Bailey And Johnson - Chapter 46

Front 1

What percentage of men and women snore?

Back 1

40% men; 28% women

Front 2

1993 report estimated how many americans have excessive daytime sleepiness from sleep apnea?

Back 2

20 million

Front 3

In a study of truck drivers, how many had OSA?

Back 3

87%

Front 4

Random sampling polysomnogram - how many had a respiratory distress index (RDI) >5? How many had OSA

Back 4

24% men, 9% women with RDI >5; 4% men, 2% had OSA

Front 5

What impact does hormones have on sleep-disordered breathing in women?

Back 5

Premenopausal women 0.6%; Postmenopausal women with HRT 0.5%; post menopausal w/o HRT 2.7%

Front 6

Define sleep

Back 6

1. Carskadon and Dement (1994) - reversible behavioral state of perceptual disengagement from and unresponsive to the environment.

2. Amount and quality of sleep needed to maintain alertness throughout the day

Front 7

Ideal amount of sleep in a young adult?

Back 7

7.5 and 8.5 hours

Front 8

What is the most significant determining factor of sleep length in america?

Back 8

Alarm clock

Front 9

EEG pattern Stage 1 sleep?

Back 9

Theta waves (2-5% of sleep)

Front 10

EEG pattern of Stage 2 sleep?

Back 10

K complexes or sleep spindles (45-55% of sleep)

Front 11

EEG pattern of Stage 3 sleep?

Back 11

Delta waves (3-8% of sleep)

Front 12

EEG patter of Stage 4 sleep?

Back 12

Delta waves (10-15% of sleep)

Front 13

EED pattern of REM sleep?

Back 13

Sawtooth waves (20-25% of sleep)

Front 14

4 major categories of sleep disorders?

Back 14

Dyssomnias, Parasomnias, Medical-psychiatric sleep disorders, Proposed sleep disorders

Front 15

What is a parasomnia?

Back 15

Undesirable physical phenomena occur while sleeping

Front 16

What are the four categories for parasomnias?

Back 16

Arousal disorders
Sleep-wake transition disorders
Parasomnias associated with REM
Other parasomnias

Front 17

How is snoring categorized?

Back 17

Other parasomnias

Front 18

What is a dyssomnia?

Back 18

Sleep disorders that produce excessive sleepiness

Front 19

What are the subcategories of dyssomnias?

Back 19

Intrinsic, extrinsic and circadian rhythm sleep disorders

Front 20

How is OSA categoriezed?

Back 20

Intrinsic dyssommnia

Front 21

Define apnea?

Back 21

Cessation of ventilation for 10 seconds or longer leading to an arousal

Front 22

Define hypopnea?

Back 22

Decrease in airflow in association with oxyhemaglobin desaturation which leads to an arousal

Front 23

Define Respiratory Effort-related arousal:

Back 23

Absence of apnea/hypopnea with 10 seconds or more of progressive negative esophageal pressure culminating in an arousal or microarousal

Front 24

What are the three patterns of apnea?

Back 24

Obstructive, cenral and mixed

Front 25

Define obsructive apnea

Back 25

lack of airflow despite ventilatory efforts

Front 26

Define central apnea

Back 26

lack of airflow with an absence of ventilatory efforts

Front 27

What histopathologic findings can be found in the soft palate of snorers and severe apneics?

Back 27

Mucous glad hypertrophy, muscle bundle disruption, atrophy of muscle fibers and edema of the lamina propria with vascular dilation

Front 28

Define Upper Airway Resistance Syndrome (UARS)

Back 28

RERA >15/hour

Front 29

Define OSA

Back 29

AHI > 5

Front 30

AHI of mild OSA

Back 30

5-14

Front 31

AHI of moderate OSA

Back 31

15-29

Front 32

AHI of severe OSA

Back 32

>30

Front 33

What conrols the size of the pharyngeal lumen?

