Question
A 75-year-old man is brought to the clinic from a nursing home with a complaint of disturbed sleep. He goes to bed at his usual time but has difficulty sleeping for long periods and wakes up every two hours multiple times during the night. He also has trouble going back to sleep after waking up, which sometimes lasts more than an hour.The patient has undergone a test and the result is shown as the in the image given below
The patient was admitted to a nursing care home after being diagnosed with dementia. Which of the following is the most likely diagnosis and identify the test performed
| A. |
Advanced sleep-wake disorder & PSG
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| B. |
Irregular sleep-wake rhythm disorder & Actigraphy
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| C. |
Delayed sleep-wake phase disorder & Actigraphy
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| D. |
Non-24-hour sleep wake rhythm disorder & PSG
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Show Answer
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Correct Answer � B
Explanation
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Ans:B-Irregular sleep wake rhythm disorder & Actigraphy
This patient has most likely presented with an irregular sleep-wake rhythm disorder. This disorder represents a failure of the circadian rhythm system to consolidate sleep, leading to multiple short periods of sleep and wakefulness.
- Diagnosis is made when no clear circadian rhythm pattern can be identified and at least three periods of wakefulness lasting at least one hour occur during an average 24 hour period.
- This disorder is generally found in patients with dementia and is attributed to dysfunction of the suprachiasmatic nuclei.
- Delayed sleep-wake phase disorder is characterized by delayed sleep and wake times relative to what is desired or expected. Not simply “night owls,” those with delayed sleep-wake phase disorder may not prefer to have such a sleep schedule, but find it difficult to adjust to desired sleep and wake times. Inadequate sleep and resultant daytime functional impairment are hallmarks of the condition.
- Advanced sleep-wake phase disorder is characterized by excessive evening sleepiness and early morning awakening. Patients may get adequate quality and quantity of sleep if no external pressures dictate that patients stay awake in the evening, but often patients are distressed and sleep-deprived because societal obligations require patients to stay awake longer than desired in the evening.
- Non 24 sleep-wake rhythm disorder is typically found in blind patients who do not receive external light cues to entrain their circadian rhythm.
Actigraphy is a certain device that is used to measure irregular sleep-wake rhythm in a person. To evaluate this disorder, actigraphy is considered as the most appropriate treatment option so far.
Nocturnal, laboratory-based polysomnography (PSG), also known as a sleep study, is the most commonly used test in the diagnosis of obstructive sleep apnea syndrome (OSAS)
