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Cadiopulmonary Medicine > Test 3 Ch. 32 Sleep Apnea > Flashcards

Test 3 Ch. 32 Sleep Apnea Flashcards

(75 cards)

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1
Q

Sleep related breathing disorders are characterized by abnormal breathing patterns during sleep and include: (4)

A
  1. Obstructive Sleep Apnea (OSA) syndrome
  2. Central Sleep Apnea (CSA) syndrome
  3. Mixed Sleep Apnea
  4. Sleep- related hypoventilation and hypoxemia syndromes
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2
Q

According to the the American Academy of Sleep Medicine (AASM) sleep disorders can be classified into

A

eight major groups

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3
Q

Obstructive Sleep Apnea (OSA) is a common

A

sleep disorders that often requires lifelong care

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4
Q

OSA is when the ____________ muscles fails to oppose the forces that tend to collapse the airway passage during ____________, the tongue moves into the _________________ area and _________ the airway

A

genioglossus
inspiration
oropharyngeal
obstructs

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5
Q

Recurring collapse of the upper airway during sleep causes (3)

A
  • obstructive apneas
  • hypopneas
  • respiratory effort-related arousals (RERA’s)
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6
Q

A sorting sound called _________ breathing maybe heard at the end of apneic periods

A

fricative

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7
Q

“The fat boy” who snored and had excessive daytime sleepiness, included features of what is now recognized as sleep apnea syndrome w/ hypercapnia or the obesity hypoventilation syndrome is called

A

Pickwickian syndorme

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8
Q

A disorder characterized by the repetitive stopping or reduction of both air flow and ventilatory effort during sleep.

A

Central sleep apnea (CSA)

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9
Q

CSA can be classified as: (2)

A
  • primary central sleep apnea (idiopathic or unknown cause)
  • secondary central sleep apnea
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10
Q

Examples of conditions associated w/ secondary CSA include (3)

A
  • Cheyne Stokes breathing (CHF)
  • medical conditions (spinal surgery, drug or substance abuse)
  • high altitude periodic breathing
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11
Q

CSA is further categorized as (2)

A
  • hyperventilation related CSA
  • hypoventilation- related CSA
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12
Q

Which is this most common CSA

A

Hyperventilation- related CSA

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13
Q

Hyperventilation- related CSA includes primary

A

CSA and CSA associated w/ Cheyne- Stokes breathing pattern

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14
Q

Is a combination of both OSA and CSA

A

Mixed apnea

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15
Q

Mixed apnea is mostly treated as

A

OSA

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16
Q

Mixed apnea usually begins as

A

central apnea followed by the onset ventilatory effort w/o airflow (obstructive apnea)

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17
Q

Sleep- related Hypoventilation and hypoxemia syndrome (SRHHs) include a broad range of sleep disorders, some are quiet common such as

A

obesity hypoventilation syndrome (pickwickian syndrome) or coexisting w/ COPD the overlap syndrome

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18
Q

A specialized sleep test that monitors and records a number of physiologic parameters that occur during

A

Polysomnography (PSG)

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19
Q

That test result is called a

A

polysomnogram

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20
Q

This considered the gold- standard diagnostic test for OSA

A

full- night, attended, in- laboratory PSG

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21
Q

The diagnosis of OSA is establish during portion of study followed by a form of positive airway pressure treatment called a………

A

split night, attended, in- laboratory PSG
and
CPAP titration polysomnogram

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22
Q

During a polysomnogram, OSA is confirmed when either of the following conditions exists

A
  • 15 or more apneas, hypopneas, or respiratory effort- related arousals (RERAs) per hour of sleep in asymptomatic pts. More than 75% of the apneas and hypopneas must be obstructive
  • 5 or more apneas, hyponeas, RERA’s per hour of sleep or signs of disturbed sleep in pts with symptoms More than 75% of the apneas and hyponeas must be obstructive
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23
Q

What is AHI

A

apnea- hypopnea index

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24
Q

What is the calculation used for in-laboratory sleep study

A

AHI=Number of apnea and or plus hyponeas/ TST(hours)

