SLEEP PHYSIOLOGY Flashcards
(35 cards)
An apnoea is classed by:
Complete cessation of breathing (>90%) resp efforts continue. >10 SECONDS
CSA (CENTRAL SLEEP APNOEA) IS…
When there is no respiratory drive and effort.
A pulse rate rise of how much may indicate cortisol arousal/sleep disturbance.
> 6bpm
What is NIV?
Non-invasive ventilation, uses masks instead if endotracheal tube
IPAP is…
- inspiratory positive airway pressure- inflates the lungs
- Higher the Ipap higher the Vt, >10cmh20 is ideal
- Stiff/fibrotic lungs may need more
EPAP is…
expiratory positive airway pressure- stents upper airway open
- Higher epap in obese patients,
- set at least 4cmH20 to help flush c02
Describe intrinsic peep
- Typical in COPD patients, airway collapse hence air trapping
- Increased lung volumes. FRC increases.
- Inspiratory muscles need to contract behind air trapping to start inspiratory flow
- EPAP should be increased to help this.
How can patients be assessed before, during and after NIV
ABG- GOLD STANDARD,
- CBG- CAN BE ACCURATE, EASY TO PERFORM, LESS PAINFUL THAN ABG
- TOSCA,TcCO2 GIVES OVERNIGHT TcC02 and Sp02 and trends
WILL those who have kyphoscoliosis need a higher pressure? And please give your reasoning.
stiff lungs-higher pressures needed to expand the chest walls (around 20-25cmH2O)
Will those who have a neuromuscular condition need a higher or lower pressures than those who have kyphoscoliosis?
Neuromuscular conditions= lower pressures (12-15cmH20)
The pros of NIV are:
- increase ventilation
- reduce PC02
- Saves endotracheal intubation
- saves ITU resources
The cons of NIV are:
- leaking
- pressure points, discomfort
- barotrauma to the lungs if high pressures applied which could lead to pneumothorax
- prolonging disease
Why paeds sleep centres?
Importance of early diagnosis and treatment. Increased risk of adult mortality and cost of treatmen if undiagnosed and untreated. ‘
In infants who sleep 12-16 hours, the percentageof REM vs nREM 3 is:
Around 50% REM Vs nREM3 50%
The N REM vs REM in teenagers/adults is:
8 Hrs Sleep: 75 nREM vs 25% REM
The main Paeds physiology features are:
Smaller space, larger tongue and epiglottis
Narrow nares. Larynx is funnel shaped
Upper airway patency is determined by-
Activity of upper airway muscle @Genioglossus-tongue @tensor veli plating- soft palate -craniofacial and soft tissue structure -sleep stage
What happens to the upper airway during sleep?
Decreased uaw muscle tone
-decreased UAW reflex responses to negative airway pressure
-decreased airway volume
All leading to uaw collapse, snore, uaw obstruction during sleep.
How is the chestwall And diaphragm different than adults?
. Ribs are more cartilaginous and therefore chest wall is more compliant
- during the first two years ribs are more horizontal which limits thoracic expansion
- infants are dependant on diaphragm for inspiratory and expiratory phase.
What is the respiration pattern in pediatrics
paradoxical inward chest wall movement during inspiration
Does respiration increaseor decrease with age?
rate decreases with age-
40-60br.min, higher in REM infancy
Is periodic breathing common in preterm infants and in what sleepstage does it occur in?
‘Common in preterm infants. Occurs in all sleep stages, but more common in REM.
How is an apnoea scored in paeds?
,, Apnoeas are scored the same as adults with the addition of 2 missed breaths.
Central apnoeas are classed as… w
90% in flow signal and absent inspiratory effort. Must last >20s
Or- a >%o2 desat with atleast 2 missed breaths.
For infants <1 year-decreased Hr, <50bpm for atleast 5 seconds or<60bpm for 15 seconds.
