Term
| what are the three main pain processing domains in the CNS? |
|
Definition
| sensory, affective, cognitive |
|
|
Term
| What regions comprise the sensory processing center of pain in the CNS? |
|
Definition
| thalamus, primary and secondary somatosensory cortex, posterior insula |
|
|
Term
| what regions comprise the affective processing center of pain in the CNS? |
|
Definition
| anterior insula, anterior cingulate cortex, amygdala |
|
|
Term
| what regions comprise the cognitive processing center of pain in the CNS? |
|
Definition
| anterior insula, anterior cingulate cortex, amygdala, pre-frontal regions |
|
|
Term
| mechanisms underlying FM? |
|
Definition
| problem with sensory processing (hyperreactive insula, higher Glutamate levels than normal), decreased descending analgesia (absent or attenuated DNIC, brainstem activations with conditioning stimulus seen in controls but not FM patients) |
|
|
Term
| deficiency of descending analgesic activity in FM patients? |
|
Definition
| opioids are ineffective or marginally effective because of decreased opioid receptor binding; noradrenergic/serotonergics are in lower levels in CSF, and all drugs that raise BOTH serotonin and epinephrine are effective |
|
|
Term
| chronic pain may be what kind of disease? |
|
Definition
| neurodegenerative disease: decreased gray matter in DLPFC and thalamus, the more pain the more neurodegeneration there has occured |
|
|
Term
| biopsychosocial continuum |
|
Definition
| neurobiological: abnormal sensory processing, decreased analgesic activity, autonomic dysfunction, psychiatric disorders, HPA dysfunction, peripheral nociceptive input; psychosocial factors: general distres, psychiatric comorbidities, cognitive factors, maladaptive illness, secondary gain issues |
|
|
Term
| in fibromyalgia, what do pharmacological therapies address? |
|
Definition
|
|
Term
| in fibromyalgia, what is used to treat symptoms? |
|
Definition
| pharmacological therapies |
|
|
Term
| in fibromyalgia, what do nonpharmacological therapies address? |
|
Definition
| dysfunction; functional consequences of the symptoms |
|
|
Term
| what are the functional consequences of the fibromyalgia symptoms? |
|
Definition
| increased distress, decreased activity, isolation, poor sleep, maladaptive illness behaviors |
|
|
Term
| fibromyalgia is primarily a ___________ disease a) peripheral b)neuropathic c) central |
|
Definition
| central, a neural disease |
|
|
Term
| T/F: FM is a polygenic disorder |
|
Definition
|
|
Term
| In FM, there is a deficiency of _____________________-_______________ activity, or excess levels of __________________ neurotransmitters |
|
Definition
|
|
Term
| lack of ________ and __________ leads to increase in pain, in FM patients AND normals |
|
Definition
|
|
Term
| loss of what kind of sleep leads to FM-like symptoms? |
|
Definition
|
|
Term
| T/F: how FM patients think about their pain (cognition) may influence their pain levels directly |
|
Definition
|
|
Term
| T/F: treatments aimed at the periphery (drugs, injections...) in FM are effective |
|
Definition
|
|
Term
| different FM patients need different treatments |
|
Definition
|
|
Term
| what kind of treatments are effective in FM patients? |
|
Definition
| those that raise NE and serotonin, or lower levels of excitatory nm's |
|
|
Term
| what other kind of therapies are effective for FM? |
|
Definition
| sleep hygiene and other behavioral interventions for biological reasons |
|
|
Term
| summary of getting rid of pain in FM |
|
Definition
| increase: ser, NE, opioids, exercise, sleep Decrease: glutamate, substance P, nerve growth factor, catastrophizing, external locus of control |
|
|
Term
| T/F: disturbed sleep is uncommon in psychiatric disorders |
|
Definition
|
|
Term
| psychiatric disorders are common in sleep disorder patients |
|
Definition
|
|
Term
| brain systems involved in sleep overlap a lot with brain systems involved in psychiatric disorders |
|
Definition
|
|
Term
| what brain areas decrease metabolism during NREM sleep relative to waking? |
|
Definition
|
|
Term
| what are the brain areas that show the largest declines in activity during NREM sleep? |
|
Definition
| thalamus-cortical networks that are associated with attention, consciousness, and executive function |
|
|
Term
| what network does REM sleep selectively activate? |
|
Definition
| anterior paralimbic network |
