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Clinical Medicine > Sleep Apnea > Flashcards

Sleep Apnea Flashcards

1
Q

How are breathing disorders characterized as?

A

A brief interruption of breathing during sleep
*apnea
*hypopnea

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2
Q

What are the 3 types of breathing disorders

A
  1. Central
  2. Obstructive
  3. Mixed
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3
Q

What do center and obstructive types of sleep related breathing disorders involve

A

Central (CNS causes RARE)
*ventilatory effort is absent for duration of episode
Obstructive
*brain says breathe but something is in the way
*most likely, the tissues in the throat
*ventilation effort continues but no airflow occurs

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4
Q

What is obstructive sleep apnea (OSA)

A
  1. Air cannot flow into or out of nose or mouth
    *effort to breathe continues
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5
Q

Who has a higher risk for sleep apnea?

A
  1. Age
  2. Male sex
  3. obesity
  4. Family history
  5. Menopause
  6. Craniofacial abnormalities
  7. Certain health behaviors (cigarette smoking and alcohol use)
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6
Q

What are the risk factors for Obstructive Sleep Apnea (OSA)

A
  1. COPD (MC)
  2. Hypothyroidism
  3. Obesity
  4. Nasal obstruction
    *VR
    *rhinitis
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7
Q

What can precipitate or worsen OSA

A
  1. Smoking
  2. ETOH
  3. Sedatives
  4. Opioid use
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8
Q

What is the pathophysiology of OSA

A
  1. Upper airway obstruction while sleep due to
    *pharyngeal muscles lose tone and collapse passively during inspirations
    *diaphragm maintains tone
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9
Q

What are some anatomically conditions that may predispose someone to OSA

A
  1. Micrognathia (small mandibular jaw)
  2. Macroglassia
  3. Tonsillar hypertrophy
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10
Q

What happens during OSA

A
  1. Collapse of the upper pharyngeal airway
  2. Airflow is impeded
    *effort to breathe continues
  3. Progressive hypoxemia
  4. Arousal, patient awakens
  5. Upper airway opens, ventilation is restored
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11
Q

What is apnea?

A
  1. Cessation of airflow for >10 seconds
    *OSA: apnea durations of 15-120 seconds
    *may have 300-500 apneic episodes in a night
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12
Q

What is Hypopnea

A
  1. Reduction in tidal volume due to decrease in depth and rate of respiration
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13
Q

What is apnea/hypopnea index (AHI)

A
  1. Average apnea or hypopnea periods per hour of sleep
    *AHI helps determine severity of OSA
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14
Q

What AHI will indicated OSA

A

> 5 AND excessive daytime sleepiness

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15
Q

What are the effects of hypoxemia?

A

Hypoxemia stimulates sympathetic nervous system
*will be systemic vasoconstriction, HTN
*bradycardia and dysrhythmias

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16
Q

What are the signs of OSA

A
  1. Almost always snoring between apneic episodes
    *not everyone who snores has sleep apnea
  2. Frequent interruptions of deep or restorative sleep
    *morning headaches
    *excessive daytime sleepiness
  3. More common in obese, middle-aged males
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17
Q

What are the symptoms of OSA

A
  1. Daytime somnolence
  2. Weight gain
  3. Arterial HTN
  4. Morning sluggishness
  5. Inability to concentrate
  6. Depression
  7. Cognitive impairment
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18
Q

As a provider what can you ask the significant other about, if their partner may have OSA?

A
  1. Loud cyclic snoring
  2. Breathing cessation
  3. Witnessed apnea
  4. Restlessness
  5. Thrashing movements
  6. Irritability
  7. Personality changes
19
Q

What will you find on the PE (OSA)

A

No significant findings
1. Weight BMI over 30
2. Appear sleepy
3. Abundant soft tissue in the neck and oral pharynx
4. Enlarged tonsils, large uvula or tongue
5. Deviated nasal septum, decreased nasal flow, nasal twang
6. Bull neck
7. Comorbidites

20
Q

What are the Ddx of OSA

A
  1. Hypothyroidism
  2. Smoking
  3. Patient history
    *alcohol use
    *Drug of medication use
  4. Seizure disorder
    *narcolepsy
  5. Depression
21
Q

What are the laboratory / diagnostic tests to run

A
  1. Thyroid function tests
  2. Hbg / HCY erythrocytes is
  3. Depression screening
  4. Ent referral
22
Q

Does the USPSTF recommend screening in an asymptomatic adult?