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25
Example of AHI Pt went apneic 200 times, they had 40 hypopneas and 8hrs of sleep
200+40=240 240/8=30 AHI= 30
26
CSA is diagnosed when the majority of the respiratory events are
central apnea or hypopneas
27
On the PSG there is an absence of....
nasal or oral air flow and thoracoabdominal movements
28
Pts w/ CSA are elevated carefully for the presence of
cardiac disease and lesions involving the cerebral cortex and the brain stem
29
_________ _________ is associated w/ CSA
Atrial fibrillation (A-Fib)
30
The AASM endorses in- home unattended, portable motoring, commonly called a
home sleep test (HST)
31
HST is a reasonable cost effective alternative for pts who have a likelihood of either
moderate or severe OSA
32
Physical Examination for Sleep Apnea (2)
- Apnea or Hypopnea - Cyanosis
33
Chest XRAY (2)
- Often normal - Right or left sided heart failure
34
Cardiac Arrhythmias
- Brady- tachycardia syndrome - Sinus arrhythmia - Sinus Bradycardia - sinus pauses - Atrioventricular block (second degree) - Premature ventricular contractions - Supraventricular tachycardia - Ventricular tachycardia - Atrial fibrillation - Sick sinus syndrome
35
Once the diagnosis of OSA is confirmed and the severity determine the pt should be
educated about the risk factors, natural history, and long term consequences of OSA
36
Help behavior modification areas includes:
- weight loss - exercise - changing sleep position - abstaining from alcohol - avoidance of certain medication
37
This is consider the first line of therapy for OSA
Positive airway pressure
38
Positive can be delivered as:
- CPAP - BPAP - APAP - PEEP
39
The most common and the most effective treatment for OSA. This device provides positive airway pressure at level that remains constant throughout the ventilatory cycle in a spontaneous breathing pt
Continuous positive airway pressure (CPAP)
40
Provides both inspiratory and expiratory positive airway pressure. Used if ventilatory failure is involved
Bilevel positive airway pressure (BPAP)
41
Increases or decreases the level of positive airway pressure in response to change in airflow, change in circuit pressure, or vibratory snore
Autotitrating positive airway pressure (APAP)
42
Defined as positive pressure at the end of expiration during either spontaneous breathing or MV
Positive end- expiratory pressure (PEEP)
43
When PEEP is used for treating OSA, it can be achieved via a a disposal nasal device that permits unimpeded inspiration but
provides increases resistance on expiration
44
Most oral appliance fall under one of the following categories:
- A mandibular- repositioning device - a tongue retains device
45
Designed to reposition the mandible forward or downward
Mandibular- reposition
46
Holds the tongue in a more anterior position
Tongue retaining device
47
Is the most effective in non obese pts who have OSA b/c of severe, surgically correctable, upper airway-- obstructing lesion
Surgery
48
This is a reasonable approach in a pt w/ OSA caused by tonsillar hypertrophy, particularly in children but occasionally adults
Tonsillectomy
49
Is one of the most common procedure to treat snoring and sleep apnea
Uvulopalatopharyngoplasty (UPPP)
50
Device that stimulates the hypoglossal nerve (XII), which in turn activates the genioglossal muscle (the tongue) to contract and increase the latency of the upper airway
Implant able upper airway stimulator
51
HypERventilation- related CSA is the
most common
52
_______ has customarily been the first- line therapy for pts w/ hypERventilation- related CSA
CPAP
53
Pts who do not respond well to CPAP should receive a trial of
adaptive servoventilation (ASV) w/ the variable positive airway pressure adapt (VPAP Adapt)
54
_______ w/ a back up RR is the first line therapy for pts w/ hyPOventilation CSA
BPAP
55
B/c of hypoxemia- related cardiopulmonary complications of sleep apnea (arrhythmia and pulmonary hypertension)....
nocturnal low-flow oxygen therapy is sometimes used to offset or minimize the oxygen desaturation
56
In any pt who does not tolerate or benefit from positive airway pressure or supplement oxygen during sleep , a respiratory stimulant such as
acetazolamide or theophylline maybe tried pts w/ CSA
57
Questions from the back What is (are) another name(s) for non- rapid eye movement (non REM) sleep?
- Slow- wave sleep - Quiet sleep
58
During non-REM sleep, ventilation becomes slow and regular apnea-hypopnea index (AHI)
Stage N3
59
Moderate sleep apnea is said to be present when the apnea-hypopnea index (AHI) is
15-30 episodes per hour
60
During periods of apnea, the pt commonly demonstrates which of the following at the termination of apnea events
- Decreased cardiac output - Transient pulmonary hypertension
61
Periods of severe apnea are commonly associated w/ which of the following?
- Ventricular tachycardia - Sinus bradycardia - Premature ventricular contraction - Sinus arrhythmia
62
During REM sleep, there is paralysis of the:
- Arm muscles - Upper airway muscles - Leg muscles - Intercostal muscles
63
Normally, REM sleep constitutes about what percentage of the total sleep time?
20% to 25%
64
Which of the following therapy modalities is therapeutic for OSA
CPAP
65
Which of the following has customarily been the first-line therapy for pts w/ hypERventilation- related CSA
CPAP
66
How long do normal periods of apnea during REM sleep last?
15 to 20 seconds
67
While a formal polysomnographic diagnosis of the precise type and severity of sleep apnea is being made (i.e obstructive, central, or mixed sleep apnea), which of the following respiratory care would be most safely used?
APAP
68
Mallampati classification Class 1:
1. Soft palate, fauces, uvula pillars are easily seen
69
Mallampati classification Class 2:
2. Soft palate, fauces, portion of uvula are seen
70
Mallampati classification Class 3:
3. Soft palate, only the base of the uvula are seen
71
Mallampati classification Class 4:
4. Only the hard palate can be seen
72
Sings and symptoms associated w/ OSA
- Loud snoring - Abrupt awakenings accompanied by SOB - Lack of concentration - Memory impairment - Nausea - Insomnia
73
Mild OSA is defined as an Pts are often
- AHI between 5 and 15 respiratory events per hour of sleep - asymptomatic
74
Moderate OSA is defined as an Pt is usually
- AHI between 15 and 30 respiratory events per hour of sleep - aware of daytime sleepiness and feels the need to nap during the day
75
Severe OSA is defined as an pts have
- AHI of more than 30 Respiratory events per hour and or SpO2 below 90% for more than 20% of the total sleep time - significantly daytime sleepiness, and often fall asleep during the day

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