|
|
Term
| what brain areas does the anterior paralimbic network consist of? |
|
Definition
| anterior paralimbic cortex, ventral striatum, basal forebrain, basal ganglia, pre-motor, primary sensorimotor cortex, cerebellum, insular cortex, mesial temporal cortex (hippocampus, amygdala, uncus = emotion), brainstem reticular formation |
|
|
Term
| "REM sleep is associated with activation of a primal neural network in which the __________ is monitored, inherent __________ conflicts detected, maybe by relating current behavior to emotional memories, then behavioral __________ to the conflicts are either newly developed, modified, or rehearsed |
|
Definition
| self; conflicts; responses |
|
|
Term
| what regions does REM sleep activate that play important roles in emotional behavior? |
|
Definition
| limbic, and anterior paralimbic |
|
|
Term
| Depression: what EEG alterations occur during REM? |
|
Definition
| short REM latency, increased REM sleep (increased eye movements per REM period), increased duration of first REM, increased percentage of REM |
|
|
Term
| Depression: what EEG alterations occur during NREM sleep? |
|
Definition
| decreased amount and percentage of NREM, decreased spectral power (?) |
|
|
Term
| Depression: what sleep continuity disturbances occur? |
|
Definition
| prolonged sleep latency, increased time of wake, early morning awakening |
|
|
Term
| Depression: monoaminergic/cholinergic imbalance hypothesis -> what does this hypothesis entail? |
|
Definition
| in normal REM, brainstem monoaminergic systems, 5HT, NE cease firing to allow brainstem Cholinergic cells to activate the cortex during REM sleep -> in depression, there is a reduced monoaminergic function, allowing greater cholinergic firing, disinhibiting REM sleep... or directly increased cholinergic activity |
|
|
Term
| REM is a ___________ activator |
|
Definition
|
|
Term
| depressed patients have increased _______ sleep |
|
Definition
|
|
Term
| depressed patients showed greater wake-to-REM activation in what cortical areas? |
|
Definition
| bilateral dorsolateral prefrontal, left premotor, left parietal... as well as in the reticular formation (noncortical) |
|
|
Term
| during what sleep state is altered limbic/anterior paralimbic function accentuated in depression? |
|
Definition
|
|
Term
| what are the two major sleep-related hypotheses related to depression, and what do they consist of? |
|
Definition
| monoaminergic/cholinergic imbalance hypothesis, circadian/homeostatic hypothesis |
|
|
Term
| Depression: circadian/homeostatic hypothesis |
|
Definition
| advancement of circadian rhythm -> earlier REM in the night; reduced homeostatic drive -> reduced NREM -> earlier REM |
|
|
Term
| depressed patients show LESS of a decline in metabolism from wake to NREM in what brain area? |
|
Definition
|
|
Term
| what happens to sleep after recovery of depression, and how does this depend on the treatment type? |
|
Definition
| sleep improves, no matter what the treatment is |
|
|
Term
| antidepresseants affect sleep how? |
|
Definition
| increase monoaminergic tone, thereby inhibiting cholinergic tone, thereby inhibiting REM sleep, so more NREM sleep |
|
|
Term
| what has a transient anti-depressant effect? |
|
Definition
|
|
Term
| Bipolar disorder: what happens to sleep during manic episodes? |
|
Definition
|
|
Term
| bipolar disorder: what happens during a depression episode? |
|
Definition
|
|
Term
| bipolar disorder: what can loss of sleep trigger? |
|
Definition
|
|
Term
| bipolar disorder: what happens to patients in remission? |
|
Definition
| hypersomnia, same as in depression episodes |
|
|
Term
| Bipolar Disorder: T/F, EEG's are disturbed |
|
Definition
| FALSE! bipolars have relatively normal REM and delta sleep |
|
|
Term
| schizo: what is their sleep cycle like? |
|
Definition
| highly variable, often found in bed during the day |
|
|
Term
| schizo: what kind of EEG disturbances take place? |
|
Definition
| reduction of SWS, which is correlated with changed prefrontal cortex function; disturbed sleep continuity, increases and decreases in REM disturbances |
|
|
Term
| anxiety: what kind of sleep disturbances? |
|
Definition
| difficulty initiating sleep, difficulty maintaining sleep, sleep is not restful |
|
|
Term
| anxiety: what kind of EEG disturbances? |
|
Definition
