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Pulmonary > Sleep Apnea > Flashcards

Flashcards in Sleep Apnea Deck (24):
1

stages of sleep

non-REM - stages 1, 2, and slow wave

REM stage

4-5 cycles per night

2

stages of sleep and ventilation

stage 1 - periodic

slow wave - regular

tonic stage REM - mostly regular

phastic stage REM - irregular

3

obstructive apnea

cessation of respiration that lasts at least 10 seconds, due to obstruction in the upper airway

may be associated with arousal and/or desaturation

hypopnea - shallow breathing in which the air flow in and out of the airway is less than half of normal - usually associated with oxygen desaturation

4

central apnea

pause in respiratory activity due to failure to initiate the breath (no obstruction present)

5

obstructive sleep apnea

characterized by repeated episodes of apnea and hypopnea rsulting from inspiratory occlusion o fhte upper airway during sleep

syndrome is defined by OSA with daytime sleepiness (hypersolmnolence)

6

possible causes of obstructive sleep apnea

anatomy

physics

genetics

neural control

hormonal control

muscle control

7

venturi effect

describes the acceleration of airflow that occurs as a current of air enters a narrow passageway

8

OSA and the obesity hypoventilation syndrome

obesity drives the development of both sleep apnea and daytime hypercapnia

9

apnea hypopnea index

the number of apneas plus hypopneas per hour of sleep

greater than 5 defines OSA, but clinically significant and potentially serious complications generally do not occur unless AHI is >15

10

affect of testosterone on control of breathing

reduces sensitivity of response and depresses breathing

11

complaints related to OSA

day time sleepiness/fatigue

AM headaches

vivid dreams

insomnia

hyperactivity

memory and learning impairments

snoring

unrefreshing sleep

12

types of questionnaires for OSA

Berlin questionnaire and STOP BANG

13

STOP BANG

snoring

Tired

Observed

Pressure (blood)

BMI

Age

Neck size

Gender

14

mallampati classification

  ○ Class I - can see clear through to posterior phalanx and bottom of uvula

  ○ Class II - can't see bottom of the uvula

  ○ Class III - can barely see the phalanx

  ○ Class IV - can barely see the palate

15

long term outcomes for OSA

cardiovascular

cognitive

inflammatory

metabolic

cancer

quality of life

16

risk factors for OSA

excess body weight

shirt collar size of 17 inches or larger

crowded pharynx

alcohol consumption

supine position during sleep

smoking

nasal congestion

hormonal changes during menopause

hypothyroidism

17

cardiac issues associated with OSA

hypertension

inability for the left ventricle to pump blood due to negative intrathoracic pressures - PH long term

18

What aspects of neuro-cognition is affected the most by OSA?

executive functioning

vigilance

19

What is the gold standard for diagnosing OSA?

overnight polsomnography

20

treatment for OSA

depends on the severity of the condition

in all cases, try to correct exacerbating conditions such as excess weight, alcohol or sedative use at bedtime, and nasal congestion

only weight loss has been shown to reliably improve OSA

21

treatment for mild cases of OSA

avoidance of supine positions

weight reduction

22

treatment for severe cases of OSA

continuous positive airway pressure (CPAP) via nasal or full-face mask

drying of mucosal membranes is a problem

severe OSA not adequately treated with CPAP is an indication for tracheostomy

23

surgical therapy for OSA

uvulopalatopharyngoplasty

laser assisted uvuolplasty

radio frequency volumetric tissue reduction

maxillary mandibular osteotomy

hyoid suspension

gastric reduction or bypass

tracheostomy

24

types of hoome nocturnal positive airway pressure devices

continuous pressure - unchanged throughout the night

bilevel pressure - separate inspiratory and expiratory pressure

autopressure - deliver pressure changes breath to breath