Sleep Apnea

Question 1

Who are more likely to have sleep apnea?

Answer 1

Women
AA
Hispanics

Question 2

What is the sleep wake cycle?

Answer 2

During sleep, the brain displays several different stages of electrical activity

Question 3

How do we measure the sleep wake cycle?

Answer 3

EEG

Question 4

What are the stages of NREM?

Answer 4

Stage 1 have the lowest amplitude and highest frequency

Stage 3 has the highest amplitude and lowest frequency

Question 5

When does HR and BP decrease during sleep?

Answer 5

Stage 3 of NREM

Question 6

When does HR and BP increase during sleep?

Answer 6

REM

Question 7

When does GI motility increase during sleep?

Answer 7

Stage 3 NREM

Question 8

What happens during REM?

Answer 8

Skeletal muscle (except those that control the eyes) are completely inhibited from moving

Question 9

When does visual dreaming occur?

Answer 9

REM

Question 10

What is a normal breath rate?

Answer 10

12-16 BMP

Question 11

What are dyssomnias?

Answer 11

Primary disorder of initiating or maintaining sleep or of excessive sleepiness

Question 12

How is dyssomnia characterized?

Answer 12

Disturbance in the amount, quality, or timing of sleep

Question 13

What is parasomnias?

Answer 13

Unusual or undesirable behavior or physiologic events that occurs during sleep or at the threshold between waking and sleeping

Question 14

What is apnea?

Answer 14

Cessation of airflow for 10 or more seconds

Question 15

What is hypopnea?

Answer 15

30% reduction in airflow for 10 or more seconds associated with a 4% decrease in oxygen saturation

Question 16

What is the AHI?

Answer 16

Apnea-hypopnea Index

Number of apnea and hypopnea episodes per hour

Question 17

What is OSA in the AHI?

Answer 17

15+ events/hr w/ or w/o sx
or
5+ events w/sx

Question 18

What is OSA?

Answer 18

Cessation of airflow despite continued respiratory effort

Question 19

What is central sleep apnea?

Answer 19

Cessation of airflow with no respiratory effort

Question 20

What are the characteristics of OSA?

Answer 20

Continued respiratory effort
Collapse in tissue near the throat
Snoring
Fragmented sleep and daytime somnolence

Question 21

What are the characteristics of CSA?

Answer 21

Less common, more serious
No respiratory effort
Common in patients w/HF and CVD
No snoring
Fragmented sleep and daytime somnolence

Question 22

What happens to the muscles in OSA?

Answer 22

Skeletal muscle of the tongue, larynx and pharynx relax as well as smooth muscle in the upper airways

Question 23

What are long term effects of OSA?

Answer 23

HTN
CVD
Stroke
Higher mortality

Question 24

What are the etiologies of OSA?

Answer 24

HTN
Pulmonary do (pulmonary HTN)
Cardiac do
Diabetes
Mortality and accidents

Question 25

What are the clinical findings of OSA?

Answer 25

``` Obesity Large neck circumference Dental overbite; malocclusion Edema, erythema, of the uvula Elongated and low-hanging soft palate Narrow mandible; narrow maxilla Tonsillar hypertrophy Adenoid hypertrophy Nasal septal deviation ```

Question 26

What are RFs for OSA?

Answer 26

``` Obesity Neck circumference (17+ men, 15+ women) Male FH AA, Pacific islander, mexican american) Downs syndrome 40+ yo Postmenopausal status EtOH before bed Respiratory allergies and nasal congestion HTN ```

Question 27

What are daytime sx of OSA?

Answer 27

``` Daytime sleepiness and fatigue Morning or nocturnal HA Impaired memory and concentration Decreased dexterity Personality changes ```

Question 28

What are nocturnal sx of OSA?

Answer 28

``` Snoring Nocturnal choking Nocturnal snorting and gasping Restlessness Dyspnea Diaphoresis Nocturia Dry mouth Drooling Gastroesophageal reflux ```

Question 29

What is the gold standard for OSA?

Answer 29

Overnight polysomnogram | AHI 5+ events per hour

Question 30

What questionnaire can be used for OSA?

Answer 30

STOP BANG Berlin Epworth sleepiness scale

Question 31

What is mild OSA?

Answer 31

5-14 events/hr

Question 32

What is moderate OSA?

Answer 32

15-29 events/hr

Question 33

What is severe OSA?

Answer 33

30 or more events/hr

Question 34

What is the treatment of OSA?

Answer 34

``` Wt loss Avoid sleep deprivation Refrain from tobacco, alcohol, and sedative use Sleep position (avoid back) Good sleep hygiene CPAP ```

Question 35

When is CPAP used in OSA?

Answer 35

Possibly mild OSA | Moderate - severe OSA definitely (possible surgical interventions)

Question 36

What are the characteristics of CSA?

Answer 36

Periodic episodes of apnea caused by loss of ventilatory motor output

Question 37

What are causes of CSA?

Answer 37

``` Idiopathic ANS lesions Neurologic dz CH Opioid abuse High altitudes ```

Question 38

What are tx for snoring?

Answer 38

``` Wt loss Nasal decongestants Drugs to reduce upper airway inflammation Avoid etoh Smoking cessation Positional therapy CPAP ```