| long latency of sleep onset, decreased sleep maintenance, decreased sleep of stages 3&4 NREM, BUT no changes in timing, duration, or intensity of REM (so REM is unaffected) |
|
|
Term
| post traumatic: what kind of sleep disturbances? |
|
Definition
| repeated post-traumatic dreams in over half of patients, disturbance in sleep continuity |
|
|
Term
| post-traumatic: what kind of EEG disturbances? |
|
Definition
| sleep continuity, increased periodic limb movements, variable REM disturbances, recurring nightmares that arise either out of REM or NREM early in the night |
|
|
Term
| alcoholism: acutely, what does alcohol do in terms of sleep onset? |
|
Definition
| helps with sleep onset, BUT leads to continuity problems later at night |
|
|
Term
| alcoholism: chronically, what does alcohol cause? |
|
Definition
| sleep problems that persist YEARS into alcohol abstinence |
|
|
Term
| alcoholism: EEG disturbances |
|
Definition
| acutely: increase in sleep, reduced REM and delta; chronically: disturbances in continuity, increased alpha waves during NREM; abstinence: short sleep times, problems with continuity, loss of delta sleep |
|
|
Term
| alcoholism: what is a predictor of relapse back into drinking? |
|
Definition
|
|
Term
| insomnia: does NREM brain metabolism increase or decrease? |
|
Definition
| increase relative to controls - hypermetabolism |
|
|
Term
| there is cerebral hypermetabolism in insomniacs both in wake and NREM sleep relative to normals |
|
Definition
|
|
Term
| insomnia: what is NOT turning off in terms of their cerebral hypermetabolism? |
|
Definition
| there is less of a decrease in postRX activity than in PreRX in arousal promoting areas (so arousal promoting areas are more active in insomniacs... pontine RAS) |
|
|
Term
| what arousal systems do not deactivate in wake-to-sleep in insomniacs? |
|
Definition
| ARAS, hypothalamus, thalamus, insular cortex, mesial temporal cortex, cingulate cortex |
|
|
Term
| what do invertentions do in insomniacs? |
|
Definition
| decrease prefrontal cortex activity, which leads to decrease in ARAS basal forebrain and hypothalamus activity, which leads to decrease in limbic system and VM prefrontal cortex activity |
|
|
Term
|
Definition
| EDS, REM sleep abnormalities, and is typically associated with cataplexy and other REM sleep phenomena, genetically based, dysfunction in sleep state boundary control |
|
|
Term
| what are the three classifications of narco? |
|
Definition
| narco with cataplexy, narco without cataplexy, narco due to a medical condition |
|
|
Term
|
Definition
|
|
Term
| it is estimated that what percentage of total narco's are actually diagnosed? |
|
Definition
|
|
Term
| T/F: there is a greater incidence of narco in men than in women |
|
Definition
| FALSE! equally prevalent in men and women |
|
|
Term
| narco and familial effects? |
|
Definition
| risk of 1st degree relatives is 1%, which is 10-40 fold increase in risk compared to overall risk |
|
|
Term
| what is the usual onset of narco? |
|
Definition
| 15-25 year olds, and is very unsually for its onset in less than 10 or older than 55 |
|
|
Term
| narco: what is the tetrad? and its prevalence in narco patients? |
|
Definition
| EDS, cataplexy, hypnagogic hallucinations (hallucinations just before falling asleep), sleep paralysis; 10-15% |
|
|
Term
| narco: what is the pentad? |
|
Definition
| EDS, hypnagogic hallucinations, cataplexy, sleep paralysis, disturbed sleep |
|
|
Term
|
Definition
| continuous sleepiness and fatigue, lifelong with some fluctuations, sleep attacks that last 20min or less in 70%, automatic behaviors in 40% |
|
|
Term
| characteristics of cataplexy |
|
Definition
| sudden bilateral loss of muscle tone, consciousness is preserved, provoked by emotions (usually positive ones, or anticipation), usually in face and neck, injury is common, twitches and jerks, brief |
|
|
Term
| characteristics of sleep paralysis |
|
Definition
| inability to move or speak while awake, falling asleep, or awakening (in 40-80% of narco patients), last several minutes, may end with sensory stimulation |
|
|
Term
| what are hypnagogic hallucinations? |
|
Definition
| hallucinations while falling asleep |
|
|
Term
| what are hypnapompic hallucinations? |
|
Definition
| hallucinations while waking from sleep |
|
|
Term
| characteristics of hallucinations in narcos |
|
Definition
