33.2 📚 國考版醫垫國考 / PGY OSCE

33.2.0.1 📌 Cram Sheet

33.2.0.1.1 🔥 高 yield 10 條
  1. Sleep architecture: N1/N2/N3/REM
  2. 5 倧障瀙insomnia / OSA / narcolepsy / circadian / parasomnia (+ RLS)
  3. OSA STOP-BANG ≥ 3 → sleep study
  4. AHI mild/mod/severe = 5/15/30
  5. CPAP = OSA first-line
  6. Insomnia first = CBT-I䞍是 BZD
  7. Narcolepsy 4: EDS / cataplexy / hypnagogic hallucination / sleep paralysis
  8. RLS = iron deficiency 可逆 cause (ferritin > 75)
  9. RBD = 50% PD/DLB/MSA 埌續
  10. Avoid diphenhydramine in elderly insomnia
33.2.0.1.2 🔢 必背
項目 æ•žå­—
Total sleep need adult 7-9 hr
AHI mild 5-15
AHI moderate 15-30
AHI severe > 30
STOP-BANG threshold ≥ 3
Insomnia chronic threshold ≥ 3 nights/week × 3 mo
RLS ferritin target > 75 ng/mL
Narcolepsy MSLT criteria mean latency < 8 min + ≥ 2 SOREMPs
33.2.0.1.3 ⚠ 陷阱
  • BZD long-term insomnia
  • 老人 diphenhydramine
  • RLS 䞍補 iron
  • RBD 䞍譊 PD
  • 䞍問 sleep history

33.2.0.2 ⭐ 高 yield

33.2.0.2.1 Sleep Stages
Stage Features
N1 Transition, theta waves, ~5%
N2 Sleep spindles, K complex, ~50%
N3 Delta waves, slow wave (deep), ~20%
REM Atonia + dream + EOM rapid + sawtooth waves, ~25%
33.2.0.2.2 OSA Diagnostics
  • STOP-BANG:
    • Snoring loud
    • Tired EDS
    • Observed apnea
    • Pressure HTN
    • BMI > 35
    • Age > 50
    • Neck > 40 cm
    • Gender male
  • ≥ 3 → sleep study
  • Polysomnography confirms AHI
33.2.0.2.3 OSA Treatment
  • CPAP first-line
  • Mandibular device (mild-moderate)
  • Hypoglossal nerve stimulator (Inspire)
  • ENT surgery (UPPP)
  • Bariatric surgery (obesity)
33.2.0.2.4 Narcolepsy
  • Type 1: with cataplexy, orexin (hypocretin) deficiency
  • Type 2: without cataplexy
  • Diagnosis: polysomnography + MSLT
  • Treatment:
    • EDS: modafinil, armodafinil, solriamfetol, pitolisant
    • Cataplexy: SNRI (venlafaxine), TCA, sodium oxybate
33.2.0.2.5 Insomnia Treatment
  • CBT-I (sleep restriction, stimulus control, cognitive)
  • Sleep hygiene
  • Pharm:
    • Z-drugs (zolpidem, eszopiclone, zaleplon) short-term
    • Suvorexant, lemborexant, daridorexant (orexin receptor antagonist) — newer
    • Doxepin low dose 3-6 mg
    • Melatonin 0.5-3 mg
    • Avoid long-term BZD + diphenhydramine in elderly
33.2.0.2.6 RLS
  • 4 criteria (URGE):
    • Urge to move + 䞍舒服
    • Rest 加重
    • Movement 緩解
    • Evening worse
  • 病因idiopathic, iron deficiency, ESRD, neuropathy, pregnancy, drugs (SSRI, antihistamine)
  • Iron: ferritin < 75 → supplement
  • DA agonist (pramipexole, ropinirole) — augmentation risk
  • α2ÎŽ (gabapentin enacarbil, pregabalin) — increasingly first-line
33.2.0.2.7 RBD
  • Loss of REM atonia
  • 50% 埌續癌 α-synucleinopathy (PD/DLB/MSA)
  • Clonazepam 0.5-1 mg HS
  • Melatonin 3-12 mg HS
33.2.0.2.8 Parasomnia by Stage
  • NREM (N3)sleepwalking, sleep talking, night terror, confusional arousal
  • REMnightmare, RBD, sleep paralysis

33.2.0.3 🎯 自我檢枬

  1. OSA AHI severe? → > 30
  2. STOP-BANG threshold? → ≥ 3
  3. Insomnia first-line? → CBT-I
  4. Narcolepsy type 1 hallmark? → Cataplexy + orexin deficiency
  5. RLS reversible cause? → Iron deficiency (ferritin > 75 target)
  6. RBD risk? → 50% PD/DLB/MSA
  7. Suvorexant 機蜉? → Orexin receptor antagonist
  8. Sleep architecture stages? → N1, N2, N3, REM
  9. Avoid 圚 elderly insomnia? → Diphenhydramine, BZD
  10. RBD 治療? → Clonazepam + melatonin

⚠ AI 草皿。