Back 33

Balance of forces - constricted by negative intrathoracic pressure (diaphragm) dilating forces of the pharyngeal dilating muscles

Front 34

What are the pharyngeal dilating muscles?

Back 34

Medial pterygoid
Tensor Veli Palatinii
Genioglossus
Geniohyroid
Sternohyoid

Front 35

At the level of the nasal cavity/nasopharynx what 4 anatomic abnormalities can contribute to obsstruction?

Back 35

Septal deviation
Turbinate hypertrophy
Nasal polyps
Adenoid hypertrophy

Front 36

At the level of the oral cavity/oral pharynx what 5 anatomic abnormalities can contribute to obstruction?

Back 36

Elongation of soft palate and uvula
Tonsillar hypertrophy
Macroglossia
Retrognathia
Rugae (vertical) of the posterior pharyngeal wall

Front 37

At the level of thel hypopharynx/larynx what 2 anatomic abnormalities can contribute to obsstruction?

Back 37

Omega shaped epiglottis
Laryngeal-tracheal stenosis

Front 38

Two most common signs/symptoms of sleep apnea?

Back 38

Snoring and daytime sleepiness

Front 39

How can sleepiness be objectively evaluated?

Back 39

Epworth sleepiness scale and Standford sleepiness scale

Front 40

How do you calculate BMI

Back 40

Kg/height (meters) squared

Front 41

Where do you measure neck size

Back 41

cricothyroid membrane

Front 42

What are the two patterns for velopharyngeal closure?

Back 42

Coronal pattern with anteroposterior movement of the velum
Circular pattern - medial movement of the pharyngeal walls

Front 43

What is the Muller maneuver?

Back 43

Ask patient to inspire with a closed oral and nasal cavity

Front 44

What radiographic findings are associated with OSAS

Back 44

Retrognathia
Narrowed posterior airway space
Increased mandibular to hyoid bone distance
Shortening of the anterior cranial base
Enlarged soft palate

Front 45

What are significant predictors of OSA?

Back 45

increased BMI
observed apnea
falling asleep while driving
male gender
increasing age

Front 46

What are the three categories of portable monitors?

Back 46

1. Type 2 - 7 channels including EEG
2. Type 3 - 4 channels (at least two of respiratory movement)
3. Type 4 - 1 or 2 channels

Front 47

What parameters are typically recorded in a standard polysomnogram (9)

Back 47

1. EEG
2. Electrooculogram
3. ECG
4. EMG (submental and anterior tibialis)
5. Oxyhemaglobin
6. Nasal or oral airflow
7. Thoracic/abdominal movement
8. Sleep position
9. Blood pressure
Some record esophageal pressure

Front 48

What 9 things should you find in a sleep report?

Back 48

1. Sleep latency
2. Sleep efficiency (total sleep/time in bed)
3. RDI (equivalent to AHI)
4. types of respiratory disturb
5. sleep architecture
6. volume and presence of snoring
7. effect of sleep position
8. Whether disturbances occur more in a particular sleep stage
9. Number and severity of O2 desaturation

Front 49

What are some classic noctural signs and symptoms of OSA obtained by history?

Back 49

Heroic snoring, Restless disturbed sleep, Observed gasping or apnea, Nocturnal sweating

Front 50

What are some classicdaytime signs and symptoms of OSA obtained by history?

Back 50

Excessive daytime sleepiness, cognitive impairment, morning headaches, impotence

Front 51

What can present as new-onset snorning in a patient that never snored?

Back 51

Nasopharyngeal, Laryngeal or BOT tumors

Front 52

What is a multiple sleep latency test? When is it performed?

Back 52

Objective measure of daytime sleepiness. Patient given 4 or more opportunities to nap at 2 hour intervals. Sleep latency and REM are evaluated. Commonly used in a patient with a normal PSG

Front 53

Why is a perioperative medical evaluation in patient with OSA important

Back 53

Comorbid factors include cardiac arrhythmias, CHF, HTN, hypothyroidism, Obesity, GERD

Front 54

What is the Sleep Heart Heath Study?

