Obstructive Sleep Apnea

Front 1

classifications of attacks/ definitions

Back 1

Apnea
hypopnea
respiratory effort related arousal
apnea-hypopnea index
respiratory disturbance index

Front 2

Apnea

Back 2

represents complete cessation of airflow
-associated with continu. resp. efforts

Front 3

hypopnea

Back 3

represents dimnished airflow

- with at least 4 % desaturation

Front 4

respiratory effort related arousal
RERAs

Back 4

a change in airflow that lead to an arousal
-but don't meet the criteria for apnea or hypopnea

Front 5

apnea-hypopnea index
AHI

Back 5

number of apnea and hypopnea per hour

Front 6

respiratory disturbance index
RDI

Back 6

number of apnea /hypopnea/and resp.effort related arousal per hour

Front 7

% in the population

Back 7

4 %

Front 8

men vs women

Back 8

men twice likely

Front 9

types of sleep apnea

Back 9

1-obstructive
2-central

Front 10

risk factors for sleep apnea

Back 10

1-obesity
2-nasal obstruction
3-tonsillar enlargment
4-adenoid hypertrophy
5-mandibular size
6-mandibular positioning
7-family Hx
8-smoking

Front 11

obstructive sleeep apnea prevention

Back 11

-wt reduction

-avoiding sedative/ hypnotics

-avoiding alcohol

Front 12

associated conditions and complications

Back 12

- HTN
-CHF
-arrythmias
-MI
-stroke
-DM (( indebendent from obesity))
-RTA
-hypoxemia/hypocapnea/polycythemia
-difficult intubation and arousal after recovery

Front 13

presentation and associated symptomes

Back 13

- excessive daytime sleepiness
-snoring
-nocturnal arousal
-nocturnal apnea
-nocturnal gasping / grunting / choking
-nocturia
-enuresis
-awakening without feeling refreshed
-morning hedache
-impaired memory and concentration
-irritability / depression
-impotence

Front 14

most common symptom of obstructive sleep apnea

Back 14

habitual loud snoring
+ with sensation of gasping or choking

Front 15

do all people who snore have OSA

Back 15

no

Front 16

how to assess pt sleep

Back 16

by (((Epworth sleepiness scale ))

Front 17

physical examination of pt with OSA

Back 17

--septal deviation
--enlarged tonsilles
--Mallampti class

Front 18

Mallampti class

Back 18

a classification for airway and difficulty of intubation

Front 19

differintial diagnosis
for excessive daytime sleep

Back 19

1-sleep debrivation
2-periodic limb movement disorder
3-narcolepsy
4-medication side effect

Front 20

DDx of nighttime awakening

Back 20

-CHF
-chronic lung dis
-GERD

Front 21

diagnostic testing
gold standard

Back 21

sleep study
((( over-night polysomn<o-graphy)))

Front 22

diagnostic criteria

Back 22

RDI ((resp disturbance index)) of
1- >15
2- >5 with one of the following :
-daytime sleep
-sleep is not refreshing
-awakening gasping
-witnessed apnea

Front 23

indications for sleep study

Back 23

-pt with snoring + daytime sleep
-titration of positive airway pressure symptomes
-assessment of response to therapy-objectively

Front 24

devices and measures used in sleep study

Back 24

-EEG
-ECG
-EMG
----------------------------------
-EOG : electro-oculography
-O2 sta
-body position

Front 25

events must be recorded during sleep study

Back 25

1-sleep stages
2-frequency of resp. events
3-limb movement
4-abnormal behaviour

Front 26

stages of sleep study

Back 26

1-diagnostic
2-therapy titration-done if mod-severe OSA found
------------------------------------
((split-study))

Front 27

alternative to sleep study if not available

Back 27

portable device measuring :
-airflow
-resp. effort
-o2 sat

Front 28

associated problem must be considered in pt with BMI > 40

Back 28

obesity hypoventilation

Front 29

management of OSA

Back 29

1-lifestyle modification
2-medications
3-non-pharmacological
4-surgical

Front 30

lifestyle modification

Back 30

-wt loss
-avoid alcohol
-avoid hypnotics/sedatives
-avoid smoking

Front 31

medications

Back 31

-no one ever used as primary therapy

-MODAFINIL (((modafinil)))
-----------------------------------------

Front 32

MODAFINIL

Back 32

-used to maintain concentration and improve daytime sleepiness , if persistant symptomes despite adequate CPAP

Front 33

surgical manegment

Back 33

1-tracheostomy
2-uvulo-palato-pharyngio-plasty
3-staged procesures

Front 34

tacheostomy

Back 34

only used in life-threatening
-cor pulmonale
-arrythmia
-severe hypoximea
can't be maneged by other modalities

Front 35

uvulo-palato-pharyngio-plasty
indication

Back 35

used only in pt's with all of these
---------------mild-moderate
---------------cannot use CPAP successfully
---------------with retropalatal obstructio
and only as 2nd line

Front 36

uvulo-palato-pharyngio-plasty
procedure

Back 36

removing of tissues from :
-tonsils
-tons. pillars
-uvula
-post. palate

Front 37

uvulo-palato-pharyngio-plasty
complications

Back 37

-change in voice
-nasal regurge
-nasopharyngeal stenosis
-intolerance to CPAP