| hypnagogic, hypnapompic, prevalent in 40-80%, visual hallucinations are quite common, somatosensory hallucinations are less common, episodes last less than 10 min |
|
|
Term
| disturbed nocturnal sleep in narcos |
|
Definition
| in 60-80% of patients, may present itself as sleep onset insomnia, high incidence of other sleep-related disorders |
|
|
Term
| memory disturbances occur in 50% of narco patients |
|
Definition
|
|
Term
| what features are associated with narco? |
|
Definition
| OSA, periodic leg movements, RBD, depression, sex dysfunction, obesity |
|
|
Term
| what parameters are used to diagnose narco? |
|
Definition
| daily EDS for more than 3 months + cataplexy, polysomnography study, CSF hypocretin levels of less than 110picograms/ml, no medica or metal disorder, no medication can account for the symptoms |
|
|
Term
| what does a polysomnography study show in narcos? |
|
Definition
| sleep latency of less than 10min, REM latency of less than 20min, multiple sleep latency test shows a latency of less than 8min |
|
|
Term
| secondary narcolepsy can be caused by what medical conditions? |
|
Definition
| infections (sarcoidosis), post-traumatic, tumors, neurodegenerative disorders, ischemia, demyelination, paraneoplastic (disease caused by presence of cancer), Neiman-Pick type C, Coffin-Lowry syndrome, PD, myotonic distrophy, Prader-Willi |
|
|
Term
| what disorders are associated with cataplexy that can lead to secondary narcolepsy? |
|
Definition
| Neiman-Pick type C, Coffin Lowry, Norrie, PD |
|
|
Term
| what are predisposing factors for narco? |
|
Definition
| mutations in DQB1 0602 (present in more than 90% of narcos with cataplexy), mutations in DR2/DRB1 1501 |
|
|
Term
| what genes are protective against narco? |
|
Definition
|
|
Term
| what major groups of drugs are used in the pharmacological treatment of narco? |
|
Definition
| stimulants, tricyclics, GHB |
|
|
Term
| narco: what do stimulants do? |
|
Definition
| increase DA transmission by increasing releasing and blocking reuptake |
|
|
Term
| narco: examples of stimulants used to treat it? |
|
Definition
| modafinil, dextroamphetamine, methylphenidate, pemoline |
|
|
Term
| narco: what does modafinil do? |
|
Definition
| promotes waking, has low potential for abuse, affects catecholamines serotonin glutamate GABA orexin and histamine, DA1 and DA2 receptors are crucial for modafinil induced wakefulness |
|
|
Term
| narco: how do tricyclics work? |
|
Definition
| inhibit monoamine inhibition of wake-inducing cholinergic activity, blocks cholinergic histaminic and alpha-adrenergic activity; alpha-adrenergic inhibition is critical for its effectiveness |
|
|
Term
| narco: examples of tricyclics used for its treatment? |
|
Definition
| protriptyline, imipramine, clomipramine, nortriptyline, SSRI's |
|
|
Term
| narco: tricyclics are how effective? |
|
Definition
|
|
Term
| narco: how does GHB work in its treatment? |
|
Definition
| increases SWS, approved for treatment of cataplexy, GHB is an endogenous metabolite of GABA, and it is thought to act as a GHB receptor agonist and a weak GABA B-receptor agonist |
|
|
Term
| narco: what does the theory of sleep state boundary control consist of? |
|
Definition
| there is an imbalance of decreased monoaminergic function, so there is increased cholinergic function. REM: decrease in activity of monoaminergic neurons in raphe nuclei and Locus Couraleus and increase in activity of cholinergic neurons in dorsal pontine tegmentum. wake: increased ARAS activity in NA, DA, and Ach neurons |
|
|
Term
| narco: what does the theory of state boundary control hypothesize happens in EDS and cataplexy? |
|
Definition
| EDS: decreased DA activity. cataplexy: decreased monoaminergic (DA and adrenergic) and cholinergic hypersensitivity |
|
|
Term
| is there an increase or decrease in CSF hypocretin in narcos? |
|
Definition
|
|
Term
| narco: what is hypocretin thought to do in normal people? |
|
Definition
| state boundary controllers, so in narcos, its deficiency leads to a loss of state boundary control |
|
|
Term
|
Definition
| controls energy metabolism, evokes arousal, affects GABA and glutamate secretion |
|
|
Term
|
Definition
| hcrtr-1 receptors in VM hypothalamus, DR, and LC; hcrtr-2 receptors in paraventricular nucleus and NAcc |
|
|
Term
| preprohypocretin transcripts are detected in hypothalamus of controls BUT NOT of narcos |
|
Definition
|
|
Term
| sleep disordered breathing in children: characteristics |
