3.2.2 Sleep Apnea

Question 1

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

Answer 1

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 2

Deep sleep occurs during which stage?

Answer 2

N3

Question 3

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

Answer 3

N3

Question 4

During which phase of sleep do most parasomnias occur?

Answer 4

N3

Question 5

What stage of sleep is shown in these graphs?

Answer 5

NREM

Question 6

What stage of sleep is shown in the graphs below?

Answer 6

REM

Question 7

What does the graph represent?

Answer 7

A typical progression through sleep

Question 8

What acts as the central control of ventilation during sleep?

Answer 8

respiratory neurons of the medulla and pons

Question 9

What type of breathing is present during REM sleep?

Answer 9

Irregular

Question 10

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

Answer 10

Less responsive, the least responsive during REM sleep

Question 11

What is the NREM respiratory pattern?

Answer 11

Question 12

What are some characteristics of the REM respiratory pattern?

Answer 12

Question 13

How are cardiovascular physiology values are changed during NREM sleep?

Answer 13

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 14

Describe the cardiovascular physiological state during REM sleep.

Answer 14

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

Question 15

Spontaneous arrousals have what effect on cardiovascular physiology?

Answer 15

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

Question 16

What is apnea?

Answer 16

No airflow for 10 seconds or longer

Question 17

What is central apnea?

Answer 17

No airflow and no respiratory effort for 10 seconds or longer

Question 18

What is obstructive apnea?

Answer 18

No airflow with obstructed respiratory effort for 10 seconds or longer

Question 19

What is hypopnea?

Answer 19

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

Question 20

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

Answer 20

Question 21

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

Answer 21

Question 22

What are some of the risk factors for OSA?

Answer 22

OBESITY and Age of >65

Question 23

What are some of the daytime symptoms of sleep apnea?

Answer 23

Question 24

What are some of the clinical features of OSA?

Answer 24

Question 25

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

Answer 25

Question 26

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

Answer 26

Question 27

Where does OSA commonly manifest in patients?

Answer 27

Narrowing in **retro-palatal** and and **retro-glossal** regions

Question 28

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

Answer 28

Question 29

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

Answer 29

Question 30

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

Answer 30

Question 31

What is the label of the bracketed area?

Answer 31

Apnea

Question 32

What two metabolic dysfunctions have been associated with sleep apnea?

Answer 32

Glucose intolerance and insulin resistance

Question 33

What are some treatment options for OSA?

Answer 33

Question 34

What is the gold standard of treatment for OSA?

Answer 34

CPAP

Question 35

Who does Miles know that wears a CPAP at night?

Answer 35

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