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inservice - sleep
Terms in this set (37)
What are the stages of sleep?
"W - wakefulness (alpha waves)
NREM1 (~5%) - transition to sleep (less alpha waves, slow eye movements, vertex waves, theta waves)
NREM2 (~50%) - K waves, sleep spindles
NREM3 (~20%) - restorative sleep (delta waves)
REM (~25%) - rapid eye movements (sawtooth, similar to N1 but no vertex waves)
N3 happens in first half of night, REM happens in last half of the night"
What 2 stages of sleep have eye movement
"NREM 1 - slow eye movement
REM - rapid eye movement
EEG readings also similar, except REM has ""sawtooth waves"" and lacks the vertex waves"
What stage of sleep is the restorative stage
stage 3 - delta waves
Where are the electrodes placed during polysomnography
"frontal, central, occipital.
Eyes for ocular motion
what stage of sleep are there delta waves
stage 3 - delta waves
what stage of sleep are there theta waves
what stage of sleep are there alpha waves
what stage of sleep are there beta waves
what stages have low amplitude, mixed frequency waves
stage 1, REM
what stage has vertex waves
what stage has K complex waves? What are they associated with?
stage 2, come with sleep spindles
what stage has sawtooth waves
describe the PSG/name the waves in stage 1
less alpha waves. Addition of slow eye movements. Vertex waves. Theta waves.
describe the PSG/name the waves in stage W sleep
describe the PSG/name the waves in stage 2 sleep
K complexes. Sleep spindles.
describe the PSG/name the waves in stage 3 sleep
delta waves (slow waves)
describe the PSG/name the waves in REM sleep
rapid eye movement. EEG similar to stage 1, except no vertex waves. Also has sawtooth waves (see next card)
what do sawtooth waves look like and what stage sleep do you see them in?
how do you differentiate between "slow" and "rapid" eye movement
slow > 0.5 seconds, fast < 0.5 seconds
what are pseudo-spindles and what stage are they seen? What cuases them?
stage 2 - longer duration and higher frequency, seen in N2 with benzos and antidepressants
how is disorganized sleep defined?
sleep pattern appears awake even though patient is asleep. Seen with opiods.
how do you define apnea
drop in oronasal thermal sensor >= 90% of baseline for > 10 seconds (no O2 desats or arousals required)
how do you define hypopnea
"1. ""30-4"" criteria: nasal air pressure decrease by >=30% of baseline lasting > 10 seconds with 4% o2 desat and no arousal required
2. ""50-3/arousal"" criteria: >=50% of baseline lasting > 10 seconds with >=3% o2 desat OR arousal"
what is respiratory related arousal
RERA - arousal preceded by respiratory effort but does not meet criteria for apnea/hypopnea lasting >= 10 seconds
obstructive vs. central apnea
"obstructive: apneic event assoc with increase in resp effort during event
central: apneic event without associated respiratory effort
mixed: apneic event that begins with lack of resp effort but effort resume in last portion"
what is AI/AHI/RDI
"apnea index: apneas/hour
apnea-hypopnea index: apneas and hypopneas/hour
respiratory distress index: apneas and hypopneas and respiratory related arousals/hour"
how is OSA defined
>= 5/hour apnea/hypopnea/RERA with symptoms OR >=15/hour respiratory events without symptoms
where is the most common location of collapse
velopharynx (normally> 11mm). 2/3 incidence of multiple airway collapse at retropalatal/retrolingual airway. Collapse happens at end of expiration
what is the scoring for the modified muller maneuver
Abnormal if > 50% collapse"
The MM consists of having the patient perform a forced
inspiratory effort against an obstructed airway with fiberoptic endoscopic visualization of the upper airway. The test is widely used and simple to perform. Despite this, its use is controversial and certainly no studies have been able to associate the maneuver as a tool to select patients who
are likely to succeed with UPPP
what is the mallampati scoring
"perform with tongue extruded
2. uvula/tonsils partially visible
3. base of uvula only, tonsils not visible
4. soft palate not visible"
what is the friedman scale
same as mallampati but done without tongue extruded (more often used)
2a: most of uvula seen but no tonsils
2b: entire soft palate visible to base of uvula
3: some soft palate
4. only hard palate visible
what is the fujita classification
"type 1: OP collapse
type 2: OP and hypopharyngeal collapse
type 3: hypopharyngeal collapse"
what is the most predictive indicator of OSAS
neck circumference >= 17 inches
how is mild/mod/severe OSA defined
"Normal: less than 5 events per hour is considered normal in adults.
Mild: AHI: 5-15
Moderate: AHI of 15-30
Severe: > 30 per hour, or an average of one hypopnea or apnea every 2 minutes or less"
what are the surgical indications for OSA surgery
"Apnea/Hypopnea Index (AHI) >20
Oxygen desaturation nadir <90%
esophageal pressure (PES) more negative than-10 cm H2O
Cardiovascular derangements (arrhythmia, hypertension), neurobehavioral symptoms (excessivedaytime sleepiness), failure of medical management, and clear anatomical sites of obstruction (nose, palate, tongue base) are all indications for surgical management"
Restless leg syndrome etiology and work up
Most commonly idiopathic but can be from low cns iron causing cell death in substantia nigra. Send for creatinine, ferritin, anemia, thyroid, b12, CSF FERRITIN MOST SENSITIVE.
Restless leg syndrome tx
Dopa agonists : pramipexole, ropinerole first line.
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