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44 Cards in this Set
- Front
- Back
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A Sleep Disorder
Characterized by pauses in breathing during sleep |
Sleep Apnea
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Obstructive Sleep Apnea (OSA)
With respiratory effort Monitors for airflow at the nose and mouth show the dynamics of airflow, but efforts to breathe are not only present, they are often _______. |
exaggerated
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Obstructive Sleep Apnea (OSA)
With respiratory effort The ______ contract and the entire body may thrash and struggle. |
chest muscles and diaphragm
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most common category of sleep-disordered breathing
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Obstructive Sleep Apnea (OSA)
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Obstructive Sleep Apnea (OSA)
3-4% of women ___?% of men |
6-7
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Lack of respiratory effort
What type of sleep apnea? |
Central Sleep Apnea
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Individuals at high risk for obstructive sleep apnea:
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1- decreased muscle tone
2- increased soft tissue around the airway 3- structural features that give rise to a narrowed airway |
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Men are more typical sleep apnea sufferers
anatomy typified by _______? especially through middle age and older |
by increased body mass in the torso and neck
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Adult women
typically suffer less frequently lesser degree than men partially due to physiology possibly due to emerging links to levels of ______ |
progesterone
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Prevalence in __________ women approaches that of men in the same age range
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post-menopausal
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OSA occurs more frequently in people with ___ Syndrome than in the general population
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Down
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A little over ___% of all people with Down Syndrome suffer from obstructive sleep apnea
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50
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Signs of Sleep Apnea
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Typically obese
Heaviness in face and neck - “Pickwickian Syndrome” Restless sleep Loud snoring - Periods of silence followed by gasps |
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Symptoms of Sleep Apnea
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Excessive daytime sleepiness (“Hallmark symptom”)
Morning headaches Trouble concentrating Irritability Forgetfulness Mood or behavior changes Decreased sex drive Increased heart rate Anxiety Depression Increased frequency of urination Nocturia Esophageal reflux Heavy sweating at night |
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Sleep Apnea in Children
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Hypersomnolence (similar to adults)
“overtired” or “hyper” Young children Toddlers Thin “failure to thrive” |
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Sequellae of Sleep Apnea
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Hypertension
heart (rt-side, CHF with OSA) Weight gain Stroke |
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Does BP drop while sleeping in essential HTN?
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yes
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Does BP drop while sleeping in Sleep apnea
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no
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Are B-blockers effective in sleep apnea HTN?
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no
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OSA pts have a ___% greater risk of MI or death
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30
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Diagnosis of Sleep Apnea
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Night Polysomnogram (gold standard)
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Classical testing performed over two nights
1st night defines type of sleep disorder 2nd night, do what? |
titrate Continuous Positive Air Pressure (CPAP) to eliminate obstructive effects
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For severe cases, do what during night of polysomnogram?
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Split-Night Polysomnogram
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An "event" can be either
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Apnea
Hypopnea |
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Hypopnea in which airflow
1- decreases by 50 percent for __ seconds 2- decreases by 30 percent if there is an associated decrease in the oxygen saturation 3- an arousal from sleep |
10
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To grade the severity of sleep apnea, the number of events per hour is reported as the _____
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apnea-hypopnea index (AHI):
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Normal, mild, moderate, severe AHI grades
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less than 5
5-15 15-30 30+ |
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General Treatments for Sleep Apnea
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Life style interventions
Physical interventions Surgery |
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Physical Interventions
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CPAP
VPAP APAP MAS |
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____ is the most common treatment for obstructive sleep apnea
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CPAP
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also known as bilevel or BiPAP
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VPAP, or variable positive airway pressure
a higher one during inhalation and a lower pressure during exhalation |
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It adjusts pressure continuously, increasing it when the user is attempting to breathe but cannot, and decreasing it when the pressure is higher than necessary
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APAP, or automatic positive airway pressure
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it is designed to hold the lower jaw slightly down and forward relative to the natural, relaxed position. This position holds the tongue farther away from the back of the airway,
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Mandibular advancement splint (MAS)
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Surgical Interventions
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Tracheostomy
Nasal surgery turbinectomy straightening of the nasal septum Tonsilectomy and/or adenoidectomy uvulopalatopharyngoplasty (UPPP) laser-assisted uvulopalatoplasty (LAUP) Reduction of the tongue base Genioglossus Advancement Hyoid Suspension Maxillomandibular advancement (MMA). Pillar procedure |
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a small portion of the lower jaw that attaches to the tongue is moved forward, to pull the tongue away from the back of the airway.
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Genioglossus Advancement
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the patient's upper and lower jaw are detached from the skull, moved forward, and reattached with pins and/or plates
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Maxillomandibular advancement (MMA).
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three small inserts are injected into the soft palate to offer support, potentially reducing snoring in mild to moderate sleep apnea
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Pillar procedure
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Many researchers believe that OSA is at root a _____ condition
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neurological
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gentle electrical stimulation to the muscles of the tongue
= ______-stimulation |
Neurostimulation
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Are there effective drug-based treatment for obstructive sleep apnea?
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no
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Oral administration of the methylxanthine theophylline (chemically similar to _____) can reduce the number of episodes of apnea
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caffeine
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Theophylline is generally ineffective in adults with OSA, but is
sometimes used to treat ______ sleep apnea infants and children with apnea |
central
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In the morbidly obese, _______ can sometimes cure the condition
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a major loss of weight (such as what occurs after bariatric surgery)
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The anti-narcoleptic
________ is seeing increased use to treat a patient's daytime sleepiness or somnolence as of 2004 |
modafinil
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