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Flashcards in sleep disorders Deck (53):
1

sleep occupies how much of a human's life?

1/3

2

obstructive sleep apnea

if a patient's breathing is interrupted or if they stop breathing completely during sleep
-respiratory obstruction
-decrease in oxygen, heart rate and pulse will increase; if no proper treatment, can lead to CV disease of higher dosage of medications

3

central sleep apnea

no obstruction of the airway, brain does not send signal to respiratory muscles

4

obstructive sleep apnea diagnoses

-hospital based test
-poly somno graphy (PSG)

5

normal

0-5 respiratory events /hr of sleep

6

mild

5-15 respiratory events/ hr of sleep

7

moderate

15-30 respiratory events/ hr of sleep

8

severe

> 30 respiratory events/ hr of sleep

9

what causes snoring

obesity
pregnancy
allergies
smoking
alcohol- muscle relaxant

10

hallmark symptom of sleep apnea

snoring, narrowing of upper airway

11

where does the snoring sound come from?

vibration of the uvula

12

percentage of snorers

25% men and 15% women are habitual snorers

13

percentage of snorers between 41 - 65 yrs

60% men and 40% of women between 41-65 yrs

14

what percent of sleep apnea patients snore?

95%

15

snoring is related to

cardiovascular disease
heavy smoking
myocardial infarction
atherosclerosis

16

nocturnal symptoms of obstructive sleep apnea

chocking or gasping
insomnia
diaphoresis (sweating)
impotence (weakness)

17

diurnal symptoms of obstructive sleep apnea

excessive daytime sleepiness

18

what percentage of people report daytime sleepiness

30% to 50% of general population

19

epworth sleeping scale

rating how much you doze during sitting, reading, watching TV, sitting inactive, passenger in a car for an hr, lying down to rest, sitting and talking to someone, sitting quietly after lunch with no alcohol, in a car while stopped in traffic

20

most common physical characteristic of obstructive sleep apnea

craniofacial anatomy-narrowing of the oropharyngeal airway

21

physical characteristics of obstructive sleep apnea

craniofacial anatomy
retrognathia
narrow maxillomandibular arches
tonsillar hypertrophy
macroglossia
inferior displacement of hyoid bone

22

retrognathia

malocclusion, abnormal posterior positioning of maxillar or mandible

23

narrow maxillomandibular arches

patient will have difficulty breathing through nose an become a mouth breather

24

macroglossia

narrow maxilla + large tongue

25

inferior displacement of hyoid bone

retrusive position of hyoid bone indicates restriction of airway

26

look for shape and size of maxillar, position of mandible, amount of missing teeth; amount of missing teeth will decrease

vertical dimension

27

clinical predictors of obstructive sleep apnea

scalloped tongue, size of tongue, position of tongue relative to occlusal plane

28

bruxism and sleep apnea?

retrusive movement during bruxism may obstruct the airway

29

friedman classification for tongue

A Tongue is normal
B tongue covers half of space in throat
C tongue covers 2/3 of space in throat
D tongue covers space in throat
E tongue covers space in throat and more

30

sleep apnea patients Friedman classification

usually between C +D

31

Friedman test for obstructive sleep apnea

patient opens mouth

32

mallampati score to test for Obstructive sleep apnea

patient protrudes tongue

33

mallampati score

I= normal
II= tongue covers half of throat
III= tongue covers more than half of throat
IV tongue covers throat

34

Is Friedman or mallampati score more accurate for testing for obstructive sleep apnea?

friedman

35

clinical predictor of obstrutive sleep apnea

wear facets

36

OSA prevalence

male, 40-70 yrs, overweight, obese, central body fat distribution, large neck girth, craniofacial and upper airway abnormalities

37

suspected risk factors for OSA

genetics
smoking
meopause
alcohol before sleep
nighttime nasal congestion

38

OSA symptoms

habitual, loud snoring
nocturnal breathing pauses, choking, gasping
excessive daytime sleepiness

39

problems with daytime functioning

daytime sleepiness
motor vehicle crashes
psychosocial problems
decreased cognitive function
reduced quality of life

40

CV and cerebrovascular disease

hypertension
coronary artery disease
myocardial infarction
CHF
stroke
diabetes and metabolic syndrome

41

oral appliance therapy

selection
fabrication
fitting
adjustment
long term follow up care
-muscle relaxation during sleep allows open airway to widen

42

oral appliance therapy aims to

-modify position of upper airway structures
-increase the airway size
-prevent the collapse of the tongue and soft tissues

43

what the oral appliance does

-hyoid bone will move forawrd and up, providing more clearance
-prevents uvula from producing snoring sound; snoring sounds are at the level of the uvula

44

oral appliance is

adjustable

45

pre-fabricated oral appliances

not recommneded, potential side effects, dentist should evaluate

46

monoblock non-adjustable oral appliance

first appliance used
-mech: increase vertical dimension and maintain jaw in forward position, which is similar to previous appliance

47

clinical protocol for oral appliance

examination
bite reg/ impressions
oral appliance selection
fitting/adjustments
follow ups (6 mos, yearly)

48

why are symptoms worse while patient is sleeping on his back?

gravity causing lower jaw to move back, muscles to relax, and decrease in size of the airway

49

during REM

increase in muscle relaxation; severity increases, oxygen decreases by 78%

50

how do these devices work?

when the lower jaw is protruded, there is more airflow and the snoring sound is not as intense

51

Home sleep monitor measures

oxygen levels and obstruction during sleep

52

5 screening questions for obstructive sleep apnea

1 what prevents you from getting a good night sleep?
2are you excessively sleepy during the day?
3 how many hours do you normally sleep
4 have you been told that you snore or stop breathing
5 what medications and other substances do you take (muscle relaxants? )

53

if you have a patient that falls asleep on the chair

send him for a consult on the 6th floor and follow up