3.2.2 Sleep Apnea

Question 1

How do the hypoxia/hypercarbia responses during sleep compare to responses during waking hours?

Answer 1

Less responsive, the least responsive during REM sleep

Question 2

What are some of the daytime symptoms of sleep apnea?

Answer 2

Question 3

What does the graph represent?

Answer 3

A typical progression through sleep

Question 4

Who does Miles know that wears a CPAP at night?

Answer 4

His dad…. How could you not know that? He’s probably told you at least 20 times.

Question 5

What are some of the physical correlations with OSA from the clinical examination?

Answer 5

Question 6

What is hypopnea?

Answer 6

Reduction in airflow associated with at least 3-4% drop in O₂ Sat

Question 7

What type of breathing is present during REM sleep?

Answer 7

Irregular

Question 8

Where are the retro-palatal and retro-glossal regions?

Answer 8

Question 10

What are some of the predisposing factors of OSA and their odds ratios?

Answer 10

Question 11

How are cardiovascular physiology values changed during NREM sleep?

Answer 11

HR, BP, CO, and SVR are all decreased, thus reducing myocardial workload. This a result of parasympathetic discharge combined with a reduce in central sympathetic discharge.

Question 12

Describe the mechansims/pathways that sleep apnea can lead to CV complications.

Answer 12

Question 13

What acts as the central control of ventilation during sleep?

Answer 13

respiratory neurons of the medulla and pons

Question 14

Where does OSA commonly manifest in patients?

Answer 14

Narrowing in retro-palatal and and retro-glossal regions

Question 15

During which phase of sleep do most parasomnias occur?

Answer 15

N3

Question 16

Which phase of sleep requires the loudest tone to wake up and most obnoxious stimuli to awake?

Answer 16

N3

Question 17

Deep sleep occurs during which stage?

Answer 17

N3

Question 18

What are some characteristics of the REM respiratory pattern?

Answer 18

Question 19

What are the stages of sleep? What are some major characteristics of stage?

Answer 19

Stage 1 (N1): low V, mixed frequency (theta), <50% alpha (wake)

Stage 2 (N2): predominately theta w/ sleep spindles or K complexes

Stage 3/4 (N3): large delta waves (stage 3 is 20-50%, stage 4 is >50%)

REM: atonia or flat EMG, irregular breathing pattern and phasic eye movements

Question 20

What is the label of the bracketed area?

Answer 20

Apnea

Question 21

What is the NREM respiratory pattern?

Answer 21

Question 22

Describe how the airflow and respiratory effort graphs of both central and obstructive apnea would look on a time strip.

Answer 22

Question 23

What are different levels of severity of OSA and their corresponding numbers of events in an hour?

Answer 23

Question 24

What are some of the cardio/cerebrovascular complications of OSA?

Answer 24

Question 25

What is central apnea?

Answer 25

No airflow and no respiratory effort for 10 seconds or longer

Question 26

What are some of the clinical features of OSA?

Answer 26

Question 27

What are some treatment options for OSA?

Answer 27

Question 28

What stage of sleep is shown in these graphs?

Answer 28

NREM

Question 29

Spontaneous arrousals have what effect on cardiovascular physiology?

Answer 29

Acute increases in HR, BP, CO, SVR much above the level of the awake state

Question 30

What stage of sleep is shown in the graphs below?

Answer 30

REM

Question 31

Describe the cardiovascular physiological state during REM sleep.

Answer 31

Unstable; Phasic REM results in flucuation in HR, BP, and SVR

Question 32

What two metabolic dysfunctions have been associated with sleep apnea?

Answer 32

Glucose intolerance and insulin resistance

Question 33

What is the gold standard of treatment for OSA?

Answer 33

CPAP

Question 34

What is obstructive apnea?

Answer 34

No airflow with obstructed respiratory effort for 10 seconds or longer

Question 35

What is apnea?

Answer 35

No airflow for 10 seconds or longer

Question 36

What are some of the risk factors for OSA?

Answer 36

**OBESITY and Age of \>65**