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11 Cards in this Set

  • Front
  • Back
What can be used in shift work disorder?

Modafinil - a stimulant
How is the severity of sleep apnea quanitified?


Can be quantified during diagnostic sleep testing by the panea-hypopnea indeax - the number of events per hour


5-15 is mild


> 30 is severe
What are oral appliances for CPAP?


Alternative to PAP therapy for mild to moderate OSA


- Advance mandible by traction or


Prevent posterior displacement of the tongue by suction


- Patients tend to be more compliant with this
What surgery is done for refractory CPAP?


UPPP - uvulopalatopharyngosgoplasty - soft palate procedure


Maxillomandibular advancement, which can be performed in conjunction w/ soft palate procedure, can be more effective at reducing AHI
What are central sleep apnea syndromes? What are the RFs?


Loss of neural output originating from the respiratory centers int eh CNS to respiratory pump machinery resulting in pauses in breathing


Typically occurs in non-REM sleep; patients have a higher CO2 by which they are stimulated to take a breath


- RFs include: CSA and HF, cheyne stokes breathing - pattern of breathing w/ waxing/waning tidal volumes


- Opiates, afib stroke, brainstem lesionskidney failure

How is central sleep apnea treated?


Treat underlying comorbid conditions


CPAP occ can be helpful
How is hypoventilation diagnosed?


Hypoventilation syndrome - occurs mostly in REM sleep w/ muscle atoniao


- Desatuarations < 90% for at least 5 minutes, or > 30% total sleep time by pulse ox


- Sustained reductions distinguish this from OSA - brief repetitive deoxygenation/reoxygenation cycles

What is obesity hypoventilation?


Dyatime hypercapenia PCO2 > 50, reflects reduced ventilation during wakefulness and sleep


- From mechanical load owing to besity and attenuation of hypoxic and hypercapnic ventilator drive


- PAP, weight loss, bariatric surgery
What are characteristics of high altitude periodic breathing?


HAPB - hypoxia induced hyperventation --> drives PCO2 toward apnea w/ decrease in RR and eventual rise in PCO2 --> increased respiratory drive and recurrent hyperventilation --> CYCLIC APENAS


- Prevent w/ gradual ascending


- Acetazolamide accelerates the acclimation process by inducing a slight metabolic acidosis to stimulate ventilation and gas exchange

What is acute mountain sickness and high altitude cerebral edema?


HA fatigue, nausea/vomiting, disturbed sleep


- Happens to 25 % of visitors


- Exacerbated by heavy exertion and dehydration


- Conservative therapy, acetazolamide, dex




High altitude cerebral ddema: 3-4k, vascular leak, brain swelling, resulting in confusion, irritability, ataxic gait to coma/death


- Treat w/ Dex, O2 and hyperbaric therapy

What is high altitude pulmonary edema?


Treat with O2, rest, descent, salavage w/ calcium channel blockers nifedipine or PDE 5 inhibitors (sildenafil, tadalafil)


- do not use BB or nitrates or diuretics as typical in HF


- Hypoxia drives vascular leak into the lungs, elevates pulmonary artery pressures