|
Definition
| abnormal gas exchange in almost 20%, 64% have excessive periodic limb movements, leading to around 43minutes less sleep |
|
|
Term
| how many limb movements per hour is condiered excessive? |
|
Definition
| more than 5 periodic limb movements per hour |
|
|
Term
|
Definition
| restoratioin and recovery, growth, energy conservation, evolutionary compromise, memory imprinting |
|
|
Term
| compare NREM in adults vs children |
|
Definition
| children spend a greater proportion of the night in deep NREM sleep |
|
|
Term
| children spend greater proportion of sleep in NREM sleep. What does this lead to? |
|
Definition
| night terrors in the first third of the night; see most night terrors when NREM is at its highest in children |
|
|
Term
| what happens to total sleep duration throughout one's lifetime? |
|
Definition
| greatest when young, decreases throughout life |
|
|
Term
| what happens to length of REM throughout life? |
|
Definition
| greatest after birth, decreases throughout life |
|
|
Term
| what happens to length of NREM throughout life? |
|
Definition
| increases after birth until 2-3 years of age, then decreases |
|
|
Term
| describe sleep in newborns |
|
Definition
| 16 hours daily, each sleep period is about 2.5 hours, all throughout the day and night |
|
|
Term
| describe sleep in 1-12month olds |
|
Definition
| sleep requirement decreases from 16 to 13.5 hours daily, 3-4 sleep periods a day, sleeping during the night increases |
|
|
Term
| describe sleep in 1-6 year olds |
|
Definition
| sleep requirement decreases from 13.5 to 11 hours a day, naps cease at 4-5 years, waking during the night is frequent |
|
|
Term
| describe sleep in 6-18 year olds |
|
Definition
| sleep requirement decreases from 11 to 9 hours a day, sleep deprivation increases, sleep requirement increases again during puberty? |
|
|
Term
| describe the difference in sleep deprivation between younger and older children |
|
Definition
| young children: more sleep deprivation on weekends than on school nights. older children: more sleep deprivation on school nights than on weekends |
|
|
Term
| what are some important factors that influence sleep in children? |
|
Definition
| feeding, cosleeping with parents, bedtime settling practices, child temperament, neurodevelopmental problems, psychosocial stressors |
|
|
Term
| what is sleep onset association disorder? |
|
Definition
| child falls asleep requiring a set of circumstances that cannot be recreated by the child or sustained during the night (presence of adult,...)... transition to sleep becomes dependent upon these circumstances, so child cannot fall asleep or return to sleep without them |
|
|
Term
| what are some characteristics of behavioral insomnia of childhood? |
|
Definition
| bedtime struggles, limit setting disorder, sleep onset dissociation disorder, night time fears |
|
|
Term
| what is the prevalence of bedtime struggles and limit-setting sleep disorder in 15-48month olds? |
|
Definition
|
|
Term
| what are possible contributors to bedtime struggles/limit setting sleep disorder? |
|
Definition
| separation issues, inconsistent limit setting (parents do not agree...), difficulty settling |
|
|
Term
| treatment for night time fears? |
|
Definition
| reassurance, night light, professional help (rare!) |
|
|
Term
| treatments for behavioral insomnia of childhood? |
|
Definition
| sleep charting, bedtime management |
|
|
Term
| what does bedtime management consist of in the treatment of behavioral insomnia of childhood? |
|
Definition
| consisten bedtime routines, constancy in setting limits, address fears, separation from parents (systematic ignoring, scheduled awakenings, graduated schedule of parental reassurance) |
|
|
Term
| what are some medical causes of poor sleep in children? |
|
Definition
| colic (inconsolable crying), acute or chronic illness, medication, neurological disorders |
|
|
Term
| T/F: disrupted sleep schedules lead to disruption in sleep EEG's |
|
Definition
| FALSE! normal sleep, just at the wrong time |
|
|
Term
| what are the two types of disrupted sleep schedules? |
|
Definition
| early sleep phase: go to sleep way to early and wake up way too early; late sleep phase: go to bed way too late, wake up way too late |
|
|
Term
| Treatments for disrupted sleep schedules? |
|
Definition
