
    • stage (15-20%) slow wave sleep
  • 7.
      • Tonic stage (desyncronized EEG ~ low voltage, frequency ↑ , muscle atonia)
      • Phasic stage (rapid eye movements ~ fast, saccadic eye movements ~, irregular breathing, heart rate ↑ , myoclonus, apnea, hyperpnea, dreaming!!!)
    REM
  • 8. Sleep disorders
  • 9. Polysomnography
    • multiparametric monitoring during 1 sleep period (1 night)
    • EEG
    • Electrooculogram
    • EMG
    • ECG
    • Respiratory effort
    • SpO 2
    • Body position
    • Snoring
  • 10. More than 80 sleep disorders are known (International Classification of Sleep Disorders, 2 nd Edition American Academy of Sleep Medicine, 2005)
    • Insomnias (33%)
    • Sleep related breathing disorders (1,4-40%)
    • Hypersomnias (0,3-16,3%)
    • Cirkadian rhythm sleep disorders
    • Parasomnia
    • Sleep related movement disorders
    • Isolated symptoms, normal variants
    • Other sleep disorders
  • 11. Traditional classification of sleep disorders
    • Dyssomnias : abnormalities in the quantity, quality or timing of sleep. They are associated with difficulty initiating or maintaining the sleep or daytime sleepiness.
    • Parasomnias : abnormal behavioral or physiological events occurring during sleep but don’t involve the sleep mechanisms per se.
  • 12. I. Insomnias
    • Difficulty in initiating sleep or in staying asleep or waking up earlier
    • Nonrefreshing, nonrestorative sleep
    • Fatigue, concentration or memory impairment
    • Mood disturbances, motivation, initiative reduction
    • Daytime sleepiness
    • Tension headache
  • 13. I. Insomnias
    • Prevalence: 33%
    • Accompanied with daytime consequences: 10%
    • Last less than 1 month: 4% (transient insomnia)
    • Last more than 1 year: 85% (persistent insomnia)
    • Male:female = 1:1.4
    • Increase with age: above 65 years: 50%
  • 14. I. Insomnias
    • Primary (idiopathic)
    • Secunder
      • Inadequate sleep hygiene (10%)
      • Paradoxical insomnia (10%)
      • Insomnia due to mental disorder (30-40%)
      • Psychophysiological insomnia (15%)
      • Insomnia due to drug or substance
      • Insomnia due to medical conditions
      • Sunday night insomnia
  • 15. Treatment
    • Treating the medical or psychiatric conditions (sec. insomnias)
    • Nonpharmacologic:
      • behavioral treatments: normalizing the circadian rhythm
      • sleep hygiene
      • cognitive behavior therapy
      • sleep restriction therapy
    • Pharmacologic treatment
  • 16. Pharmacologic treatment
    • Benzodiazepines
      • midazolam, triazolam ~ rebound insomnia
      • cinolazepam, quazepam
      • brotizolam, temazepam
      • nitrazepam ~ drowsiness
  • 17. Pharmacologic treatment
    • Selective GABA A agonists: nonbenzodiazepines
      • no rebound insomnia
      • zolpidem, zopiclon
    • Melatonin receptor agonist
      • ramelteon
  • 18. II. Sleep related breathing disorders (International Classification of Sleep Disorders, 2 nd Edition American Academy of Sleep Medicine, 2005) 3. Sleep related hypoventilation/hypoxemia 1. 2.
  • 19. Apnea-hypopnea index (AHI)
    • Numbers of apneas and hypopneas/ 1 sleeping hour
    • Severity of sleep related breathing disorders:
    • Normal: AHI<5/h
    • Mild: AHI: 5-15/h
    • Moderate: AHI:16-30/h
    • Sever: AHI>30/h
    Sleep, 1999:22:667-89.
  • 20. OSAHS: symptoms
    • Daily
    • Excessive daytime sleepiness
    • Unrefreshing sleep
    • Memory disturbances
    • Morning headache
    • Depression
    • Decreased libido
    • Stomach ache
    • Nightly
    • snoring
    • apneas
    • choking, gasping
    • arousals
    • sweating
    • dry mouth
    • palpitation
    • nycturia
  • 21. OSAHS: diagnostic criteria
    • (1. or 2.) and 3.
    AASM, Sleep, 1999:22:667-89.
  • 22. Risk factors of OSAHS
    • Obesitas
    • Age
    • Male gender
    • Pozitive family history of OSAHS
    • Alcohol consumption before bedtime
    • Race
    • Smoking
    • Sedatives
    • Craniofacial anomalies
    • Hypothyroidism, acromegaly
  • 23. Treatment of bening snoring
    • Weight loss, alcohol withdrawal
    • Position training
    • Nasal, pharyngeal surgery (UPPP)
    • Oral appliances
    Treatment of OSAHS : nasal CPAP
  • 24. IV. Cirkadian rhythm sleep disorders
    • Primary
      • Delayed sleep phase type
      • Advanced sleep phase type
      • Irregular sleep phase type
    • Secondary
      • Jet lag type
      • Shift work type
    • Treatment
      • Sleep hygiena
      • Cronotherapy
      • Light therapy
      • Melatonin, zolpidem
  • 25. V. Parasomnias
    • In NREM
      • Myoclonus
      • Enuresis nocturna
      • Pavor nocturnus, night terrors
      • Sleep walking - somnambulism
      • Bruxism
    • In REM
      • Nightmares
      • REM sleep behavior disorder
  • 26. VI. Sleep related movement disorders
    • Restless legs syndroma
      • Therapy: dopamin agonists
    • Periodic limb movement disorder
    • Sleep related leg cramps
    • Sleep related rhythmic movement disorder

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