CVPR Week 6: Sleep Disordered Breathing

Question 1

Objectives

Answer 1

Question 2

Physiologic changes during sleep

Answer 2

• Heart rate drops
• Breathing rate slows
• Blood pressure decreases
• Urine output decreases

Question 3

Polysomnogram of various apnea

Answer 3

Question 4

Two types of breathing events during sleep

Answer 4

• Apnea
• Hypopnea

Question 5

Apnea description

Answer 5

Cessation of airflow >= 10 seconds

Question 6

Hypopnea description

Answer 6

Decreased airflow >= 30% from baseline lasting >= 10 seconds associated with >= 4% oxyhemoglobin desaturation Or an arousal from sleep

Question 7

Obstructive sleep apnea description and criteria

Answer 7

Question 8

Sleep apnea cycle

Answer 8

Question 9

Physiologic stressors of sleep apnea

4 listed

Answer 9

• Cyclic hypoxemia
• Strenuous respiration
• Sympathetic activation
• Reduced total sleep time

Question 10

Central sleep apnea description and criteria

Answer 10

• A lack of effort to breathe
• Respiratory drive under metabolic control in NREM sleep
• Mu receptors sense CO2 in brainstem
• Breath is triggered by CO2 hitting threshold (individual)

Question 11

Central sleep apnea dysregulation is due to?

4 listed

Answer 11

• Brain lesion
• Genetic
• Medication
• Poor cardiac function

Question 12

Brain lesions that can lead to central sleep apnea

Answer 12

• Stroke
• anatomical
• vascular
• tumor

Question 13

Genetic conditions that can lead to central sleep apnea

Answer 13

Odine’s Curse (“forget” to breathe)

Question 14

Medication that can that can lead to central sleep apnea

Answer 14

narcotics block Mu receptors

Question 15

Cardiac functioning that can lead to central sleep apnea

Answer 15

• CHF
• Atrial fibrillation
• Signal to brain is “old news”

Question 16

Central sleep apnea is driven by?

Answer 16

CO2

Question 17

Quick screening tool for Obstructive Sleep Apnea

Answer 17

STOPBANG

Question 18

OSA AKA

Answer 18

Obstructive Sleep Apnea

Question 19

Physical findings predisposing to OSA

11 listed

Answer 19

• BMI > 35
• Neck Circumference > 17
• chronic nasal congestion
• Nasal speech
• Obligate mouth breathing
• mandibular retrognathia
• Mid face hypoplasia
• Micrognathia
• Crowded dentition
• Overbite
• Crowded oropharynx

Question 20

Crowded oropharynx

6 listed

Answer 20

Question 21

Related to OSA

Answer 21

Question 22

Case

Question 23

Cardiovascular consequences of sleep apnea

Answer 23

Hypertension

loss of nocturnal dipping

Question 24

Nocturnal dipping and CVD risk

Answer 24

• Normally blood pressure drops 10-20% when sleeping
• 5 mmHg loss of reduction increases CVD risk by 17%
• 10 mmHg loss of reduction increases CVD risk by 35%

Question 25

Loss of nocturnal dipping

Answer 25

Question 26

Cardiometabolic risks of sleep apnea

Answer 26

* OSA increases risk of hypertension 3-4 fold * OSA prevents nocturnal dipping * Blood pressure usually drops 10-20% during sleep * OSA causes insulin resistance due to stress response * Also true in non-diabetics * OSA increases impulsive eating of foods rich in fats and carbohydrates * Sugar us the only energy source that the brain uses * Sleep deprivation increases impulsivity

Question 27

Major red flag for OSA

Answer 27

Waking unrefreshed after sufficient sleep and taking day time naps is a major red flag for OSA

Question 28

Snoring can also increase

Answer 28

relationship strain by bothering the partner more than the patient

Question 29

Erectile dysfunction can be a symptom of?

Answer 29

Sleep apnea

Question 30

Case key points

Answer 30

Question 31

Nocutria in OSA 6 listed

Answer 31

Question 32

Sympathetic surges in OSA

Answer 32

Question 33

Case Mr HEart

Answer 33

Question 34

Case Ms. Nellie

Answer 34

Question 35

Prevalence of sleep apnea

Answer 35

Question 36

Sleep stage dependent apnea

Answer 36

Question 37

Measures of sleep apnea frequency

Answer 37

Question 38

Treatment for OSA

Answer 38

Question 39

Standard of treatment for OSA

Answer 39

Question 40

Before and after PAP

Answer 40

Question 41

Oral appliances for Sleep apnea

Answer 41

Question 42

Surgical alternatives for OSA

Answer 42

Question 43

Behavioral interventions for OSA

Answer 43