Flashcards in Sleep Related Breathing Disorders Deck (53):
What is the sleep requirements for neonates? Adults?
What is the level of caffeine intake that is safe for adults?
How many sleep disturbances per hour can affect performance?
What are the waves that are found in deep sleep?
What is the length of the sleep cycle? How many times are cycles repeated each night?
3-6 cycles per night
What are the two general stages of sleep?
What is a hypnogram?
A recording of the sleep cycle
What are the four major effects of sleep deprivation?
-excessive daytime sleepiness
-HTN, insulin resistance
What percent of adults have complaints of sleep disruption?
What is the most common sleep disorder?
What happens to Vt with sleep?
Reduced by 6-16% during NREM and 25% in REM
What happens to airway resistance with sleep? Why?
Increases by 230% during NREM
Reduced tonic drive to the pharyngeal muscles
What is the effect of the reduction of ventilation with sleep?
increases PaCO2 by 2-4 mmHg, and reduces PaO2 by 3-9 mmHg
What are the three major sleep related breathing disorders?
-Obstructive sleep apnea
-Central sleep apnea
-Sleep related hypoventilation syndrome
What is OSA? What are the two major physiologic causes?
Dynamic upper airway narrowing or closure during sleep d/t a combination of:
-Decreased muscular tone
-Crowding of upper airway structures
is snoring an upper or lower airway obstruction? When, then, does it occur in the respiratory cycle?
What is the triad of OSA?
What is the incidence of OSA in men and women?
4% and 2% respectively
Who should be screened for OSA?
-Dissatisfied with sleep
-Do they have daytime sleepiness
What are the non-obvious risk factors for OSA? (heart x2, metabolic conditions)
What occupation in particular should be screened for OSA?
High risk driving occupations
What are the two questionnaires that can be administered to screen for OSA?
Over what BMI is OSA particularly common?
What is the most common reason for OSA in children?
What is the scale used to determine the severity of sleepiness?
Epworth sleepiness scale
What type of work specifically can lead to excessive daytime sleepiness?
What are the components of the PE that should be done if you suspect OSA?
A mallampati score of what is suspicious for OSA?
3 or 4
What neck circumference for men and women are concerning for OSA?
16" for females
17" for males
What is class I mallampati score?
Can see uvula, soft and hard palate and pillars
What is class II mallampati score?
Uvula touches tongue, pillars not present
What is class III mallampati score?
Can barely see uvula and hard palate
What is class IV mallampati score?
Can only see soft palate
How do you evaluate for OSA?
Polysomnography in the sleep lab
What are the two types of sleep studies?
Full night sleep
Split night sleep (before and after CPAP)
What is CPAP?
Continuous positive airway pressure
Why are EKGs needed with sleep studies?
Apnea may cause arrhythmias
An event on a sleep study must last how long to be considered sleep apnea?
What is the classic breathing pattern with OSA?
What is the definition of Hypopnea?
Decrease in airflow by 30% AND drop in pulse ox by 4%
What is apnea hypopnea index (AHI)?
Number of apnea and hypopneas per hour of sleep
What is the role of in-home sleep studies?
Uncomplicated patients, but does not definitively exclude diagnosis
Sleeping in what position may lead to an increase in sleep apnea episodes?
What are the therapies for OSA, besides CPAP?
What is the last resort for sleep apnea?
What is "adequate" CPAP use?
more than 4 h/night on 70% of nights
What are the sequelae of untreated sleep apnea?
What is central sleep apnea (CSA)?
Recurrent cessation of respiration during sleep without associated ventilatory effort
What is the pathophysiology of central sleep apnea?
High ventilatory chemo responsiveness to PaCO2 with exaggerated hyperapnea
What is Cheyne-stokes respiration?
irregular crescendo-decrescendo pattern of breathing
What are the diseases associated with Cheyne stokes respiration?
What is the cause of Cheyne-stoke respiration?
Decreased perfusion of breathing centers of the brain (maybe)