Sleep Apnea

Question 1

Describe sleep stages and architecture

Answer 1

Non-REM: stage1 and 2, slow wave sleep. Stage REM. 2-5 cycles/night. SWS predominant second half of night. Longer REM as night progresses

Question 2

What is the breathing like in each stage?

Answer 2

stage 1-periodic, SWS-regular, Tonic REM-regular, Phasic REM-irregular

Question 3

Two types of Apnea. Difference b/w apnea and hypopnea

Answer 3

Obstructive apnea- cessation of respiration for at least 10 seconds. Obstructive hypopnea-shallow breathing (VT<50%)
Central Apnea- failure to initiate breathing

Question 4

OSA anatomy

Answer 4

small airway, larger tongue, soft palate and pharyngel walls

Question 5

Describe influence of testosterone/menopause on OSA

Answer 5

more frequent in post menopausal regardless of BMI due to increased testosterone:estrogen ratio

Question 6

How is OSA influenced by UA muscles?

Answer 6

genioglossus and tensor palatini have normal strength, fatigue early. Least muscle activity during phasic REM

Question 7

What are the two OSA questionnaires

Answer 7

Berlin and STOP BANG (Snore, Tired, Observed by others being apneic, blood Pressure, BMI, Age, Neck size, Gender (yes to 3=high risk)

Question 8

What BMI and Neck size are at risk

Answer 8

> 30, >17.5 inches

Question 9

Why is htn associated with apnea

Answer 9

Low O2->increase SVR. If you occlude UA you get very neg intrathoracic pressure (increased pre/afterload). Pulm htn.

Question 10

what are the main cognitive areas affected by OSA

Answer 10

Executive Fx, vigilance