ABFM Sleep Medicine flashcards
ABFM Sleep Medicine · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Apnea-hypopnea index threshold
- OSA is diagnosed when AHI is at least 5 with symptoms, or at least 15 events per hour regardless of symptoms, on polysomnography or home testing.
- Cheyne-Stokes respiration
- A cyclic pattern of crescendo-decrescendo breathing with central apneas, most often seen in heart failure with reduced ejection fraction during sleep.
- REM sleep behavior disorder
- Dream enactment with loss of normal REM atonia; strongly associated with later development of Parkinson disease, Lewy body dementia, or multiple system atrophy.
- Narcolepsy type 1 criteria
- Requires cataplexy or CSF hypocretin-1 of 110 pg/mL or less, plus supportive MSLT findings of short sleep latency and sleep-onset REM periods.
- Multiple sleep latency test
- A daytime nap study; mean sleep latency of 8 minutes or less with two or more sleep-onset REM periods supports narcolepsy.
- Restless legs syndrome features
- Urge to move legs, worse at rest and in the evening, relieved by movement; check ferritin and treat iron deficiency if ferritin is below 75 ng/mL.
- NREM parasomnias
- Confusional arousals, sleepwalking, and sleep terrors arise from slow-wave sleep, typically in the first third of the night, and are common in children.
- Sleep-related hypoventilation
- Defined by PaCO2 above 55 mmHg during sleep or a rise of at least 10 mmHg versus the awake value; consider obesity, neuromuscular disease, and COPD.
- Periodic limb movements of sleep
- Repetitive limb movements lasting 0.5 to 10 seconds occurring in series; common but not diagnostic of a disorder on their own.
- Insomnia disorder definition
- Difficulty initiating or maintaining sleep, or early awakening, at least three nights weekly for three months or longer, with daytime impairment.
- First-line insomnia treatment
- Cognitive behavioral therapy for insomnia is first-line; pharmacotherapy is adjunctive and generally limited in duration.
- Depression sleep pattern
- Major depression often shows early morning awakening and shortened REM latency; anxiety disorders more often show prolonged sleep-onset latency.
- STOP-BANG screening
- Screens OSA risk using snoring, tiredness, observed apneas, pressure, BMI, age, neck circumference, and gender; higher scores indicate greater risk.
- Nocturnal asthma
- Asthma symptoms peak at night due to circadian cortisol nadir and increased vagal tone; frequent nocturnal symptoms indicate poor control.
- Medications disrupting sleep
- SSRIs suppress REM sleep, beta-blockers can cause nightmares, and corticosteroids and stimulants fragment sleep; alcohol worsens snoring and apneas.
- Nocturnal GERD management
- Reflux worsens when supine; elevating the head of the bed and avoiding late meals reduce nocturnal symptoms.
- Chronic pain and sleep
- Pain fragments sleep, and poor sleep amplifies pain perception, creating a bidirectional cycle that requires treating both components.
- Nocturnal polyuria
- Excess urine production at night, distinct from frequency from benign prostatic hyperplasia; it fragments sleep and requires its own evaluation and management.
- Shift work disorder
- Insomnia or excessive sleepiness lasting at least three months, temporally linked to a work schedule that overlaps typical sleep time.
- Delayed sleep phase disorder
- Sleep and wake times are shifted late relative to social demands; common in adolescents and treated with morning light and timed melatonin.
- Advanced sleep phase disorder
- Sleep and wake times are shifted early, with early evening sleepiness and early morning awakening; more common in older adults.
- Melatonin timing principle
- Evening melatonin delays circadian phase and morning melatonin advances it; timing relative to the internal clock determines the direction of shift.
- Bright light therapy timing
- Morning bright light advances the circadian phase, while evening light exposure delays it; used to treat circadian rhythm sleep-wake disorders.
- Sleep loss and glucose
- Sleep restriction reduces glucose tolerance and insulin sensitivity, raising risk for impaired glucose regulation and type 2 diabetes.
- Sleep loss and appetite
- Short sleep increases ghrelin and decreases leptin, increasing hunger and caloric intake and contributing to weight gain and obesity.
- OSA cardiovascular risk
- Untreated obstructive sleep apnea is associated with hypertension, atrial fibrillation, stroke, and increased risk of motor vehicle crashes.
- Bipolar disorder and sleep
- Sleep loss and circadian disruption can precipitate manic episodes; stabilizing sleep-wake schedules is a core treatment target.
- Drowsy driving impairment
- Staying awake about 17 to 19 hours produces psychomotor impairment roughly comparable to a blood alcohol concentration near 0.05 percent.
- Aging circadian changes
- Circadian amplitude and phase advance change with age; timed light exposure and structured daytime activity improve sleep-wake consolidation.
- Cataplexy definition
- Sudden loss of muscle tone triggered by emotion, such as laughter, lasting seconds to minutes while consciousness is preserved; hallmark of narcolepsy type 1.
- Obesity hypoventilation syndrome
- BMI of 30 or higher with awake hypercapnia not explained by other causes, worsening during sleep; often coexists with obstructive sleep apnea.
- Sleep terrors vs nightmares
- Sleep terrors arise from slow-wave sleep with confusion and amnesia; nightmares occur in REM sleep with vivid recall and full orientation on waking.