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Continuum Postreading Test 29(4) August 2023 (Sleep Neurology)

Continuum Postreading Test 29(4) August 2023 (Sleep Neurology)

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Sleep Neurology issue, participants will be able to:
  • Identify and describe basic concepts related to brain structures involved in the regulation of wakefulness and sleep physiology, and their interactions with pharmacologic interventions and circadian rhythms
  • Evaluate patients with sleep-related symptoms, the association between neurologic conditions and sleep disorders, and testing modalities to diagnose and monitor common sleep disorders
  • Identify common presentations of narcolepsy and idiopathic hypersomnia and apply evidence-based clinical guidelines for the treatment of patients with central disorders of hypersomnolence
  • Describe the epidemiology, pathophysiology, clinical presentation, and diagnosis and treatment options for obstructive sleep apnea
  • Describe parasomnias that arise from rapid eye movement sleep, including rapid eye movement sleep behavior disorder and its diagnosis, management, and association with neurodegenerative diseases
  • Recognize the clinical characteristics, classification, and treatments of parasomnias that occur in non–rapid eye movement sleep
  • Discuss the evaluation and management of restless legs syndrome and other sleep-related movement disorders
  • Describe the ubiquity of physiologic clocks in biological functions and the impact of circadian rhythm sleep-wake disorders on neurologic conditions and overall health, and convey the importance of a healthy circadian rhythm to patients and advise them on management strategies
  • Describe the diagnosis and management of insomnia, including the role of pharmacologic and nonpharmacologic therapies and the growing use of technology within this field
  • Elucidate the growing body of evidence showing a bidirectional relationship between sleep and multiple neurologic disease states
  • Describe the pathophysiology, clinical presentation, diagnosis, and management of common pediatric sleep disorders
  • Identify, define, and describe the signs and symptoms of sleep deprivation and its main consequences, and apply this knowledge to neurologic practice

Core Competencies

This Continuum: Lifelong Learning in Neurology Sleep Neurology issue covers the following core competencies:
  • Patient Care and Procedural Skills
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice

Contributorsa

Anita Valanju Shelgikar, MD, MHPE, FAASM,
Guest Editor
Director, Sleep Medicine Fellowship; Clinical Professor, Neurology, University of Michigan School of Medicine, Ann Arbor, Michigan

Relationship Disclosure: Dr Shelgikar has received personal compensation in the range of $10,000 to $49,999 for serving as an officer or member of the board of directors for the American Academy of Sleep Medicine.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Shelgikar reports no disclosure.

Margaret Blattner, MD, PhD
Clinical Fellow in Medicine, Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts

Relationship Disclosure: Dr Blattner reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Blattner discusses the unlabeled/investigational use of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants for the treatment of cataplexy in narcolepsy type 1; armodafinil, clarithromycin, flumazenil, modafinil, and traditional stimulants for the treatment of idiopathic hypersomnia; armodafinil and modafinil for the treatment of hypersomnia; and amantadine, carbamazepine, IV steroids, lithium, phenobarbital, phenytoin, and valproate for the treatment of Kleine-Levin syndrome.

Pablo R. Castillo, MD, FAAN
Professor of Neurology and Program Director of Sleep Medicine, Mayo Clinic Florida, Jacksonville, Florida

Relationship Disclosure: Dr Castillo reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Castillo discusses the unlabeled/investigational use of trazodone for the treatment of insomnia.

Oleg Y. Chernyshev, MD, PhD
Professor of Neurology and Sleep Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana

Relationship Disclosure: Dr Chernyshev reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Chernyshev reports no disclosure.

Flavia B. Consens, MD
Associate Professor of Neurology, University of Washington, Seattle, Washington

Relationship Disclosure: Dr Consens reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Consens reports no disclosure.

Karin G. Johnson, MD, FAAN, FAASM
Professor of Neurology, UMass Chan Medical School, Springfield, Massachusetts

Relationship Disclosure: Dr Johnson has received personal compensation in the range of $0 to $499 for serving as an officer or member of the board of directors for Save Standard Time. The institution of Dr Johnson has received research support from Avadel.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Johnson discusses the unlabeled/investigational use of acetazolamide, hormone replacement therapy, and montelukast for the treatment of obstructive sleep apnea.

Christine Juang, PhD, DBSM
Clinical Assistant Professor of Psychiatry and Neurology, Washington University School of Medicine, St. Louis, Missouri

Relationship Disclosure: Dr Juang reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Juang discusses the unlabeled/investigational use of diphenhydramine, doxepin, gabapentin, hydroxyzine, mirtazapine, quetiapine, and trazodone for the treatment of insomnia.

Meena Khan, MD, FAASM
Clinical Associate Professor of Internal Medicine, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio

Relationship Disclosure: Dr Khan reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Khan reports no disclosure.

Scott Kutscher, MD
Clinical Associate Professor of Psychiatry and Behavioral Sciences, Standford University School of Medicine, Stanford University, Stanford, California

Relationship Disclosure: Dr Kutscher has received personal compensation in the range of $5000 to $9999 for serving as a consultant for Jazz Pharmaceuticals, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Kutscher discusses the unlabeled/investigational use of diphenhydramine, doxepin, gabapentin, hydroxyzine, mirtazapine, quetiapine, and trazodone for the treatment of insomnia.

Joyce K. Lee-Iannotti, MD
Director, Sleep Disorders Center; Clinical Associate Professor of Neurology, University of Arizona College of Medicine, Phoenix, Arizona

Relationship Disclosure: Dr Lee-Iannotti reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Lee-Iannotti reports no disclosure.

