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Lecture 1

PSYC 3P68 Lecture 1: PSYC 3P68 NOV 9 DISORDERS OF EDS
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by OneClass336486 , Fall 2017
8 Pages
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Department
Psychology
Course Code
PSYC 3P68
Professor
Dr.Cote
Lecture
1

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November 9, 2017
Disorders of EDS: Apnea, PLM/RLS, Narcolepsy
Lecture Objectives
Learn about the diagnosis and treatment, and impact on
waking function in apnea, and PLM/RLS, and Narcolepsy
Describe the signs and symptoms, and nature of sleep apnea (OSA and CSA).
Outline the daytime consequences of apnea.
Compare the current treatment options for apnea.
Describe the clinical features, epidemiology, and diagnosis of
PLM and RLS?
Describe what is known today about the etiology and pathophysiology of RLS?
Identify the recent advances with respect to understanding the causes of Narcolepsy?
Sleep Apnea (Discovered 1965)
Apnea (want of breath): a breathing
disorder characterized by brief
interruptions of breathing during sleep
Associated completely with sleep,
not with asthma etc.
Types of Sleep Apnea
Central Sleep Apnea (CSA): brain fails to
send signals to breathing muscles to initiate
respirations
Less prevalent
Neurons in brainstem not
functioning, dont signal the rest of
the brain to carry out breathing.
These periods of not breathing can
be quite long
Obstructive Sleep Apnea (OSA): ai caot flo i o out of peso’s ose o outh, although
efforts to breathe continue
More prevalent, commonly associated with obesity (more fatty tissue leads to this sagging
more into the airway and blocking it)
Apnea events can be quite frequent (20-60 times in the night). The number of times
recorded tell you your severity of sleep apnea
Difference in this is that they are signalling to breath but something blocking them breathing
so they wake up to gasp air.
More likely to have apnea events while sleeping on your back
Positional therapy (sleeping on side instead of on back)
Prevalence and Gender
all age groups and both sexes, more common in men, more common as you age
8 mil
SIGNS AND SYMPTOMS:
EDS (Excessive Daytime Sleepiness)
Obesity
Snoring
almost all will snore, but snoring does
not mean you have sleep apnea
Witnessed Apneas
Bed partner reports they saw their
partner stop breathing for several
seconds, take a gasp of air, wake up
and go back to sleep.
They stop breathing hundreds of times
periodically over the night.
Morning Headache & Dry Mouth
Narrowed Airway
Highly prevalent
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November 9, 2017
5% of population undiagnosed for OSA
As prevalent as adult asthma
Wisconsin Study:
Every time you stop breathing is called and apnea
Hypopnea is a reduction of air intake by up to 50%
Measure these on AHI (apnea-hypopnea index)
At least 5 or more events ha clinical significance
24% of men, 9% of women: AHI >5 (lowest for clinical significance for diagnosis)
9% of men, 4% of women: AHI >15
4% of middle-aged men, 2% of women: AHI>5 and excessive daytime sleepiness
becomes problematic in their life,
Many argue that this is under diagnosed
Obstructive Sleep Apnea
When upper airway repeatedly collapses
Mechanical or structural problems in the airway
Normal breathing restored by awakenings
Alcohol and sleeping pills increases the frequency and
duration of breathing pauses
Video show trying to take in air, but cant
Quiet snoring clicking noise (not taking in air), can see
lungs moving trying to take in air
Loud gasp where subject wakes up to take in air
Depicting Narrow Airway
Basic Anatomy of the airway (picture B)
The fatty tissue is obstructing the airway (pictured in
black and white Picture A)
So when you lay on your back, the fatty tissue will sag
even more and collapse the airway (obstructive sleep
apnea)
Sleep Alterations in Obstructive Sleep Apnea (OSA)
Apneaic events worse in REM sleep
Much more variability in
respiratory and heart rate, and
brain wave more variable.
Autonomic nervous system in REM
as well.
Some patients exclusively have
apneaic events in REM
Sleep apnea much worse after alcohol
intake and suppressants
Reduced oxygen in the blood alerting
the brain to wake up
Having to wake up to breathe leads to
Sleep fragmentation
because you go in and out of sleep so much, leads to less SWS
Non-restorative sleep
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November 9, 2017
Health Consequences of Untreated OSA
Short-term
Daytime sleepiness
Car accidents
Neurocognitive deficits
Decreased quality of life
Long-term
Hypertension
Heart disease
Heart attack
Stroke
Reduced glucose tolerance
Increased weight gain and increased
risk of diabetes
Diagnosis of Apnea
Clinical Polysomnography
Excessive daytime sleepiness is most common way they are referred to a sleep clinic for
diagnosis
Abdominal and Thoracic respiration recordings
Through respiratory resistance bands
Airflow
In and out from your nose, little plastic tube in nose
Oxygen saturation
See if blood oxygen declining during apneaic event
Through clip on finger llike in the hospital
Apneas & hypopneas
AHI > 5 events / hour = mild apnea
Key factors to diagnosis alon with sleep clinic observations
Look at neck size
Body weight
Snoring
Excessive daytime sleepiness
Headaches reported
Witnessed/ Observed apneas
Airflow and respiratory Effort Signals
Central apnea
- no effort to take in air for 10 sec
(no message sent from brain stem
to rest of brain to breathe)
Obstructive apnea
- effort is recorded but it is a
struggle for them to physically get
air through airway for a long
period of time.
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Description
November 9, 2017 Disorders of EDS: Apnea, PLMRLS, Narcolepsy Lecture Objectives Learn about the diagnosis and treatment, and impact on waking function in apnea, and PLMRLS, and Narcolepsy Describe the signs and symptoms, and nature of sleep apnea (OSA and CSA). Outline the daytime consequences of apnea. Compare the current treatment options for apnea. Describe the clinical features, epidemiology, and diagnosis of PLM and RLS? Describe what is known today about the etiology and pathophysiology of RLS? Identify the recent advances with respect to understanding the causes of Narcolepsy? Sleep Apnea (Discovered 1965) Apnea (want of breath): a breathing disorder characterized by brief SIGNS AND SYMPTOMS: interruptions of breathing during sleep Associated completely with sleep, EDS (Excessive Daytime Sleepiness) Obesity not with asthma etc. Snoring almost all will snore, but snoring does Types of Sleep Apnea not mean you have sleep apnea Witnessed Apneas Central Sleep Apnea (CSA): brain fails to Bed partner reports they saw their send signals to breathing muscles to initiate partner stop breathing for several respirations seconds, take a gasp of air, wake up Less prevalent and go back to sleep. Neurons in brainstem not They stop breathing hundreds of times periodically over the night. functioning, dont signal the rest of the brain to carry out breathing. Morning Headache Dry Mouth These periods of not breathing can Narrowed Airway be quite long Highly prevalent Obstructive Sleep Apnea (OSA): air cannot flow in or out of persons nose or mouth, although efforts to breathe continue More prevalent, commonly associated with obesity (more fatty tissue leads to this sagging more into the airway and blocking it) Apnea events can be quite frequent (2060 times in the night). The number of times recorded tell you your severity of sleep apnea Difference in this is that they are signalling to breath but something blocking them breathing so they wake up to gasp air. More likely to have apnea events while sleeping on your back Positional therapy (sleeping on side instead of on back) Prevalence and Gender all age groups and both sexes, more common in men, more common as you age 8 mil
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