| restrict daytime sleep, for early sleep phase: delay bedtime prograssively. for late phase: progressive advance bedtime and enforce morning awakening, OR, delay bedtime to go other way, around clock, until normal bedtime is reached |
|
|
Term
| what is the therapy called that is used for late sleep phase patients that cannot easily be corrected, and what does it consist of? |
|
Definition
| Chronotherapy, delaying bedtime to go around the clock until normal bedtime is reached (bedtime at 4am, then 7am, then 1pm, etc...) |
|
|
Term
|
Definition
| nightmares, night terrors, sleepwalking, sleep talking, rhythmic head and body movements, bruxism |
|
|
Term
| characteristics of nightmares |
|
Definition
| waking from REM, prevalence of 20-50% in 3-5y/olds; awakening is crucial (differentiates from night terrors, from which one does not wake) |
|
|
Term
| characteristics of night terrors (pavor nocturnus) |
|
Definition
| PARTIAL arousal from deep NREM (nightmares are during REM), inconsolable agitation, familial predisposition, treated by alleviating stressors and rarely with benzodiazepines |
|
|
Term
| characteristics of sleep walking |
|
Definition
| PARTIAL arousal from deep NREM, incidence of 40% in 6-16y/o, semi-purposeful activities, eyes usually open, treat by protecting environment and addressing whatever precipitates sleepwalking |
|
|
Term
| characteristics of sleep talking |
|
Definition
| arousal from REM or NREM sleep, prevalence of 8% in 5y/o, prevalence of 50% in sleepwalkers |
|
|
Term
| common rhythmic movements in children? |
|
Definition
| bead banging, head rolling, body rocking |
|
|
Term
| when do rhythmic movements occur in children? |
|
Definition
| near sleep onset, last less than 15min, and are most common in 8-14 month olds |
|
|
Term
| characteristics of bedwetting? |
|
Definition
| more common in boys, familial, improves with age (15% in 5yo to 2% in 14yo), affects 5-7 million US children |
|
|
Term
|
Definition
| reduced bladder capacity in children, failure to arouse from sleep when bladder fills |
|
|
Term
| treatments for bedwetting? |
|
Definition
| minimize fluid intake late in the day, avoid brown drinks (colas, teas, coffee, cocoa), go to bathroom before bed and during planned awakening, enuresis alarm, bladder training exercises, mostly outgrown (15% per year), medications |
|
|
Term
| what are some medications for the treatment of bedwetting? |
|
Definition
| imipramine, desmopressin, oxybutinin |
|
|
Term
| there is a correlation between periodic limb movement disorder and ADHD in children |
|
Definition
| 117/129 moderate to severe PLMD sufferers were diagnosed with ADHD |
|
|
Term
| how does sleept restriction (5 hours of sleep per night) affect sleep latency in normals? |
|
Definition
| baseline latency is of 18 minutes; after 7 days, latency is increased to below 8min (considered pathological when below 10, narcoleptic when below 8!) |
|
|
Term
| OSA has what consequences on children? |
|
Definition
| growth delay, failure to thrive, learning and behavioral problems, EDS, cor pulmonale (failure of heart's right ventricle) |
|
|
Term
| what are the nighttime clinical features of childhood OSA? |
|
Definition
| snoring, restless sleep, unusual positions, excessive sweating, enuresis |
|
|
Term
| what are the daytime clinical features of childhood OSA? |
|
Definition
| grogginess, irritability, morning headache, sore throat, mouth breathing, somnolence, problems in learning attention and behavior |
|
|
Term
| physical features of childhood OSA? |
|
Definition
| adenoid facies (long face and open mouth due to overgrown adenoids), overgrown tonsils, atypical craniofacial anatomy |
|
|
Term
| treatments of childhood OSA? |
|
Definition
| surgical: adenotonsillectomy, UPPP (removal of uvula, soft palate, tonsils, adenoids, pharynx... some or all of these), tracheostomy (widening of airway). nonsurgical: CPAP, weight reduction in the case of obesity, palatal expander, nasal steroids |
|
|
Term
| how many persons suffer from insomnia? |
|
Definition
|
|
Term
| how many persons suffer from OSA? |
|
Definition
|
|
Term
| how many persons suffer from narco? |
|
Definition
|
|
Term
| what other effects does OSA have on personal life? |
|
Definition
| cardiovascular health, productivity, motor vehicle accidents, mental health, inflammation, immunity, quality of life |
|
|
Term
| T/F: fall-asleep crashes kill more young americans than alcohol related crashes |
