Bonus Material-17_SD2_Collop_2025

Pdf Summary

This 2025 Pulmonary Medicine Board Review presentation by Dr. Nancy Collop focuses on sleep disorders, specifically central sleep apnea (CSA), obesity hypoventilation syndrome (OHS), insomnia, hypersomnia disorders, and movement disorders such as restless legs syndrome (RLS).<br /><br />Central Sleep Apnea requires specific diagnostic criteria including an apnea-hypopnea index ≥5, with at least 50% central apneas/hypopneas, and symptoms like excessive sleepiness. CSA can arise from heart failure (often with Cheyne-Stokes Breathing), medication effects (particularly long-acting opioids), or other medical conditions. Treatment options include optimizing medical therapy for heart failure, positive airway pressure devices such as CPAP, bilevel PAP, adaptive servo ventilation (ASV) (though ASV is contraindicated in heart failure with reduced ejection fraction), oxygen therapy, and transvenous phrenic nerve stimulation, which shows promise in idiopathic CSA.<br /><br />Obesity hypoventilation syndrome (OHS) is defined by obesity (BMI ≥30) with awake hypercapnia (pCO2 >45 mm Hg) after excluding other causes. It is usually accompanied by severe obstructive sleep apnea (OSA) and results in poorer quality of life, higher morbidity, pulmonary hypertension, and increased mortality compared to OSA alone. Treatment primarily involves positive airway pressure—starting with CPAP to treat OSA; some require bilevel PAP or volume-assured pressure support (VAPS), especially post-hospitalization for respiratory failure.<br /><br />Circadian rhythm disorders stem from misalignment of sleep-wake cycles, with delayed sleep phase syndrome being the most common type. Management includes light therapy and timed melatonin.<br /><br />Insomnia is characterized by difficulty falling or staying asleep, with cognitive behavioral therapy for insomnia (CBT-I) being the preferred long-term treatment. Pharmacotherapy is useful short-term, with agents including non-benzodiazepine hypnotics and dual orexin receptor antagonists.<br /><br />Hypersomnia disorders, including narcolepsy types 1 and 2 and idiopathic hypersomnia, are diagnosed via sleep studies and daytime sleepiness scales. Treatments target symptom relief with stimulants (modafinil, solriamfetol), sodium oxybate, and others.<br /><br />Restless legs syndrome features an urge to move, worsening at rest and night, and is treated by addressing iron deficiency and using alpha-2-delta ligands. Periodic limb movement disorder often coexists and is managed similarly.<br /><br />Key points emphasize tailored therapies based on etiology, importance of diagnosing comorbidities, and the nuanced approach needed for sleep-disordered breathing, especially in heart failure and obese patients.

Meta Tag

Concept Central Sleep Apnea

Concept Obesity Hypoventilation Syndrome

Concept Chronic Insomnia

Concept Narcolepsy

Concept Delayed Sleep Phase

Keywords

central sleep apnea

obesity hypoventilation syndrome

insomnia

hypersomnia disorders

restless legs syndrome

adaptive servo ventilation

Cheyne-Stokes breathing

positive airway pressure

circadian rhythm disorders

narcolepsy

Central Sleep Apnea

Obesity Hypoventilation Syndrome

Chronic Insomnia

Narcolepsy

Delayed Sleep Phase