POLYSOMNOGRAPHY GABAergic neurons to the
wake-promoting area of the
1. It is believed that during sleep, a person can brain.
recover from illness. Which of the following o Monoaminergic nuclei
stage/s of sleep that is/are important in the Wakefulness
restoration of brain processes? Part of the reticular activating
ANS: REM system (RAS)
o Fx of sleep: Restoration and
energyconservation 4. Damage to the hypocretin neurons leads to a
NREM: PROMOTE PHYSICAL GROWTH condition in which a person is not able to
AND HEALING maintain either state and experiences bouts of
REM: restoration of brain processes AND sleepiness during wakefulness. Which of the
ATTENTION SPAN, LEARNING AND following condition is being described?
MEMORY, EMOTIONAL HEALING, ANS: NARCOLEPSY
PERFORMING BASIC TASK Insomia: common that can make it hard for
you to fall asleep, hard to stay asleep, wake
2. Phase delay is common in which of the up too early
following age group? Somnolence: sleepiness, state of being
ANS: Adolescence drowsy
Sleep across ages OHS (Pickwickian syndrome): common
total sleep time of an infant is around 18-20 with obese patient with poor breathing that
hours which reduces as the child grows and could lower O2 and increase CO2 in the
comes to adult timing during mid- blood
adolescence (6-8 hours), after which it Narcolepsy: is a relatively rare autoimmune
remains more or less stable. disease and has pentad of clinical features
It starts declining in the fourth decade of a including:
person’s life. During old age, it reduces to 5- o Irresistible attacks of sleep, which is
6 hours/day. usually present in all patients
Regarding continuity, infants have o Is characterized by sudden “sleep
fragmented sleep and they tend to wake up attacks” that often occur several
multiple times. It becomes consolidated into times a day. The attacks last from
a single sleep as the age grows. several seconds to more than 30
Children often go to bed early at night, minutes
however, during adolescence, they develop
a phase delay. 5. Which of the following is considered as the as
o Phase delay: delayed bedtime and wake the ‘master clock’ circadian clock?
time. ANS: suprachiasmatic nucleus (SCN)
On the other hand, the phase is considered Zeitgebers: environment, (+) light-dark,
advance in old age. Aging also influenced provide stimulus
the electrophysiology of sleep. Children Monoaminergic nucleus: wake-promoting
have a proportion of N3 (deep sleep), which area of the brain
reduces as the person grows old. suprachiasmatic nucleus: master clock,
circadian clock
3. Which major area of the brain that sends
inhibitory signals through the GABAergic 6. Martina feels sleepy and often experiences
neurons to the wake-promoting area of the drifting or floating sensation. Which sleep
brain? stage is being described?
ANS: ventrolateral preoptic nucleus (VLPO) ANS: N1
Homeostatic – homeostatic process is N1: transition from wakeful or drowsiness to
dependent upon two major areas of the sleep; 10-12mins
brain. o waves: ATV (Alpha, Theta, Vertex)
o Ventrolateral preoptic nucleus N2: light sleep; arousal is a bit difficult;
(VLPO) decreased vital signs; occurs at about 40-
The sleep-promoting area 50% of sleeping time
Which sends inhibitory o Waves: K complex, spindle, theta
signals through the N3: deep sleep
, o Wave: delta Inhibitors (SNRI) Venlafaxine are used as
REM: mental and physical restoration first-line treatment.
o Waves: delta waves For difficult cases, Sodium Oxybate (Xyrem)
can be used.
7. Which stage of sleep in which the heart rate,
blood pressure, respiratory rate and 12. Which of the following is not a characteristic
temperature is decreased, snoring may of a normal sleep?
occur and it comprises about 40-50% of ANS: INCREASE SENSORY ACTIVITY
sleep?
ANS: N2 13. What is the primary zeitgeber in human?
ANS: Light dark cycle
8. Which of the following waves are present
during N1 sleep stage? Select all that 14. What is the mainstay of therapy for
applies. moderate to severe obstructive sleep apnea?
ANS: Alpha, Vertex, Theta Waves ANS: Positive airway pressure therapy - CPAP
9. Which of the following waves are present 15. Which of the following is described as five
during N2 sleep stage? Select all that or more strange obstructed breathing
applies. events per hour of sleep?
ANS: Theta, K complex, spindles ANS: Obstructive Sleep Apnea
CHEYNE-STOKES – cyclical fluctuations in
10. The end of which particular sleep stage breathing with periods of central
ends the first sleep cycle? apnea/hypopneas, waxing and waning
ANS: END OF REM SLEEP fashion
OHS: OBESE
NARCOLEPSY
OSA:
OSA CENTRAL MIXED
SLEEP SLEEP
APNES APNEA
AIRFLOW NO NO NO
DIAPHRAGMATIC YES NO YES
MOVEMENT AND
NO
Diaphragmatic movement – use a respiratory belt
to check the movement if there is presence of
respiration
16. What is the severity of a patient’s
obstructive sleep apnea if he/she has an
apnea-hypopnea index of 25 per hour?
ANS: Moderate
OSA SEVERITY SCALE – determined by the
number of apneas and hypopneas per hour of
sleep
o NORMAL = AHI <5/hour
11. What is the treatment of choice for
o MILD = 5-15/hour
narcolepsy when the most serious symptom
o MODERATE = 15-30/hour
is excessive daytime sleepiness?
o SEVERE = >30/hour
ANS: MODAFINIL
o
Methylphenidate – may be used in patients
HYPOPNEA: DECREASE DEPTH OF
who do not respond to Modafinil
BREATHING
For cataplexy, the Serotonin Reuptake
Inhibitors (SSRI) Fluoxetine, or the
17. Which breathing disorder is defined by
Serotonin-Norepinephrine Reuptake
American Association of Sleep Medicine
wake-promoting area of the
1. It is believed that during sleep, a person can brain.
recover from illness. Which of the following o Monoaminergic nuclei
stage/s of sleep that is/are important in the Wakefulness
restoration of brain processes? Part of the reticular activating
ANS: REM system (RAS)
o Fx of sleep: Restoration and
energyconservation 4. Damage to the hypocretin neurons leads to a
NREM: PROMOTE PHYSICAL GROWTH condition in which a person is not able to
AND HEALING maintain either state and experiences bouts of
REM: restoration of brain processes AND sleepiness during wakefulness. Which of the
ATTENTION SPAN, LEARNING AND following condition is being described?
