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SLEEP MEDICINE BOARD REVIEW ALL
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SLEEP MEDICINE BOARD REVIEW ALL
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SLEEP MEDICINEBOARD REVIEW
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What is the healthy sleep duration for infants (4-12 months)?
12-16 hours
What is the diagnostic criteria for alternating leg muscle activation?
>= 4 EMG bursts, 0.5-3 Hz in frequency
alternating between legs with usual duration of .1-.5s
What is the diagnostic criteria for bruxism?
- either brief (Rhythmic masticatory muscle activity) or sustained elevations in chin EMG
at least 2x amplitude of background EMG
- 0.25-2s in duration and if at least 3 elevations occur in regular sequence
- sustained elevations in EMG are scored as bruxism if duration is >2s
- a period of stable background chin EMG must occur before a new episode can be
scored
- can be scored reliably if at least 2 audible tooth grinding episodes are heard in the
absence of epilepsy
What is the diagnostic criteria for rhythmic movement disorder?
- 0.5-2 Hz
- >=4 individual movements
- >= 2 x background EMG tone
What is the diagnostic criteria for Excessive Fragmentary Myoclonus?
,- usual max EMG burst duration is 150 msec
- At least 20 min of NREM sleep with EFM must be recorded
- at least 5 EMG potentials per min
What are PSG changes seen in depression?
prolonged sleep latency
increased percent REM
increased REM density
decreased sleep efficiency
decreased REM latency
decreased SWS
What is the diagnostic criteria for hypnagogic foot tremor?
- >= 4 EMG bursts
- frequency 0.3-4 Hz
- usual duration is .25-1s
Identifying an apnea
Use an oronasal thermal airflow sensor to monitor airfow
What is the prevalence of Narcolepsy? Gender predominance?
M=F
0.03-0.07%
Low education and socioeconomic status are more/less likely to report insomnia
symptoms?
More
What is the dorsal respiratory group? Where is it located?
mainly inspiratory neurons
located in medulla
What are the typical filter settings for EEG channels?
LFF 0.3 Hz, HFF 35 Hz
Remember the low frequency filter=high pass filter
high frequency filter=low pass filter
When do narcolepsy symptoms typically occur?
10-19 yo (highest 15-19)
typically not diagnosed until 20s or 30s
There is a bimodal age of onset at 14.7 years and 35 years
What is the ventral respiratory group? Where is it located?
,both inspiratory and expiratory neurons.
- drives spinal respiratory neurons and auxiliary muscles of respiration
- pre-Botzinger complex: essential for generation of respiratory rhythm
Located in medulla
What % of patients have comorbid insomnia?
70-90%
Alternate ways to identify an apnea
Nasal pressure transducer, RIPsum, RIPflow, PVDFsum
What is the association of insomnia with Major depressive disorder?
Young adults who reported insomnia were 4x more likely to develop MDD than those
without insomnia
- sleep disturbance has been shown to precede recurrence of MDD- if sleep doesn't
improve, your chance of recurrence is higher
What are the typical filter settings for EOG channels?
LFF 0.3 Hz, HFF 35 Hz
What is the healthy sleep duration for toddlers (1-2 years)?
11-14 hours
What is the healthy sleep duration for preschoolers (3-5 years)?
10-13 hours
What are the typical filter settings for EMG channels?
LFF 10 Hz, HFF 100 Hz
What is the association of circadian rhythms and depression?
Associated with phase delay
Identifying a hypopnea
Use a nasal pressure transducer to monitor airflow
What are the characteristics of cataplexy?
recurrent, brief episodes of muscle weakness triggered by emotions
- patients are medically stable, conscious with eye movements intact
- duration <2 minutes
- areflexia during event in involved limbs
All of the following have been associated with the pathophysiology of insomnia
EXCEPT:
, a. increased low-frequency EEG activity during NREM
b. increased whole-body metabolic rate
c. elevated 24 hour cortisol level
d. increased adrenocorticotropic hormone
A
What is the pontine respiratory group?
normally inactive neurons during quiet breathing
"pneumotaxic center"
modulates activity of the apneustic center
What disorders can cataplexy be seen in?
Narcolepsy
Niemann-Pick type C
Norrie disease
Prader-WIlli
Coffin-lowry
What is the apneustic center and where is it located?
located in lower pons
activity defined by transection experiments which caused "apneustic breathing"
A diagnosis of insomnia requires:
A. presence of a co-morbid psychiatric condition
B. nighttime sleep symptoms and daytime consequences
C. Presence of symptoms at least 3 times a week for one month
D. Evidence of hyperarousal
B
- need symptoms for 3 months
What is the healthy sleep duration for school age children (6-12 years)?
9-12 hours
Alternate ways to identify a hypopnea
Oronasal thermal airflow, RIPsum, RIPflow, dual thoracoabdominal belts, PVDFsum
What are the typical filter settings for EKG channels?
LFF 0.3 Hz, HFF 70 Hz
What % of patients with GAD have insomnia?
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