Chapter 291 - Sleep Apnea

Question 1

causes daytime sleepiness, impairs daily function, and is a major contributor to cardiovascular disease in adults and to behavioral problems in children

Answer 1

OSAHS

Question 2

Which medical condition can predispose to central sleep apnea

Answer 2

Heart failure

Question 3

Condition the results to frequent awakening and daytime fatigue and patients are at increased risk for HF an AF

Answer 3

CSA

Question 4

Formula for AHI

Answer 4

no. of episodes of A/H divided by number of hours of sleep

Question 5

What are the three things that happen in every episode of apnea or hypopnea?

Answer 5

• reduction in breathing for at least 10 s
• ≥3% drop in O2 sat
• brain cortical arousal

Question 6

OSAHS severity is based on which parameters?

Answer 6

• frequency of breathing disturbances (AHI)
• amount of oxyhemoglobin desaturation with respiratory events
• the duration of apneas and hypopneas
• the degree of sleep fragmentation
• level of daytime sleepiness or functional impairment

Question 7

Diagnosis of OSAHS

Answer 7

(1) Sx + AHI 5 or more

(2) AHD >15 episodes/h

Question 8

In patients with collapsible airway, Transient episodes of pharyngeal collapse result in

Answer 8

apnea

Question 9

transient episodes of pharyngeal near collapse is manifested as

Answer 9

hypopnea

Question 10

Episodes of collapse or near collapse are terminated how?

Answer 10

activation of ventilatory reflexes causing arousal

Question 11

Most common site of airway collapse?

Answer 11

soft palate

others: tongue base, lateral pharyngeal walls, epiglottis

Question 12

When is OSAHS most severe?

Answer 12

REM sleep

supine position

Question 13

Factors that narrow the pharyngeal lumen

Answer 13

• enlargement of soft tissue structures
• Craniofacial factors
• Lung volume
• High degree of nasal resistance

Question 14

Major risk factors of OSAHS

Answer 14

Obesity

Male sex

Question 15

Additional risk factors of OSAHS

Answer 15

• mandibular retrognathia and micrognathia
• positive family history of OSAHS
• genetic syndromes that reduce upper airway patency (e.g., Down syndrome, Treacher-Collins syndrome)
• adenotonsillar hypertrophy (especially in children)
• menopause (in women)
• endocrine syndromes (e.g., acromegaly, hypothyroidism).

Question 16

How many percent of cases of OSAHS are attributable to excess weight?

Answer 16

40-60%

Question 17

How does lung volume influence airway collapse?

Answer 17

lung volumes influence the caudal traction on the pharynx

Question 18

Obese individuals are at how many times at risk for OSAHS?

Answer 18

4x

Question 19

10% weight gain is associated with a how many percent increase in AHI

Answer 19

> 30%

Question 20

Even modest weight loss or weight gain can influence the risk and severity of OSAHS. However, the absence of obesity does not exclude this diagnosis.

Answer 20

true

Question 21

factors that predispose men to OSAHS

Answer 21

android patterns of obesity

greater pharyngeal length

Question 22

Prevalence of OSAHS among middle aged adults

Answer 22

2-15%

Question 23

Prevalence of OSAHS among elderly

Answer 23

> 20%

Question 24

Peak of OSAHS between ages 3 to 8 is due to?

Answer 24

lymphoid hypertrophy

Question 25

Most common complaint of OSAHS

Answer 25

Snoring

Question 26

What distinguishes OSAHS from paroxysmal nocturnal dyspnea, nocturnal asthma, and acid reflux with laryngospasm

Answer 26

Absence of Dyspnea

Question 27

Frequent awakening or sleep disruption is more common among?

Answer 27

Women and older adults

Question 28

Most common daytime symptom

Answer 28

excessive sleepiness

Question 29

Gold standard for diagnosis of OSAHS

Answer 29

overnight Polysomnogram

Question 30

tests that record only a few respiratory and cardiac channels commonly are used as a cost-effective means for diagnosing patients without significant comorbidity who have a high pretest probability of OSAHS.