|
Definition
|
|
Term
|
Definition
| Epworth sleepiness Scale, Polysomnography, Multiple Sleep Latency test |
|
|
Term
| Epworth Sleepiness Scale: how does it work? |
|
Definition
| in each of the presented scenarios, rate from 0-3 (0=would never doze, 3=high chance of dozing); interpretation: 9 and up, seek advice of sleep specialist immediately. 10 and up, sleep disorder very likely |
|
|
Term
| some problems with epworth sleepiness scale? |
|
Definition
| subjective, OSA might not become apparent, might not correlate with objective measures, such as pathologies or sleepiness |
|
|
Term
| what are the three core measurements of a polysomnogram? |
|
Definition
|
|
Term
|
Definition
| desynchronized, low voltage, mixed frequency |
|
|
Term
| PSG: describe stage 1 NREM |
|
Definition
| light sleep, at sleep onset and transitions throughout night, slow rolling eye movements, more than 50% is theta activity (3-7Hz), relatively high muscle tone |
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Term
| PSG: describe stage 2 NREM |
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Definition
| spindles (high frequency bursts .5-3sec), K-complexes (sharp slow waves with (-) then (+) deflection .5sec or longer, background acitivity is theta in nature (3-7Hz), high muscle tone |
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Term
| PSG: describe stage 3 NREM |
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Definition
| SWS, high voltage slow waves (delta waves comprise 20-50%), slightly reduced muscle tone |
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Term
| PSG: describe stage 4 NREM |
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Definition
| SWS, high voltage slow waves (delta waves comprise more than 50%), slightly reduced muscle tone |
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Term
| where are PSG leads placed? |
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Definition
| three of them: frontal (delta), central (theta), occipital (alpha) |
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Term
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Definition
| high frequency (8-12Hz), occipital |
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Term
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Definition
| medium frequency (4-8Hz), central vertex region, most common sleep frequency |
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Term
| what is the most common sleep frequency? |
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Definition
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Term
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Definition
| low frequency (.5-4Hz), frontal, amplitude is greater than 75mn |
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Term
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Definition
| picks up movements of eyes due to changes in in voltage relative to the fixed position of the electrode next to the eyes (cornea=(+)V, retina=(-)V |
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Term
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Definition
| more than 5 apneas or hypoapneas pwer hour of sleep, oxygen saturation below 90%, increases in breathing effort before arousals, more than 5 PLM's per hour of sleep |
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Term
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Definition
| patients attempt to take 5 naps in a day, with two hour separations; measure sleep latency and number of REM periods |
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Term
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Definition
| adjustment insomnia, psychophysiological insomnia |
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Term
| how does sleep affect cortisol levels? |
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Definition
| peak exactly when you wake up, lowest when you fall asleep. with sleep deprivation, cortisol remains throughout, though not as extreme as the peak. is intimately tied with circadian rhythms |
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Term
| how does sleep affect TSH? |
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Definition
| circadian variation is muted during sleep; circadian rhythm functions in the release of TSH as well as its inhibition |
