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Respiratory > OSA > Flashcards

OSA Flashcards

1
Q

What are the two types of sleep apnoea?

A

Obstructive
Central

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2
Q

What are the causes of OSA?

A

Obstruction of airway:
- allergies
- adenotonsillar hypertrophy
- glossomegaly
- overbite
- OW = weight on trachea by parapharyngeal tissue
- hormonal weakening of hyoid muscles

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3
Q

What is the pathophysiology of CSA?

A

Cycle of hyperpnoea - apnoea stimulated exclusively by the brain in response to fluctuating CO2 levels

(hypercapnia = hyperventilation etc)

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4
Q

What are the symptoms of sleep apnoea?

A

Sleep deprivation
- nocturia
- difficulty concentrating
- headaches
- fatigue
Loud snoring

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5
Q

What are the potential complications of sleep apnoea?

A
  • arrhythmias (low O2)
    RISK:
  • HF, RF
  • DM
  • cancer
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6
Q

How is sleep apnoea diagnosed?

A

Sleep studies
- polysomnogram (EEG, O2/CO2 levels, obs, snoring, movement)
- more episodes = more severe

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7
Q

How is sleep apnoea treated?

A

Conservative
- avoid depressants (alcohol, sleeping pills) as relaxes airways
- sleeping on side
- CPAP/BiPAP (requires continuous use)

(OSA - WL, mouthpieces)

Surgery
- adenectomy
- jaw realignment/dental

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8
Q

What must be taken into account when counselling a patient about surgical options for resolving sleep apnoea?

A

Surgical anaesthesia & swelling can worsen symptoms in the short term

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9
Q

What would sats/an ABG of a person with sleep apnoea show while awake?

A

Normal sats/PaO2 (only low when asleep)

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10
Q

What can cause CSA?

A

CNS injury/toxicity
- opioids
CHF
- increased chemo sensitivity to pps (lower threshold for hypercapnia causing hyperventilation at resp centre; hypocapnia = apnoea)

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11
Q

What is Cheyne-Stokes respiration?

A

Cyclic respiration associated with CHF-caused CSA
- periodic breathing of alternating hyperpnoea & apnoea

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12
Q

What are the 3C’s of CSA?

A

CNS injury/toxicity
CHF
Cheyne-Stokes respiration

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13
Q

What is the hallmark presentation of OSA in adults?

A

Loud snoring in obese individual with excessive daytime sleepiness

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14
Q

What is the most common cause of OSA in adults?

A

Excess parapharyngeal tissue (obesity)

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15
Q

What is the most common cause of OSA in children?

A

Adenotonsillar hypertrophy

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16
Q

Pickwickian syndrome (OHS)

A

OHS: Obesity hypoventilation syndrome
- excess weight restricts lung expansion
- slow & shallow breathing
(Associated with OSA, but also hypoventilation while awake)

17
Q

How is OHS managed?

A

Diagnosis - high PaCO2 (asleep & awake)
- low PaO2 (asleep)

Treat - WL, CPAP/BiPAP

18
Q

What is the threshold indicative of PHTN?

A

MPP (rest) > 25 mmHg

19
Q

What are the 4 hallmark pathological changes that indicate PHTN?

(Ants In My Pants)

A

Arteriosclerosis
Intimal fibrosis
Medial hypertrophy
Plexiform lesions (new networks of vascular channels due to narrowing of PAs)

20
Q

What is cor pulmonale?

A

RHF caused by PHTN (or resp condition)

PHTN = more resistance = more R afterload = RVH = RHF

21
Q

What is the pathophysiology of PAH?

A

Pulmonary arterial HTN
- progressive stiffening & constriction f arterial vessels
- endothelial dysfunction
- more endothelia’s (vasoconstrict)
- fewer NO/prostacyclins (vasodilate)

22
Q

What causes PAH?

A

Most common: idiopathic
- Congenital shunts (L-R)
- Portal HTN
- CTDs (SLE, scleroderma)
- HIV/schistosomiasis
- cocaine/amphetamines
- heritable (BMPR2 gene inactivated = medial hypertrophy)

23
Q

LHF can cause PHTN. What are the common causes of LHF?

A
  • congenital heart defects
  • essential HTN
  • systolic/diastolic dysfunction (MI, AF)
  • valvular disease
24
Q

How do chronic lung diseases cause PHTN?

A

COPD - lung parenchyma destroyed (stricture)
ILD - inflammation & fibrosis
Chronic hypoxia (living at high altitude, sleep apnoea) = shunting via hypoxic pulmonary vasoconstriction

25
Q

How do chronic VTEs cause PHTN?

A
  • shunting away from poorly perfused (blocked) area

(Clotting disorders, chronic inflammatory disease, systemic disease (cancer)).

26
Q

What are the causes of PHTN?

A
  1. PAH (atherosclerosis)
  2. LHF (PVD, EHTN, valvular/congenital, shunts)
  3. Chronic lung diseases
  4. Thromboembolic disease
  5. Other:
    Thyroid, anaemia, sarcoidosis, tumours compressing pulmonary vessels
27
Q

How is PHTN diagnosed?

A

Catheterisation of R heart (measure MABP)
- identify ULC w/ ECG, echo, CXR, bloods. Etc.

28
Q

How is PHTN treated?

A
  • O2 Tx
    PAH - epoprostenol
    endothelin receptor agonists, prostacyclins (vasodilators)
    LHF - ACEis, ARBs, ß-blockers
    improve performance, reduce BP
    VTE - LMWH, DOACs
    anticoagulation, surgical removal of clot
29
Q

How to treat OSA?

A

CPAP

Respiratory (15 decks)

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