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* CMS neuro 77m
  dream250 - 12/24/17 03:54
  A 77 year old man with Parkinson disease is brought to the physician by his wife because of a 3 month history of unusual behavior at night. She says that he yells in his sleep and waves his arms as if defending himself. Two night ago, he bit her and tried to push her out of the bed. Current medications include carbidopa-levodopa. Examination shows little facial expression, a pill-rolling tremoer of both hands, and muscle rigidity. Which of the following is the most appropariate next step in diagnosis?

A. Multiple sleep latency testing
B. Overnight pulse oximetry testing
C. Polysomnography
D. Sleeping and waking EEG
e. wrist actigraphy

why C? Can anyone share their knowledge about other options plz.

A. Multiple sleep latency testing ---daytime nap study, the MSLT used to diagnose narcolepsy and idiopathic hypersomnia.
B. Overnight pulse oximetry testing----to dx obstructive sleep apnea
C. Polysomnography- --- for any sleep disorder? OSA?
D. Sleeping and waking EEG--- provide biomarkers of depression and antidepressive therapy
e. wrist actigraphy---for monitoring insomnia, circadian sleep/wake dis- turbances, and periodic limb movement disorder
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* Re:CMS neuro 77m
  patel88 - 12/25/17 01:43
  Stage 3 NREM sleep causes sleep behavior disorder as exhibited in this patient - yells in sleep, waves his arm, etc. Patient will not remember upon waking. To best diagnose, you need to see the stages of sleep -- best done by polysomnography  
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* Re:CMS neuro 77m
  patel88 - 12/25/17 02:07
  Extremely sorry, this is REM sleep behavior disorder -- which is assoc with parkinsons....regardless you do polysomnography.

NREM - is usually sleep walking, sleep terror, etc.
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* Re:CMS neuro 77m
  dream250 - 12/25/17 18:38
  patel88, thank you!  
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* Re:CMS neuro 77m
  dream250 - 12/25/17 18:39
  I didn't now it was associated with Parkinson. Learned something new. :) Thank you  
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