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Term
| how does sleep affect GH? |
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Definition
| surge at the beginning of sleep. during sleep deprivation, there is an attenuated increase or no increase at all |
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Term
| how does sleep affect PRL? |
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Definition
| sleep-related stimulation, but not circadian based, since sleep deprivation results in no change in PRL |
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Term
| urinary potassium is synchronized with feeding, which occurs right when the animal wakes up. Does K rhythm of the kidneys follow sleep or cortisol levels? |
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Definition
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Term
| how is GH released in males and females? |
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Definition
| males: during SWS and has a specific peak, must sleep at the right time, and SWS is stimulant for GH but is not necessary. females: secreted in anticipation of sleep, before going to bed, and there are may peaks rather than one |
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Term
| LH is secreted during sleep right at the beginning of puberty |
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Definition
|
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Term
| in late puberty, LH is released day and night |
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Definition
|
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Term
| in a child that sleeps during the day and is awake at night, when will LH will be released? |
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Definition
| during the day (during sleep) |
|
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Term
| how does sleep affect GnRH? |
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Definition
| sleep slows GnRH pulse generation. in order to ovulate, GnRH pulse generator must be shut off once a day |
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Term
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Definition
|
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Term
| what effects does melatonin have? |
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Definition
| in humans, causes sleep. in rats, causes wakefulness, because they sleep during the day |
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Term
| the more fat, the more leptin |
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Definition
|
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Term
| CPAP treatment causes leptin levels to decrease, showing that hypoxia causes high leptin |
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Definition
|
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Term
| ghrelin works opposite leptin, and seeks to store fat and stimulate feeding |
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Definition
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|
Term
| sleep deprivation decreases glucose clearing abilities so that it is more readily available for use (NE) |
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Definition
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Term
| sleep deprivation decreases leptin and increases ghrelin, causing starvation feeling |
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Definition
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Term
| those who get 6 or fewer hours of sleep at night are significantly more likely to be obese than those who sleep more (low leptin, high ghrelin) |
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Definition
|
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Term
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Definition
| increased GH, grow soft tissue not height, causing OSA |
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Term
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Definition
| octreotide therapy: decrease IGF, increase REM, increase SWS, decrease in respiratory disturbance index |
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Term
| hyperthyroidism - leads to same condition as acromegaly -- sleep apnea |
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Definition
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