371.2 🩺 國考版

371.2.1 高頻考點

371.2.1.1 Sleep Stages

  • N1: light
  • N2: spindles, K-complexes; 50%
  • N3: slow wave, deep
  • REM: dreaming, atonia, rapid eye movements

371.2.1.2 OSA Risk Factors

  • Obesity (BMI > 30, neck > 17/16)
  • Male
  • Age
  • Anatomic
  • Acromegaly, hypothyroid

371.2.1.3 OSA Diagnosis

  • PSG (gold standard)
  • HSAT for high pretest without comorbidities
  • AHI ≥ 5 with symptoms OR AHI ≥ 15 = OSA

371.2.1.4 OSA Severity

  • 5-15: mild
  • 15-30: moderate
  • ≥ 30: severe

371.2.1.5 OSA Consequences

  • CV: HTN, AF, stroke, HF, sudden death
  • Daytime sleepiness
  • MVA risk

371.2.1.6 CPAP First-Line

  • Continuous positive airway pressure
  • Eliminates apneas/hypopneas
  • Reduces CV consequences

371.2.1.7 Hypoglossal Nerve Stimulation (Inspire)

  • Moderate-severe OSA
  • PAP intolerance
  • BMI < 32
  • No concentric collapse

371.2.1.8 CSA Causes

  • HF (Cheyne-Stokes)
  • Opioids
  • Stroke

371.2.1.9 CSA + HFrEF

  • ASV contraindicated if EF < 45% (SERVE-HF)
  • Use CPAP, oxygen, optimize HF therapy

371.2.1.10 Narcolepsy Type 1

  • ↓ Orexin
  • Cataplexy
  • HLA-DQB1*06:02
  • MSLT: latency < 8 min, ≥ 2 SOREMPs

371.2.1.11 Narcolepsy Treatment

  • Modafinil/armodafinil
  • Stimulants (methylphenidate, amphetamines)
  • Pitolisant (Wakix) — H3 antagonist
  • Solriamfetol (Sunosi) — DA/NE reuptake
  • Sodium/mixed-salt oxybate — also cataplexy

371.2.1.12 Cataplexy Treatment

  • Sodium oxybate / mixed-salt oxybate
  • Pitolisant
  • SNRIs (venlafaxine)

371.2.1.13 REM Behavior Disorder

  • Loss of REM atonia
  • Acting out dreams
  • Older men
  • Prodrome of synucleinopathy (PD, DLB, MSA)
  • Clonazepam or melatonin

371.2.1.14 NREM Parasomnias

  • Slow-wave sleep
  • Sleepwalking, sleep terrors, confusional arousal
  • Early in night
  • Children > adults

371.2.1.15 Insomnia Treatment

  • CBT-I first-line
  • DORAs: suvorexant, lemborexant, daridorexant
  • Z-drugs: short-term
  • Melatonin agonists: ramelteon, tasimelteon
  • Low-dose doxepin

371.2.1.16 Circadian Rhythm Disorders

  • DSPD: melatonin evening + morning light
  • ASPD: evening light + afternoon melatonin
  • Shift work: scheduled light, modafinil
  • Jet lag: melatonin + light
  • Non-24 blind: tasimelteon

371.2.2 Key Tests

371.2.2.1 Polysomnography (PSG)

  • EEG, EOG, EMG, ECG, respiratory effort, airflow, oximetry
  • Gold standard

371.2.2.2 MSLT (Multiple Sleep Latency Test)

  • After overnight PSG
  • 5 nap opportunities
  • Mean sleep latency
  • SOREMPs (sleep-onset REM)
  • Narcolepsy: latency < 8 min, ≥ 2 SOREMPs

371.2.2.3 MWT (Maintenance of Wakefulness Test)

  • Ability to stay awake
  • Treatment monitoring

371.2.2.4 Actigraphy

  • Wrist activity monitor
  • Circadian + RLS

371.2.2.5 Epworth Sleepiness Scale

  • Subjective sleepiness
  • 0-24 score; ≥ 10 excessive