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PULMONOLOGY > Chapter 291 - Sleep Apnea > Flashcards

Chapter 291 - Sleep Apnea Flashcards

1
Q

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

A

OSAHS

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2
Q

Which medical condition can predispose to central sleep apnea

A

Heart failure

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3
Q

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

A

CSA

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4
Q

Formula for AHI

A

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

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5
Q

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

A
  • reduction in breathing for at least 10 s
  • ≥3% drop in O2 sat
  • brain cortical arousal
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6
Q

OSAHS severity is based on which parameters?

A
  • 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
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7
Q

Diagnosis of OSAHS

A

(1) Sx + AHI 5 or more

(2) AHD >15 episodes/h

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8
Q

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

A

apnea

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9
Q

transient episodes of pharyngeal near collapse is manifested as

A

hypopnea

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10
Q

Episodes of collapse or near collapse are terminated how?

A

activation of ventilatory reflexes causing arousal

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11
Q

Most common site of airway collapse?

A

soft palate

others: tongue base, lateral pharyngeal walls, epiglottis

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12
Q

When is OSAHS most severe?

A

REM sleep

supine position

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13
Q

Factors that narrow the pharyngeal lumen

A
  • enlargement of soft tissue structures
  • Craniofacial factors
  • Lung volume
  • High degree of nasal resistance
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14
Q

Major risk factors of OSAHS

A

Obesity

Male sex

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15
Q

Additional risk factors of OSAHS

A
  • 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).
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16
Q

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

A

40-60%

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17
Q

How does lung volume influence airway collapse?

A

lung volumes influence the caudal traction on the pharynx

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18
Q

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

A

4x

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19
Q

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

A

> 30%

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20
Q

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.

A

true

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21
Q

factors that predispose men to OSAHS

A

android patterns of obesity

greater pharyngeal length

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22
Q

Prevalence of OSAHS among middle aged adults

A

2-15%

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23
Q

Prevalence of OSAHS among elderly

A

> 20%

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24
Q

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

A

lymphoid hypertrophy

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25
Q

Most common complaint of OSAHS

A

Snoring

26
Q

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

A

Absence of Dyspnea

27
Q

Frequent awakening or sleep disruption is more common among?

A

Women and older adults

28
Q

Most common daytime symptom

A

excessive sleepiness

29
Q

Gold standard for diagnosis of OSAHS

A

overnight Polysomnogram

30
Q

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.

A

Home sleep tests

31
Q

Key physiological information collected during a sleep study for OSAHS assessment

A

breathing
oxygenation
body position
cardiac rhythm

additional: sleep continuity, sleep stages, limb movements, snoring intensity

32
Q

defined as time from lights off to first sleep onset

A

sleep latency

33
Q

defined as percentage of time asleep relative to time in bed

A

sleep efficiency

34
Q

defined as the number of cortical arousals per hour of sleep

A

arousal index

35
Q

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

A

non-dipping pattern

36
Q

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

A

obstructive apnea

37
Q

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

A

central apnea

38
Q

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

A

hypopnea

39
Q

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

A

Respiratory effort-related arousal (RERA)

40
Q

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

A

Flow limited breath

41
Q

Number of apneas plus hypopneas per hour of sleep

A

AHI

42
Q

Number of apneas plus hypopneas plus RERAs per hour of sleep

A

Respiratory disturbance index (RDI)

43
Q

Mild OSAHS

A

AHI of 5–14 events/h

44
Q

Moderate OSAHS

A

AHI of 15–29 events/h

45
Q

Severe OSAHS

A

AHI of ≥30 events/h

46
Q

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

A

rounded and peaks in the middle

47
Q

A partially obstructed airway exhibits what pattern

A

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

48
Q

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

A

2-4 mmHg

49
Q

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

A

more than 50%

50
Q

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

A

2x increased risk

51
Q

Optimum sleep duration

A

7-9h

52
Q

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

A

within 3 hours

53
Q

Beneficial effects on CPAP

A 
BP
Alertness
Mood
QOL
Insulin sensitivity
54
Q

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

A

≥50%

55
Q

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

A

Patients who snore
have mild OSAHS
cannot tolerate CPAP

Upper airway surgery is less effective in severe OSAHS and in obese patients.

56
Q

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

A

Uvulopalatopharyngoplasty

57
Q

Enrolled patients for upper airway neuro-stimulation

A
  • BMI ≤32 kg/m2
  • moderate OSAHS
    absence of complete - concentric pharyngeal collapse
  • unable to be treated successfully with CPAP
58
Q

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

A

Central sleep apnea

59
Q

Cheyne-Stokes respiration

A

crescendo-decrescendo breathing pattern occurring with prolonged circulation delay

60
Q

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

A

Complex Sleep Apnea

PULMONOLOGY (10 decks)

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