Flashcards in Sleep Apnea Deck (22):
Define sleep apnea
1. Disorder where normal breathing is periodically interrupted during sleep
2. Pauses in breathing can be length of 2-3 breaths
3. Results in significant decrease in gas transport during episodes
Where is the breathing problem in central sleep apnea? What is the result?
Brain centers are dysregulated
Results in lack of effort to breathe
Where is the breathing problem in obstructive sleep apnea? What is the result?
Obstruction prevents airflow
Respiratory effort is normal
Where is the breathing problem in complex sleep apnea? What is the result?
Combination of central & obstructive
What is the clinical significance of sleep apnea?
↑ incidence of heart disease and stroke
What comorbidity is usually present with OSA?
What demogrpahic is OSA most prevalent in?
obese middle aged men
What are the risk factors for OSA?
1. Patients with anatomically narrowed airways:
C. Tonsillar hypertrophy
2. Ingestion of alcohol or sedatives before sleep
3. Nasal obstruction
5. Tobacco Use
What is the pathophys of OSA?
Loss of normal pharyngeal muscle tone allows pharynx to collapse during inspiration
What are the important symptoms in OSA?
1. Daytime somnolence/fatigue
2. Disrupted sleep
What are the other symptoms in OSA?
Irritability, mood changes
What are the witnessed symptoms in OSA?
1. Loud snoring
2. Witnessed apnea
5. Thrashing movements of extremities
What signs may be present on physical exam that indicate OSA?
1. Physical exam may be normal or patients may have systemic HTN or pulmonary HTN
2. Narrowed oropharynx
A. Excessive neck soft tissue folds
B. Large tonsils
C. Prominent uvula or tongue
3. Nasal obstruction may be present
What are the Hgb/Hct dx studies results in OSA?
Why should the TSH dx studies be checked OSA?
1. Should be checked due to presenting sx’s
2. Association between hypothyroidism & OSA
What other studies should be performed in OSA?
1. Sleep study (polysomnography)
2. Overnight oximetry and apnea link screening
Define sleep study
Observation of sleeping patient reveals loud snoring interrupted by episodes of increasing ventilatory effort that fail to produce airflow
How long do apneic episodes last? What do they follow?
Loud snort often accompanies first breath, followed by apneic episodes lasting up to 60 seconds
What happens to the heart rhythms in OSA?
Bradydysrhythmias occur followed by tachydysrhythmias when airflow is re-established
What are the lifestyle change treatments for OSA?
1. Weight loss
2. Avoidance of alcohol & hypnotic meds
A. Suppress respirations
What is the surgical treatment of OSA?
1. Uvulopalatopharyngoplasty (UPPP)
A. Resection of pharygeal soft tissue
B. Helpful in 50% of select patients