Narcolepsy

CYNTHIA MATTICE

NOTE: This chapter corresponds to Chapter 11 in Fundamentals of Sleep Technology, 2nd edition.

1. Symptoms of narcolepsy typically develop during the ______________ decade of life.

A. First

B. Second

C. Third

D. Fourth

2. Compared to the general population, risk of narcolepsy among first-degree relatives is:

A. Twice as high

B. Five times higher

C. Ten to forty times higher

D. One hundred times higher

3. The standard diagnostic evaluation of a patient suspected of narcolepsy without cataplexy requires:

A. Serum hypocretin levels

B. Multiple sleep latency testing

C. Stanford sleepiness scale

D. Brain imaging

4. Over the course of an entire 24-hour day, the total amount of sleep obtained by narcoleptic patients is:

A. Twice the normal amount for age

B. About 12 hours on average

C. Less than half of the usual amount for age

D. About the same as the usual amount for age

5. A teenager reports that she unexpectedly won an award for best article in her school paper. She was surprised and pleased but suddenly felt weak in the knees and unable to get up from her chair to accept the award. She was fully conscious during this event. Which of the following is the most likely diagnosis?

A. Cataplexy

B. Generalized seizure

C. Panic attack

D. Vasovagal attack

6. Treatment of narcolepsy involves:

A. Gene replacement therapy

B. Neurosurgery

C. Relief of symptoms

D. Brief course of immunosuppression

7. Many medications for cataplexy are also used to treat:

A. Schizophrenia

B. Depression

C. Epilepsy

D. Generalized anxiety disorder

8. Polysomnographic features of narcolepsy include:

A. Shortened latency to stage R sleep

B. Prolonged latency to stage R sleep

C. Rapid eye movements in all sleep stages

D. Sawtooth waves during stage N3 sleep

9. A medication prescribed to increase alertness in narcolepsy patients is:

A. Sodium oxybate

B. Diazepine

C. Eszopiclone

D. Zolpidem

10. Reduced sleep latency during the Multiple Sleep Latency Test (MSLT) is defined as a mean sleep latency:

A. Less than 4 minutes

B. Less than 8 minutes

C. Less than 12 minutes

D. Within 30 seconds of lights out

Consider the following history of a sleep center patient: A 17-year-old boy repeatedly falls asleep in class. Past medical history is unremarkable, and physical examination is normal. During school days, he falls asleep quickly at his usual bedtime at midnight and wakes up at 6 am. In contrast, bedtimes and wake times are generally later at 2 to 3 am and 10 to 11 am on weekends. He often wakes during the night and has always been a restless sleeper. For the past few years, he has wakened with frightening dreams sometime involving a troll from a storybook that his mother read to him when he was a child. This troll had enormous sharp teeth and asked him to answer ambiguous riddles. The penalty for an incorrect response was death. Once, after pondering a riddle, the patient woke abruptly and felt unable to move for several minutes. On several occasions, just as he was falling asleep, he experienced a very realistic sensation of the troll nibbling on his feet. Problems with daytime sleepiness began approximately a year ago after a week off of school due to an upper respiratory tract illness. When he returned to class, he found himself unable to stay awake during classes. He naps for 45 minutes regularly after school at 4 pm. He reports several episodes of feeling weak when laughing. On one occasion, when watching the Colbert Report, he found a piece on “Truthiness” particularly funny and his knees buckled, causing him to slump to the floor.

Match the symptoms with the description in the history:

11.	Cataplexy	A.	He dreamt that he was being chased by a troll from a storybook that his mother read to him when he was a child.
12.	Sleep paralysis	B.	On several occasions, just as he was falling asleep, the patient had a very realistic sensation of the troll nibbling on his feet.
13.	Vivid dreams	C.	When watching the Colbert Report, he found a piece on “Truthiness” particularly funny and his knees buckled.
14.	Excessive daytime sleepiness	D.	After pondering the riddle, the patient woke abruptly and found he was unable to move for an extended period of time.
15.	Hypnagogic hallucinations	E.	When he returned to class, he found himself unable to stay awake during math, which was previously his favorite class.