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ENT Specialties MAIN > OSAS > Flashcards

OSAS Flashcards

1
Q

What % of patients with OSAS have systemic hypertension

A

0.4

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2
Q

What level of oxygen desaturation is associated with a significantly higher incidence of PVCs

A

0.5

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3
Q

What is the respiratory arousal index

A

apneas + hypopneas + RERAs per hour.

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4
Q

What is the RDI in patients with severe OSAS

A

>30 events per hour.

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5
Q

What is the relative risk for sleep-disordered breathing in a patient with allergic rhinitis

A

1.8.

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6
Q

How far is the genioglossus normally moved with the genioglossus advancement (GA)

A

10 - 14 mm.

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7
Q

What are the normal dimensions of the osteotomy in GA

A

10 x 20 mm.

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8
Q

What % of patients with OSAS will be considered difficult to intubate

A

19%.

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9
Q

What proportion of patients with OSAS are obese

A

2/3.

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10
Q

What is the prevalence of obstructive sleep apnea syndrome (OSAS)

A

24% of adult men and 9% of adult women; about 30 million people in the US.

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11
Q

What is the minimal mandibular height necessary for performing GA

A

25 mm.

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12
Q

What is the prevalence of behavioral and emotional problems in children undergoing tonsillectomy and adenoidectomy for treatment of sleep-disordered breathing

A

25%.

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13
Q

When should PSG be performed after surgery for OSAS

A

6 months after surgery.

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14
Q

What is the incidence of postoperative hypertension in patients with OSAS without history of hypertension

A

63%.

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15
Q

What is the cure rate for OSAS in patients with RDI

A

77% (Riley and Powell).

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16
Q

How far from the inferior border of the mandible should the osteotomy be placed

A

8 - 10 mm.

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17
Q

What % of cases of anesthesia of the chin/lip after GA will resolve by 6 months

A

95%.

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18
Q

What is the definition of a hypopneic episode

A

A 50% or more decrease in flow with a drop in oxygen saturation of 4°/o or more.

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19
Q

What is the Bernoulli principle

A

A column of air flowing through a conduit produces a partial vacuum or negative pressure at the margins of the column that increases as the rate of flow increases.

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20
Q

What is the normal thickness of the soft palate in adults

A

About 12 mm; gets thinner laterally.

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21
Q

How is an arousal defined during PSG

A

Abrupt shift in EEG frequency consisting of an alpha wave, theta wave or wave with frequency > 16 Hz, excluding spindle waves; must be preceded by at least I 0 seconds of sleep, must last at least 3 seconds, and must be accompanied by increase in chin EMG.

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22
Q

What preoperative factor is associated with a positive long-term response to UPPP

A

AHI

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23
Q

What is an RERA (respiratory effort related arousal)

A

An arousal related to an obstructive respiratory event other than apnea or hypopnea (ie, esophageal pressure crescendo, snoring, increased diaphragm EMG, or increased nasal resistance).

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24
Q

What is the AHI

A

Apnea-hypopnea index or # apneic and hypopneic events per hour.

25
Q

Neurocognitive dysfunction is most related to which two measurements on PSG

A

Arousal index and hypoxemia.

26
Q

Where is dehiscence most likely to occur after UPPP

A

At the inferior tonsillar poles.

27
Q

What is the ideal MAP after surgery for OSAS

A

Below 100 mm Hg.

28
Q

What factors are associated with an increased risk of base of tongue obstruction

A

BMI >31, mandibular skeletal deficiency, and RDI >40.

29
Q

What are some adjunctive procedures for patients who do not improve after UPPP

A

BOT reduction, mandibular advancement with LeFort I osteotomy and maxillary advancement, genioglossus advancement, tracheostomy.

30
Q

What are the categories of apneic or hypopneic episodes

A

Central, obstructive, or mixed.

31
Q

What is the definition of sleep apnea

A

Cessation of airflow due to obstruction or cessation of respiratory effort during sleep.