MEMORY, EMOTIONAL HEALING, ANS: NARCOLEPSY
PERFORMING BASIC TASK Insomia: common that can make it hard for
you to fall asleep, hard to stay asleep, wake
2. Phase delay is common in which of the up too early
following age group? Somnolence: sleepiness, state of being
ANS: Adolescence drowsy
Sleep across ages OHS (Pickwickian syndrome): common
total sleep time of an infant is around 18-20 with obese patient with poor breathing that
hours which reduces as the child grows and could lower O2 and increase CO2 in the
comes to adult timing during mid- blood
adolescence (6-8 hours), after which it Narcolepsy: is a relatively rare autoimmune
remains more or less stable. disease and has pentad of clinical features
It starts declining in the fourth decade of a including:
person’s life. During old age, it reduces to 5- o Irresistible attacks of sleep, which is
6 hours/day. usually present in all patients
Regarding continuity, infants have o Is characterized by sudden “sleep
fragmented sleep and they tend to wake up attacks” that often occur several
multiple times. It becomes consolidated into times a day. The attacks last from
a single sleep as the age grows. several seconds to more than 30
Children often go to bed early at night, minutes
however, during adolescence, they develop
a phase delay. 5. Which of the following is considered as the as
o Phase delay: delayed bedtime and wake the ‘master clock’ circadian clock?
time. ANS: suprachiasmatic nucleus (SCN)
On the other hand, the phase is considered Zeitgebers: environment, (+) light-dark,
advance in old age. Aging also influenced provide stimulus
the electrophysiology of sleep. Children Monoaminergic nucleus: wake-promoting
have a proportion of N3 (deep sleep), which area of the brain
reduces as the person grows old. suprachiasmatic nucleus: master clock,
circadian clock
3. Which major area of the brain that sends
inhibitory signals through the GABAergic 6. Martina feels sleepy and often experiences
neurons to the wake-promoting area of the drifting or floating sensation. Which sleep
brain? stage is being described?
ANS: ventrolateral preoptic nucleus (VLPO) ANS: N1
Homeostatic – homeostatic process is N1: transition from wakeful or drowsiness to
dependent upon two major areas of the sleep; 10-12mins
brain. o waves: ATV (Alpha, Theta, Vertex)
o Ventrolateral preoptic nucleus N2: light sleep; arousal is a bit difficult;
(VLPO) decreased vital signs; occurs at about 40-
The sleep-promoting area 50% of sleeping time
Which sends inhibitory o Waves: K complex, spindle, theta
signals through the N3: deep sleep
, o Wave: delta Inhibitors (SNRI) Venlafaxine are used as
REM: mental and physical restoration first-line treatment.
o Waves: delta waves For difficult cases, Sodium Oxybate (Xyrem)
can be used.
7. Which stage of sleep in which the heart rate,
blood pressure, respiratory rate and 12. Which of the following is not a characteristic
temperature is decreased, snoring may of a normal sleep?
occur and it comprises about 40-50% of ANS: INCREASE SENSORY ACTIVITY
sleep?
ANS: N2 13. What is the primary zeitgeber in human?
ANS: Light dark cycle
8. Which of the following waves are present
during N1 sleep stage? Select all that 14. What is the mainstay of therapy for
applies. moderate to severe obstructive sleep apnea?
ANS: Alpha, Vertex, Theta Waves ANS: Positive airway pressure therapy - CPAP
9. Which of the following waves are present 15. Which of the following is described as five
during N2 sleep stage? Select all that or more strange obstructed breathing
applies. events per hour of sleep?
ANS: Theta, K complex, spindles ANS: Obstructive Sleep Apnea
CHEYNE-STOKES – cyclical fluctuations in
10. The end of which particular sleep stage breathing with periods of central
ends the first sleep cycle? apnea/hypopneas, waxing and waning
ANS: END OF REM SLEEP fashion
OHS: OBESE
NARCOLEPSY
OSA:
OSA CENTRAL MIXED
SLEEP SLEEP
APNES APNEA
AIRFLOW NO NO NO
DIAPHRAGMATIC YES NO YES
MOVEMENT AND
NO
Diaphragmatic movement – use a respiratory belt
to check the movement if there is presence of
respiration
16. What is the severity of a patient’s
obstructive sleep apnea if he/she has an
apnea-hypopnea index of 25 per hour?
ANS: Moderate
OSA SEVERITY SCALE – determined by the
number of apneas and hypopneas per hour of
sleep
o NORMAL = AHI <5/hour
11. What is the treatment of choice for
o MILD = 5-15/hour
narcolepsy when the most serious symptom
o MODERATE = 15-30/hour
is excessive daytime sleepiness?
o SEVERE = >30/hour
ANS: MODAFINIL
o
Methylphenidate – may be used in patients
HYPOPNEA: DECREASE DEPTH OF
who do not respond to Modafinil
BREATHING
For cataplexy, the Serotonin Reuptake
Inhibitors (SSRI) Fluoxetine, or the
17. Which breathing disorder is defined by
Serotonin-Norepinephrine Reuptake
American Association of Sleep Medicine