Roneil Malkani, MD, MS
Associate Professor of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Neurologist, Jesse Brown Veterans Affairs Medical Center, Chicago, IL

Relationship Disclosure: Dr Malkani has received research support from the National Institutes of Health (NIH) and Northwestern University.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Malkani discusses multiple medications and therapies for the treatment of rapid eye movement sleep behavior disorder, none of which are approved by the US Food and Drug Administration (FDA).

Beth A. Malow, MD, MS, FAAN
Professor of Neurology and Pediatrics; Burry Chair in Cognitive Childhood Development, Vanderbilt University Medical Center, Nashville, Tennessee

Relationship Disclosure: Dr Malow has received personal compensation in the range of $500 to $4999 for serving as a consultant for Neurim Pharmaceuticals, Ltd. The institution of Dr Malow has received research support from the National Institutes of Health (NIH), the US Department of Defense, and the Patient-Centered Outcomes Research Institute.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Malow reports no disclosure.

Kiran Maski, MD, MPH
Associate Professor of Neurology, Boston Children's Hospital, Boston, Massachusetts

Relationship Disclosure: Dr Maski has received personal compensation in the range of $500 to $4999 for serving as a consultant for Alkermes, Eisai Pharmaceuticals, and Zevra Therapeutics and on a scientific advisory or data safety monitoring board for Idorsia Pharmaceuticals, Ltd., and in the range of $5000 to $9999 for serving as a consultant for Harmony Biosciences, Jazz Pharmaceuticals, Inc., and Takeda Pharmaceutical Company Limited and as an expert witness for Hayes Legal Services. Dr Maski has received publishing royalties from a publication relating to health care. An immediate family member of Dr Maski has received personal compensation for serving as an employee of Sanofi and has stock in Sanofi. Dr Maski has received research support from Coverys, Harmony Biosciences, Jazz Pharmaceuticals, Inc., and the National Institutes of Health (NIH)(5K23NS104267-2).

Unlabeled Use of Products/Investigational Use Disclosure: Dr Maski discusses the unlabeled/investigational use of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants for the treatment of cataplexy in narcolepsy type 1; armodafinil, clarithromycin, flumazenil, modafinil, and traditional stimulants for the treatment of idiopathic hypersomnia; armodafinil and modafinil for the treatment of hypersomnia; and amantadine, carbamazepine, IV steroids, lithium, phenobarbital, phenytoin, and valproate for the treatment of Kleine-Levin syndrome.

Althea Robinson Shelton, MD
Associate Professor of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee

Relationship Disclosure: The institution of Dr. Shelton has received research support from Harmony Biosciences.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Shelton discusses the unlabeled/investigational use of clonazepam, clonidine, cyproheptadine, daridorexant, doxepin, gabapentin, guanfacine, hydroxyzine, lemborexant, mirtazapine, pregabalin, ramelteon, suvorexant, tasimelteon, and trazodone for the treatment of insomnia; lithium for the treatment of Kleine-Levin syndrome; amphetamine derivatives, armodafinil, clomipramine, methylphenidate, modafinil, pitolisant, and venlafaxine for the treatment of narcolepsy; and clonazepam for the treatment of parasomnias, none of which are approved by the US Food and Drug Administration (FDA).

Andrew R. Spector, MD
Associate Professor of Neurology, Department of Neurology, Duke University School of Medicine, Durham, North Carolina

Relationship Disclosure: Dr Spector has received personal compensation in the range of $500 to $4999 for serving as an expert witness for Shevlin Smith, and in the range of $10,000 to $49,999 for serving as an editor, associate editor, or editorial advisory board member for Neurology Today. The institution of Dr Spector has received research support from Harmony Biosciences. The institution of an immediate family member of Dr Spector has received research support from the American Academy of Allergy, Asthma, and Immunology Foundation, the National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases, and the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Spector discusses multiple medications and therapies for the treatment of non–rapid eye movement parasomnias, none of which are approved by the US Food and Drug Administration (FDA).

Samuel A. Taylor Jr, MD, MS
Assistant Professor of Neurology, Virginia Commonwealth University, Richmond, Virginia

Relationship Disclosure: Dr Taylor reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Taylor reports no disclosure.

Self-Assessment and CME Test Writers

D. Joanne Lynn, MD, FAAN
Clinical Professor Emeritus, Department of Neurology, The Ohio State University, Columbus, Ohio

Relationship Disclosure: Dr Lynn has received personal compensation in the range of $500 to $4999 for serving as a Continuum Self-Assessment and CME multiple-choice question writer with the American Academy of Neurology (AAN). Dr Lynn has stock in Abbott Laboratories, AbbVie Inc., Amgen Inc., Biogen Inc., Bristol-Myers Squibb Co., Merck and Co. Inc., Pfizer Inc., Regeneron Pharmaceuticals, and Zimmer Biomet. Dr. Lynn has received publishing royalties from a publication relating to health care.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Lynn reports no disclosure.

Allyson R. Zazulia, MD
Professor of Neurology and Radiology and Associate Dean for Continuing Medical Education, Washington University, St. Louis, Missouri

Relationship Disclosure: Dr Zazulia reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Zazulia reports no disclosure.

AAll relevant financial relationships have been mitigated.

Accreditation

Accreditation Statement: The American Academy of Neurology Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. For information on Continuum Audio CME, please visitcontinuum.audio-digest.org.

AMA Credit: The American Academy of Neurology Institute designates this enduring material for a maximum of 20 AMA PRA Category1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished authors who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive continuing medical education (CME) and self-assessment offerings. For detailed instructions regarding Continuum CME and self-assessment activities, visit continpub.com/CME.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.