A
  1. No recommendation
23
Q

What is the home nocturnal pulse oximetry

A

Screening and not diagnostic for OSA
1. Normal result = high negative predictive value
*will rule out significant episodes of apnea

24
Q

What is the gold standard for OSA

A

Polysomnography (components are below)
1. Electroencephalography
2. Electro-oculography
3. Electro-myography
4. ECG
5. Pulse ox
6. Measure of respiratory effort, airflow

25
Q

What will some of the findings be of the polysomnography be?

A
  1. Evidence or witnessed apneic upsides
  2. Fall in ox saturation
  3. Brady-dysrhythmias
  4. Tachy-dysrhythmias
    *once airflow is re-established
26
Q

what are the Brady dysrhythmias

A

*sinus bradycardia
*sinus arrest
*atrioventricular block

27
Q

What are the tachy-dysrhythmias

A
  1. Paroxysmal supaventricular tachycardia
  2. Atrial fibrillation
  3. Ventricular tachycardia
28
Q

What is essential for the diagnosis of OSA

A
  1. Daytime somnolence or fatigue
  2. History of loud snoring with witnessed apneic events
  3. Overnight polysomnography demonstrating apneic episodes with hypoxemia
29
Q

What the treatment options for OSA (initial steps)

A
  1. Weight loss (if obese)
  2. Avoid alcohol, meds
  3. Improve sleep hygiene
  4. Devices that displaces the tongue and mandible forwards and prevent pharyngeal occlusion
30
Q

What is the treatment for OSA (secondary steps)

A
  1. Nasal continuous positive airway pressure (nasal CPAP)
31
Q

What are the components to a nasal CPAP device

A

Pressure will be determined by the polysomnography
1. Can be curative in many patients
*resolve obstructive apneic episodes, improves hypoxemia

32
Q

What is the compliance rate of OSA

A

75% after 1 year
1. Compliant = at least 4 hours / night at least 70% of the total nights
2. Higher the AHI = more compliant
3. Decreased compliance = claustrophobia, self-conscious, reluctant to wear

33
Q

What are the different types of CPAP masks

A
  1. Nasal pillow
  2. Full face
  3. Nasal
34
Q

What to use for treatment if a patient cannot handle CPAP

A
  1. Use mandibular advancement (Repositioning device)
    *mild/moderate OSA
35
Q

Is supplemental oxygen recommended for OSA

A

No
*prolongs apneic episodes

36
Q

When are surgical interventions used?

A

If the patient has
*large tonsils
*nasal polyps

37
Q

What is uvulopalatopharyngoplasty?

A
  1. Resection of the pharyngeal soft tissue
    *amputation of the soft palate and uvula
    *helps 50% (eliminates snoring but not apneic episodes)
    *laser surgery outpatient
38
Q

What is tracheostomy

A
  1. Numerous adverse effects
    *granuloma formation, speech issues, stoma infection
    *reserved for those with most life threatening conditions when conservative treatment does not help
39
Q

What are some complications of OSA

A
  1. Cardiac disease
  2. COPD exacerbations
  3. Hypoxemia during sleep
  4. Severe daytime somnolence
  5. Pulmonary HTN
40
Q

What is the prognosis of OSA

A
  1. Excellent if treatment is instituted and followed
    *untreated or unrecognized OSA can lead to serious or death
41
Q

What should you educate a patient who has OSA about>

A
  1. Warn of the risk of driving
  2. Operating heavy machinery
  3. Engaging in other activities in which unintentional sleep episodes would be hazardous
42
Q

What is obesity hypoventilation syndrome

A
  1. Applied to OSA and COPD
    *if positive
    *leads to increased M&M due to hypoxia
    *intensifies the episodes of OSA
43
Q

What can overlap syndrome lead to>

A
  1. OSA contributes to airway inflammation and worsen disease severity of COPD
    *leads to pulmonary HTN, cor pulmonale, death

Clinical Medicine (164 decks)

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