Obstructive Sleep Apnea Flashcards Preview

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Flashcards in Obstructive Sleep Apnea Deck (22):
1

RERA

respiratory effort-related arousals

2

apnea vs hypopnea

apnea - breathing pauses lasting at least 10 seconds
hypopnea - 50%-30% reduction of airflow lasting at least 1 seconds with 3-4% drop on o2 sat

3

pathophysiology of OSA

collapse of flexible musculature of upper airway during sleep leads to reduced or absent airlow despite continued respiratory effort

4

what are some conditions associated with OSA

obesity, a fib, resistant HTN, ACS, CHF, t2dm, stroke, pulmonary htn

5

Suspect OSA on history, how to confirm diagnosis?

PSG (polysomnography) with CPAP titration

also helps determine severity of OSA

6

What parts of the hx can suggest OSA?

snoring, excessive daytime sleepiness, gasping for air, witnessed apneas, tired despite 7-8 hours of sleep, concentration/memory/attention problems

7

What is the most widely used scale to assess fatigue/sleepiness

Epworth Sleepiness Scale

can also use Stanford Sleepiness Scale and Fatigue Severity Scale

8

Physical exam findings indicative of OSA

BMI>30, HTN, retrognathia, thick neck, macroglossia, thyroid enlargement, enlarged uvula, large tonsils

9

Ddx for OSA

snoring
narcolepsy
pulmonary disease
periodic limb movements of sleep
shift workers syndrome
obesity hypoventilation syndrome (can have concomitant OSA)

10

Components of PSG

EEG, ECG, electroculogram (EOG), chin electromyogram (EMG), airflow, 02 sat

11

apnea hypopnea index (AHI)

number of apnea and hypopnea episodes per hour of sleep

12

respiratory disturbance index

number of apnea, hypopnea, and repsiratory effort related arousal (RERA) episodes per hour of sleep

13

Dx criteria for OSA

AHI or RDI of at least 15 defined by at least 15 obstructive events per hour on PSG with or without symptoms

or

AHI/RDI of at least 5 + SYMPTOMS (daytime sleepiness, unrefreshing sleep, fatigue, insomnia, nighttime awakenings or witnessed loud snoring/breathing interruptions)

14

treatment of choice for all severities

positive airway pressure PAP

15

What is the connection smoking and development of sleep apnea

direct correlation
increased risk of sudden cardiac death

16

When to re-evaluate for continued therapy or PAP adjustment

after weight loss

all patients should be educated on lifestyle modifications (weight loss, driving safety, avoidance of alcohol or sedating meds, smoking cessation)

17

How does PAP work?

maintain patency of upper airway to reduce AHI

18

How to determine level of PAP

in-lab attended overnight PSG and/or split night diagnostic and titration study

19

When to use oral appliances

mild-moderate OSA or who have contraindication to PAP, or if PAP + behavioral modification don't work

20

When to use surgery

can be primary therapy if OSA is mild, resistant to PAP, and when there is an anatomic cause of major airway obstruction that can be reversed

21

Mallampati score

degree of neck thickness as suggested by visibility of palate

Out of 4, score>3 suggestive of OSA

22

How to improve comfort of PAP machine

heated humidification...if that fails, try different mask or pressure relief...if that fails try alt therapy like oral appliance or surgery