Crr Week 7: Sleep Disorders (Tawk)

Front 1

During which stages of sleep does deep sleep occur?

Back 1

NREM 3 and NREM4

Front 2

During which stages of sleep does dreaming occur?

Back 2

During REM

Front 3

What happens to skeletal muscle tone during sleep?

Back 3

There is progressive and significant decrease in tone

*Loss of tonic and phasic activity of the pharyngeal muscles and inspiratory muscles (diaphragm less affected)

Front 4

List 2 factors that narrow the pharynx during sleep.

Back 4

1. Increased pressure around it
2. Decreased pressure within it (or increased wall compliance)

Front 5

What causes the airways to collapse after sleep onset in patients with sleep apnea?

Back 5

1. Loss of neuromuscular compensation
2. Decreased pharyngeal muscle activity

Front 6

What causes sleep arousal in patients with sleep apnea?

Back 6

Hypoxia and hypercapnea cause increased ventilation effort which results in sleep arousal.

*Once aroused, pharyngeal muscle activity can be restored and airway opens

Front 7

Apnea is suspension of air flow for at least how many seconds?

Back 7

10 seconds

Front 8

How is hypopnea defined?

Back 8

At least 10 sec of REDUCTION in air flow by 30% with oxygen desaturation of 4%

Front 9

What is AHI?

Back 9

Apnea Hypopnea Index
(index used to assess the severity of sleep apnea based on the total number of complete cessations (apnea) and partial obstructions (hypopnea) of breathing occurring per hour of sleep)

AHI = Apnea + Hypopnea / hours of sleep

Front 10

What does an AHI greater than 5 indicate?

Back 10

Obstructive sleep apnea (OSA)

Front 11

What are some risk factors associated with obstructive sleep apnea?

Back 11

1. Obesity
2. Age
3. Male sex
4. Neck size
5. Craniofacial skeletal abnormalities
5. Adenotonsillar hypertrophy (children/ young adults)
6. Alcohol use
7. Endocrine diseases (acromegaly, hypothyroidism)

Front 12

What neck sizes pose a risk factor for obstructive sleep apnea in men and women?

Back 12

Men --> 17 in
Women --> 16 in
(neck circumflex)

Front 13

Obstructive sleep apnea in children and young adults is often caused by what abnormality?

Back 13

Adenotonsillar hypertrophy

Front 14

Which endocrine diseases are risk factors for OSA?

Back 14

1. Acromegaly
2. Hypothyroidism

Front 15

What are some daytime complaints of patients with OSA?

Which is the most common?

Back 15

1. Sleepiness <--MOST COMMON
2. Daytime fatigue
3. Morning headaches
4. Dry mouth on awakening

Front 16

What are some nighttime complaints of patients with OSA?

Back 16

1. *Loud snoring <-- MOST COMMON
2. *Witnessed apnea (2nd most common)
3. Restless sleep
4. Nocturnal gasping and choking
5. Nocturia
6. Night sweats

Front 17

What are the most common complaints made by family members/ partners about patients with OSA?

Back 17

1. *Loud snoring
2. *Apnea
3. Gasping or choking

Front 18

What parameters are recorded during sleep analysis with polysomnography?

Back 18

1. EEG
2. ECG
3. Electromyogram
4. Oronasal airflow
5. Chest wall effort
6. Body position
7. Snore microphone
8. Oxyhemoglobin saturation

Front 19

How is central sleep apnea defined?

Back 19

Absence of airflow at the nose and mouth for >10 seconds due to a complete absence of respiratory effort.

Front 20

In CSA, what is the absence of expiratory effort measured by?

Back 20

1. Thoracic expansion
2. Abdominal expansion
3. Intercostal/ Diaphragmatic EMG

Front 21

Cheyne-Stokes respiration is usually associated with what condition?

Back 21

Congestive heart failure
(central sleep apnea)

Front 22

What is the name of the crescendo-decrescendo respiratory pattern seen in patients with central sleep apnea?

Back 22

Cheyne-Stokes respiration

Front 23

What is the hypothesis of CSA-Cheyne-Stoke respiration?

Back 23

Reduced CIRCULATION causing delayed and gradual transmission of changes in PO2 and PCO2 between lungs and chemoreceptors

Front 24

Sleep apnea can increase a patients risk for which other conditions?

Back 24

1. Hypertension
2. Stroke
3. Arrythmias
4. Pulmonary hypertension
5. Diabetes
6. Motor vehicle accident

Front 25

What risk factors can be modified to improve obstructive sleep apnea?

Back 25

1. Weight loss
2. Adjust body position
3. Avoid alcohol and sedatives
4. Treat nasal congestion

Front 26

What kind of upper airway surgeries can be done to treat obstructive sleep apnea?

Back 26

1. UPPP
2. Nasal surgery
3. Tracheostomy
4. Craniofacial reconstruction

Front 27

List some treatments for obstructive sleep apnea.

Back 27

1. Modify risk factors
2. Oral appliances
3. Nasal CPAP (continual positive airway pressure mask)
4. Upper airway surger

Front 28

Which patients should use CPAP for OSA?

Back 28

1. AHI > 15 (regardless of symptoms)
2. AHI 5 - 15 with the following symptoms:
Daytime sleepiness, HTN, cardiovascular disease, stroke, insomnia, and/or mood disorder

Front 29

What are some side effects of CPAP?

Back 29

1. Feeling of suffocation
2. Nasal drying
3. Rhinitis
4. Sinus congestion
5. Ear pain
6. *Chest pain
7. Conjunctivitis

Front 30

What should a patient take who is experiencing nasal dryness, rhinitis, and/or sinus congestion as a result of CPAP?

Back 30

1. Antihistamines
2. Humidifier
3.. Nasal steroids

Front 31

List 3 indications for using bilevel ventilation (BiPAP) for the treatment of apnea.

Back 31

1. Chronic hypoventilation in addition to OSA
2. Intolerance to CPAP
3. Central apnea

Front 32

What is the major problem with CPAP?

Back 32

Compliance
(only about 50% of patients use it on a regular basis)

Front 33

List 3 surgeries that can be done to treat obstructive sleep apnea.

Back 33

1. Tracheostomy
2. Uvulapalatopharyngoplasty (UPPP)
3. Maxillomandibular advancement

Front 34

What does a uvulapalatopharyngoplasty (UPPP) involve?

Back 34

Removal of excess tissues at the back of the throat
(tonsils, uvula, and part of the soft palate)

Front 35

What three signs should trigger a high index of suspicion of OSA in a patient?

Back 35

Obesity + Snore + Daytime sleepiness

Front 36

List the order of sleep stages experienced during the night.

Back 36

1. Wake
2. NREM1
3. NREM2
4. NREM3
5. REM
6. Cycle between REM --> NREM2,3,4 through the rest of the night

Front 37

How does REM sleep change throughout the night?

Back 37

REM sleep increases with each cycle

Front 38

For most kids with sleep apnea, what is the first line of therapy?

Back 38

Tonsillectomy
(most kids with sleep apnea suffer from adenotonsillar hypertrophy)