OSA

Question 0

What are the co-morbiditiez associated with OSA regarding pulmonary?

Answer 0

asthma, pulmonary HTN

Question 1

What are the co-morbid conditions associated with OSA regarding cardiac?

Answer 1

HTN
biventricular heart failure
ischemic heart diseases, 
atrial fibrillation
cardiac dysrrhythmias

Question 2

What are the co morbidities associated with OSA regarding Neurological and Neurocognition?

Answer 2

Neurological - TIA, CVA

Neuro cognition - daytime hyper-somnolence, memory impairment, concentration difficulties

Question 3

What are the comorbidities associated with OSA regarding Endocrine and Metabolic?

Answer 3

DM II, metabolic syndrome, hypothyroidism, cortisol stress hormone dysregulation, obesity, pickwickian syndrome,

Question 4

Pathophysiology of OSA?

Answer 4

Lose tonic muscle input during sleep + anatomical predisposition = complete closure

Question 5

What is the cycle that repeats for OSA?

Answer 5

Sleep->REM stage-> loss of pharyngeal tone-> obstruction -> apnea -> arousal -> resolved obstruction -> resumption of breathing-> arousal

Question 6

Screening tools for OSA: STOP-BANG stands for?

Answer 6

S-snoring
T-tired (daytime somnolence)
O-observed apnea
P-pressure elevation 
*high risk for OSA with 2 or more

B-bmi > 35
A-age > 50
N-neck circumference > 40 cm
G-gender (male)
*high risk for OSA with 3 or more

Question 7

What is the difference between apnea and hypopnea?

Answer 7

Apnea - cessation or total obstruction of breathing

Hypopnea - reduction in breathing depth or frequency

Question 8

ASA 14 pt checklist has a _____ sensitivity % with AHI 15

Answer 8

79 %

Question 9

Berlin questionnaire has a _____ sensitivity % with _____ specificity %?

Answer 9

Sensitivity 69%
Specificity 56%
With AHI 15

Question 10

STOP-BANG has a ____ sensitivity % with a ____ specificity %?

Answer 10

Sensitivity 93%
Specificity 43%
With AHI 15

***most sensitive but less specific than the Berlin questionnaire

Question 11

What is the gold standard for OSA diagnosis?

Answer 11

Polysomnography

• Diagnosis and classification of severity
• titration of CPAP

Question 12

What is OSA prevalence in population?

Answer 12

2 - 25%

Question 13

Complication risks of OSA?

Answer 13

1. Most occur within 72 hrs of surgery
2. AHI progressively increases over 3 nights
3. REM rebound may play a role

Question 14

What are the perioperative risks?

Answer 14

1. Difficult intubation
2. Increased morbidity
3. Increased mortality
4. Respiratory distress
5. Respiratory obstruction

Question 15

Postoperative adverse outcomes with OSA are?

Answer 15

1. Hypoxia
2. Respiratory arrest
3. Ischemia
4. Delirium
5. Cardiac arrest
6. Death

Question 16

True or False. Benzos can cause intraoperative obstructive problems, central apnea induction followed by obstructive apnea?

Answer 16

True

Question 17

True or False. All inhalation agents cause no effect on OSA patients?

Answer 17

False. Isoflurane combined with propofol has shown increased obstruction

Question 18

True or False. Narcotics can increase risks for OSA pts?

Answer 18

True

Question 19

Clonidine and analogs are beneficial in OSA patients in what way?

Answer 19

Decrease perioperative anesthetic and analgesic requirements