32
Q

What is the definition of an apneic episode

A

Cessation of airflow for I 0 seconds, usually associated with an arousal and/or desaturation.

33
Q

What does a standard polysomnography (PSG) record

A

EEG, EOG, EMG (submentalis and mentalis, anterior tibialis), EKG, oxygen saturation, nasal airflow, rib cage and abdominal respiratory effort.

34
Q

What preoperative symptom best correlates with improvement in AHI after UPPP

A

Excess daytime sleepiness.

35
Q

Increased electrical activity of which muscles has been demonstrated in patients with OSAS while awake

A

Genioglossus and tensor palatini muscles.

36
Q

What is the only patient characteristic shown to increase the likelihood of OSAS

A

High body mass index.

37
Q

When is clock-dependent alerting most active

A

In the afternoon.

38
Q

Why should adenoidectomy be avoided when performing UPPP

A

Increases the risk of nasopharyngeal stenosis.

39
Q

What is “clock-dependent alerting”

A

Internal signal from the biological clock that opposes the tendency to fall asleep.

40
Q

What are the 4 basic types of polysomnographies

A

Level I - standard. Level II - comprehensive portable. Level III - modified portable. Level IV - continuous single or dual bioparameter.

41
Q

What physical features are predictors of difficult intubation in patients with OSAS

A

Low hyoid (mental protuberance to hyoid distance >30cm), mandibular deficiency, and large neck circumference (>45.6 em).

42
Q

What are the possible complications of GA

A

Mandible fracture, dental injury, failure to advance, infection, anesthesia of lower lip, gums, and chin, bleeding/hematoma.

43
Q

What is considered abnormal negative esophageal pressure (-Pes)

A

More negative than - 12 mm Hg.

44
Q

Why is OSAS worse during REM sleep

A

Muscle relaxation is maximal during REM sleep.

45
Q

What disease is characterized by a decreased sleep latency time with quick onset of REM sleep on polysomnogram

A

Narcolepsy.

46
Q

What are the primary disadvantages of an outpatient study

A

No EEG to assess total sleep time and no EMG to study periodic limb movements.

47
Q

What are the most common physical signs associated with OSAS

A

Obesity, systemic and pulmonary hypertension, erythrocytosis, congestive heart failure, sleep-related arrhythmias, unexplained cognitive/psychiatric disturbances.

48
Q

What is the success of UPPP for the treatment of OSAS in adults

A

Overall, 50% experience a 50°/o reduction in AHI or in the amount of oxyhemoglobin desaturation.

49
Q

What are the general indications for performing tracheostomy on patients with OSAS

A

Oxygen saturation

50
Q

What is a split-night study

A

Patient is studied for the first half of the night then placed on a CPAP machine for the latter half.

51
Q

What is the primary disadvantage of a split-night study

A

REM sleep is most concentrated in the final 1/3 of the night; OSAS is worse during REM sleep.

52
Q

What are the most common symptoms associated with OSAS

A

Restless sleep, loud snoring, excess daytime sleepiness, decreased intellectual capacity and memory loss, personality changes or depression, decreased libido, morning headaches (in decreasing order of frequency).

53
Q

What are the advantages of the uvulopalatal flap

A

Reversible; less pain and less incidence of dehiscence than UPPP.

54
Q

What is upper airway resistance syndrome (UARS)

A

Snoring with pathologic daytime sleepiness, poor sleep efficiency, and fragmented sleep; near-normal RDis and oxygen saturations but abnormal negative esophageal pressures.

55
Q

Where in the brain is the “biological clock”

A

Suprachiasmatic nuclei.

56
Q

What is the Venturi effect

A

The acceleration of flow as a current of air or liquid enters a narrowed passage.

57
Q

What is the preferred treatment for OSAS in children

A

Tonsillectomy and adenoidectomy.

58
Q

What is Fujita’s classification of airway obstruction in patients with OSAS

A

Type I - palate only (normal base of tongue). Type Il/IIA - palate and base of tongue. Type III/liB - base of tongue only (normal palate).

ENT Specialties MAIN (17 decks)

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