Back 54

Modest to moderate effect of mild sleep disordered breathing on cardiovascular disease

Front 55

What routine screening test should be done in newly diagnosed sleep apnea patients

Back 55

Hypothyroidism

Front 56

What endocrine disorders are associated with sleep apnea?

Back 56

hypothyroidism and acromegaly

Front 57

What effect does a 10% weight gain or loss have on AHI

Back 57

Gain - 32% increase, Loss - 26% decrease

Front 58

What are non-surgical therapies for OSA?

Back 58

Behavioral (weight loss, diet change), Positive airway pressure, oral appliances, positioning devices

Front 59

What are sugical options for snoring?

Back 59

UPPP, Laser-assisted Uvuloplasty, Radiofrequency tissue ablation of the soft palate, snoreplasty (sclerosing agent), Pillar implants, nasal surgery (septum, turbs)

Front 60

What five anatomical areas can be addressed in OSA?

Back 60

Nasal Surgery, Palatal surgery with or without tonsillectomy, Tongue base reduction surgery, Maxillomandibular surgery, Tracheotomy

Front 61

What can develop after surgery in patients with severe OSA?

Back 61

Postobstructive pulmonary edema

Front 62

What are the contraindications for performing a UPPP?

Back 62

VPI, submucous cleft palate, patients with special voice/swallowing issues

Front 63

What procedures can be performed to address obstruction from the tongue base?

Back 63

Lingual tonsillectomy, laser midline glossectomy, lingualplasty, radiofrequency ablation of the tongue, tongue base suspension

Front 64

What is the Repose system?

Back 64

Titanium screw placed in the inner mandibular cortex with a suture looped through the posterior tongue base and secured to the screw

Front 65

Complications of the repose system?

Back 65

sialadenitis, dysphagia, dysarthria, globus sensation, extrusion/release of the suture

Front 66

What are the options for maxillomandibular surgery?

Back 66

mandibular advancement with genioglossus advancement, hyoid myotomy and suspension, maxillomandibular osteotomy and advancement (MMO)

Front 67

How is a mandibular osteotomy with genioglossus advancement performed?

Back 67

Bicortical retangular osteotomy in the mandible at the genioturbercle - Advance and rotate 90 degrees - advances the genioglossus 10-14 mm and increases tongue tension

Front 68

What are indications for a permanent tracheostomy for OSA?

Back 68

morbid obesity, significant cardiac arrhythmias with apnea, severe apnea with desats below 40% on PSG, cor pulmonale and disabling somnolence

Front 69

Is there a relationship between sleep-disordered breathing and nasal obstruction?

Back 69

Yes, but cause is unclear - Increased nasal resistance is known to increase collapsibility of the pharynx. Nasal packing is associated with hypoxemia

Front 70

Has nasal surgery been shown to be beneficial in patients with OSA?

Back 70

Series et al. (1992) - no significant reduction in AHI, total apnea or desats, however allowed better CPAP compliance in 1/2 and 4 of the 14 had improvement in their AHI

Front 71

What is the overall success for UPPP?

Back 71

41% for all comers (Sher et al. Sleep 1996) - higher success in purely retropalatal colapse

Front 72

Complications of UPPP?

Back 72

bleeding, velopharyngeal insufficiency, voice change, pharyngeal foreign body sensation, nasopharyngeal stenosis, respiratory distress, and death

Front 73

What palate surgery can be performed after UPPP failure?

Back 73

Transpalatal advancement pharyngoplasty

Front 74

Complications of transpalatal advancement pharyngoplasty?

Back 74

oronasal fistula, flap necrosis, wound dehiscence

Front 75

How does a hyoid myotomy and suspension work?

Back 75

Advances hyoid anteriorly advancing the epiglottis and base of tongue