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57 Cards in this Set
- Front
- Back
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Definition of apnea.
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complete cessation of airflow during stable sleep
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Definition of OSA.
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Repetitive episodes of complete or partial obstruction of the airway during sleep.
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W/ sleep onset, airway becomes more ____ .
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floppy due to decreased muscle tone
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By definition, an event of apnea or hyponea last a minimum of ____ seconds.
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10
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OSA is associated w/ O2 ____.
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desaturation
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Lack of airflow leads to brief ____ disrupting sleep architecture causing ____.
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arousal, daytime sleepiness
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Number of events (apnea or hypopnea) per hour
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Apnea-Hypopnea Index (AHI)
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Measure ___ ____ w/band aroudn chest and abdomen.
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respiratory effort
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W/ obstruction, there is ___ the abdomen goes up and the thorax goes down w/o _____.
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paradoxing, synchrony
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It costs more to ____ OSA than to treat it.
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diagnose
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Treating OSA will ___ medical costs.
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decrease
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OSA syndrome = AHI > ? w/ _____
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5, daytime sleepiness
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Treatment of children w/ sleep apnea.
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surgery, tonsillectomy/adeniodectomy
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Risk factors for developing OSA.
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increasing age
obesity male gender positive family history craniofacial features alcohol consumption drug use (barbituates, benzodiazapines) hypothyroidism nasal congestion |
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OSA prevalence in women increases after ___
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menopause
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By age ___ women and men have similar incidence rates for OSA.
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50
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OSA is influenced by ____ ratios.
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waist-hip
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BMI influence on OSA is ___ w/ age.
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decreased
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Stereotypical OSA patient
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male, middle aged, w/ large neck circumference
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Consequences of OSA
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excessive daytime sleepiness (most common)
cognitive impairment depression increased risk for MVA impaired vigilance decreased QOL morning headache weight gain insulin resistance disruption of partner's sleep CV events |
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Normal ESS
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<10
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Increased in MVA if you __ (which indicates possible OSA)
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snore
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Treating OSA w/ CPAP may ____ Insulin sensitivity, greatest in those w/ ____ BMIs.
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improve, lower
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Those treated w/ CPAP improved partner's sleep and hence their partner's ____ and ____.
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ESS, QOL
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CV consequences of OSA
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hypertension, MI, arrythmia, strokes, pulmonary HTN, sudden death
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Start treatment for OSA when ___ events of apnea/hypopnea occur per hour.
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5
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Why is compliabnce a problem w/ CPAP?
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skin irritation, nasal complaints
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OSA patients are more likely to die when?
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in the middle of the night while asleep
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How does OSA cause pulmonary HTN?
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w/ hypoxemia, there is vasoconstriction of pulmonary arteries
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Explain anatomic pathogenesis of OSA.
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upper airway is small in size or has a narrow radius
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Explain neural pathogenesis of OSA.
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allows airway to collapse and become more compliant during sleep
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During REM all sk. muscle is relaxed except?
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diaphragm, and extraocular muscles
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Name four muscles that can be involved w/ OSA
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genioglossus - collapse during sleep
geniohyoid sternohyoid pharyngeal constrictors |
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Explain OSA pathogenesis.
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Sleep --> decrease airway dilator activity, decrease respiratory drive --> continue respiratory effort --> become hypoxic and acidotic --> triggers chemoreceptors in brainstem -->arousal and breathing stimulated
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OSA is worse during ___ sleep.
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REM
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Why is OSA the worst during REM?
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least muscle tone w/ minimal resp. responsiveness
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OSA resp symptoms
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loud snoring (worse supine)
loud snorts w/ arousal choking or gasping episodes witness apneic events irregular breathing patterns mouth breathing & dry mouth |
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Women w/ OSA are more likely to have ____ and ____.
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excessive daytime sleepiness, depression
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OSA symptoms
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unrefreshing/restless sleep
nocturia diaphoresis insomnia decreased libido cognitive impairment personality changes morning headache excessive daytime sleepiness nocturnal arrythmia polycythemia atrial tachycardia |
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Neck size in OSA
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17 inches in men
16 inches in women |
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OSA physical findings:
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rhinitis, nasal obstruction, nasal polyps, retrognathia, macroglossia, narrow facies, mandibular insufficiency, high arched palate, long soft palate, large uvula, tonsilar enlargement, overbite
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Diagnostic workup for OSA
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overnight polysomnography (gold standard)
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What is included in a polysomnography?
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EOG, EEG, electromyogram, air flow, eye movements, snoring, pulse oximetry, body position, EKG, and leg m'ments
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If patient only has apnea in supine position, try ___
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positional therapy
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Examples of arrythmias seen w/ OSA.
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PVCs, ventricular tachycardias, atrial tachycardias
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Anti-depressants inhibit ___ sleep, therefore patient w/ ___ associated OSA, will not show symptoms.
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REM, REM
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A study where the diagnosis of OSA is made during the first part of the overnight polysomnogram, followed by a period of CPAP. Used for AHI > 20.
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Split Night Studies
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OSA Treatment
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behavioral treatments
CPAP |
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Blows air into your airway through your nose, provides continuous positive airway pressure to keep airway open.
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CPAP
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Similar to CPAP w/ higher pressure during inhalation than exhalation used for patients that can't blow against positive pressure. (COPD)
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BiPAP
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Problems w/ CPAP:
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wearing it, arousals, electricity needed, skin irritation, air leaks, and maintenance
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What aids nasal irritation complaints and relieves obstruction?
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air humidification
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Give CPAP for AHI greater than ___ or greater than ___ with comorbidities.
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15, 5
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How do oral appliances help OSA?
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brings jaw forward which increases muscle tone to stent open the airway
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When should you treat with oral appliances?
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primary snoring problems, mild to moderate OSA that doesn't meet CPAP criteria, previously CPAP, or preference,
mild to moderate OSA w/ low BMI or positional OSA |
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What are the cons of a UPPP?
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painful, works only half the time, not very effective
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Examples of region-specific surgery.
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nasal surgery, mandibular advancement or osteotomy, genioglossus advancement
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