Answer 30

Home sleep tests

Question 31

Key physiological information collected during a sleep study for OSAHS assessment

Answer 31

breathing oxygenation body position cardiac rhythm additional: sleep continuity, sleep stages, limb movements, snoring intensity

Question 32

defined as time from lights off to first sleep onset

Answer 32

sleep latency

Question 33

defined as percentage of time asleep relative to time in bed

Answer 33

sleep efficiency

Question 34

defined as the number of cortical arousals per hour of sleep

Answer 34

arousal index

Question 35

pattern seen in an overnight BP monitoring with a the absence of the typical 10 mmHg fall of BP using sleep compared to wakefulness

Answer 35

non-dipping pattern

Question 36

Cessation of airflow for >10s accompanied by persistent respiratory effort

Answer 36

obstructive apnea

Question 37

cessation for airflow for 10s accompanied by absence of respiratory effort

Answer 37

central apnea

Question 38

A ≥30% reduction in airflow for at least 10 s during sleep that is accompanied by either a ≥3% desaturation or an arousal

Answer 38

hypopnea

Question 39

Partial obstruction that does not meet the criteria for hypopnea but provides evidence of increasing inspiratory effort (usually through pleural pressure monitoring) punctuated by an arousal

Answer 39

Respiratory effort-related arousal (RERA)

Question 40

A partially obstructed breath, typically within a hypopnea or RERA, identified by a flattened or “scooped-out” inspiratory flow shape

Answer 40

Flow limited breath

Question 41

Number of apneas plus hypopneas per hour of sleep

Answer 41

AHI

Question 42

Number of apneas plus hypopneas plus RERAs per hour of sleep

Answer 42

Respiratory disturbance index (RDI)

Question 43

Mild OSAHS

Answer 43

AHI of 5–14 events/h

Question 44

Moderate OSAHS

Answer 44

AHI of 15–29 events/h

Question 45

Severe OSAHS

Answer 45

AHI of ≥30 events/h

Question 46

what is the inspiratory flow pattern of a patient with a patent airway

Answer 46

rounded and peaks in the middle

Question 47

A partially obstructed airway exhibits what pattern

Answer 47

early peak followed by mid-inspiratory flattening, yielding a scooped-out appearance

Question 48

Impact of CPAP in reducing 24h ambulatory BP averages how much?

Answer 48

2-4 mmHg

Question 49

How many percent of patients with moderate to severe OSAHS report daytime sleepiness.

Answer 49

more than 50%

Question 50

Patients with OSAHS symptoms have how much risk of occupational accidents?

Answer 50

2x increased risk

Question 51

Optimum sleep duration

Answer 51

7-9h

Question 52

Alcohol ingestion must be avoided within how many hours of bedtime?

Answer 52

within 3 hours

Question 53

Beneficial effects on CPAP

Answer 53

``` BP Alertness Mood QOL Insulin sensitivity ```

Question 54

CPAP with oral appliance reduces AHI by how much in 2/3 of individuals?

Answer 54

≥50%

Question 55

Upper airway surgery for OSAHS is less effective than CPAP and is mostly reserved in 3 situations

Answer 55

Patients who snore have mild OSAHS cannot tolerate CPAP **Upper airway surgery is less effective in severe OSAHS and in obese patients.**

Question 56

What is the most common surgery of the upper airway fir OSAHS?

Answer 56

Uvulopalatopharyngoplasty

Question 57

Enrolled patients for upper airway neuro-stimulation

Answer 57

- BMI ≤32 kg/m2 - moderate OSAHS absence of complete - concentric pharyngeal collapse - unable to be treated successfully with CPAP

Question 58

This is often caused by an increased sensitivity to pCO2, which leads to an unstable breathing pattern that manifests as hyperventilation alternating with apnea.

Answer 58

Central sleep apnea

Question 59

Cheyne-Stokes respiration

Answer 59

crescendo-decrescendo breathing pattern occurring with prolonged circulation delay

Question 60

This refers to a condition when CPAP particularly at high pressures induce central apnea

Answer 60

Complex Sleep Apnea