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57 Cards in this Set

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