sleep disorders

Question 1

sleep occupies how much of a human’s life?

Answer 1

1/3

Question 2

obstructive sleep apnea

Answer 2

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

Question 3

central sleep apnea

Answer 3

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

Question 4

obstructive sleep apnea diagnoses

Answer 4

• hospital based test

- poly somno graphy (PSG)

Question 5

normal

Answer 5

0-5 respiratory events /hr of sleep

Question 6

mild

Answer 6

5-15 respiratory events/ hr of sleep

Question 7

moderate

Answer 7

15-30 respiratory events/ hr of sleep

Question 8

severe

Answer 8

> 30 respiratory events/ hr of sleep

Question 9

what causes snoring

Answer 9

obesity
pregnancy
allergies
smoking
alcohol- muscle relaxant

Question 10

hallmark symptom of sleep apnea

Answer 10

snoring, narrowing of upper airway

Question 11

where does the snoring sound come from?

Answer 11

vibration of the uvula

Question 12

percentage of snorers

Answer 12

25% men and 15% women are habitual snorers

Question 13

percentage of snorers between 41 - 65 yrs

Answer 13

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

Question 14

what percent of sleep apnea patients snore?

Answer 14

95%

Question 15

snoring is related to

Answer 15

cardiovascular disease
heavy smoking
myocardial infarction
atherosclerosis

Question 16

nocturnal symptoms of obstructive sleep apnea

Answer 16

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

Question 17

diurnal symptoms of obstructive sleep apnea

Answer 17

excessive daytime sleepiness

Question 18

what percentage of people report daytime sleepiness

Answer 18

30% to 50% of general population

Question 19

epworth sleeping scale

Answer 19

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

Question 20

most common physical characteristic of obstructive sleep apnea

Answer 20

craniofacial anatomy-narrowing of the oropharyngeal airway

Question 21

physical characteristics of obstructive sleep apnea

Answer 21

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

Question 22

retrognathia

Answer 22

malocclusion, abnormal posterior positioning of maxillar or mandible

Question 23

narrow maxillomandibular arches

Answer 23

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

Question 24

macroglossia

Answer 24

narrow maxilla + large tongue

Question 25

inferior displacement of hyoid bone

Answer 25

retrusive position of hyoid bone indicates restriction of airway

Question 26

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

Answer 26

vertical dimension

Question 27

clinical predictors of obstructive sleep apnea

Answer 27

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

Question 28

bruxism and sleep apnea?

Answer 28

retrusive movement during bruxism may obstruct the airway

Question 29

friedman classification for tongue

Answer 29

``` 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 ```

Question 30

sleep apnea patients Friedman classification

Answer 30

usually between C +D

Question 31

Friedman test for obstructive sleep apnea

Answer 31

patient opens mouth

Question 32

mallampati score to test for Obstructive sleep apnea

Answer 32

patient protrudes tongue

Question 33

mallampati score

Answer 33

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

Question 34

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

Answer 34

friedman

Question 35

clinical predictor of obstrutive sleep apnea

Answer 35

wear facets

Question 36

OSA prevalence

Answer 36

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

Question 37

suspected risk factors for OSA

Answer 37

``` genetics smoking meopause alcohol before sleep nighttime nasal congestion ```

Question 38

OSA symptoms

Answer 38

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

Question 39

problems with daytime functioning

Answer 39

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

Question 40

CV and cerebrovascular disease

Answer 40

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

Question 41

oral appliance therapy

Answer 41

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

Question 42

oral appliance therapy aims to

Answer 42

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

Question 43

what the oral appliance does

Answer 43

- 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

Question 44

oral appliance is

Answer 44

adjustable

Question 45

pre-fabricated oral appliances

Answer 45

not recommneded, potential side effects, dentist should evaluate

Question 46

monoblock non-adjustable oral appliance

Answer 46

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

Question 47

clinical protocol for oral appliance

Answer 47

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

Question 48

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

Answer 48

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

Question 49

during REM

Answer 49

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

Question 50

how do these devices work?

Answer 50

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

Question 51

Home sleep monitor measures

Answer 51

oxygen levels and obstruction during sleep

Question 52

5 screening questions for obstructive sleep apnea

Answer 52

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? )

Question 53

if you have a patient that falls asleep on the chair

Answer 53

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