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40 Cards in this Set
- Front
- Back
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Non REM sleep has how many stages? These account for what percentage of sleep?
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I-IV, 75-80%
REM is 20-25% of sleep |
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how long is a sleep cycle? how many per night?
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90-120 minutes. usually 3-4 cycles per night
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describe stage I NREM sleep?
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transition to sleep.
2-5% of sleep. loss of awareness and tone. increase in theta waves and decrease in alpha |
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stage II NREM sleep?
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50% of sleep
true sleep - loss of awareness and tone K-complexes and spindles on EEG |
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stages III and IV NREM sleep?
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8% and 15 percent of sleep respectively
presence of delta waves marks the most restful aspect of sleep decreases in % with age |
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what are the two stages of REM sleep? what do they mean?
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tonic and phasic
tonic - EEG is asynchronous. loss of muscle tone phasic - REM, cardiac and respiratory activity erratic patterns |
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define apnea
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cessation of breathing for > 10 sec
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define hypopnea
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decreased in airflow 10% to < 70% for 10 seconds
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whats the difference between AHI and RDI?
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AHI - ap/hypopnea index is # of apneas + hypopneas per hour. need 2 hrs of monitoring to determine.
RDI is AHI + arousal index. |
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classify AHI degrees
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< 5 is normal
5-15 is mild 15-29 moderate 30+ severe |
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what is OSAS or OSA syndrome?
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AHI > 15 and daytime and night time symptoms
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what encompases obesity hypoventilation syndrome?
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chronic alveolar hypoventilation
obesity daytime hypercapnia (PaCO2 > 45 mm Hg usually results in pulm hypertension and right heart failure |
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what are the essentials of diagnosis for OSA?
breathing pattern neck circumference what tests to diagnose |
loud snoring, obstructions at night
> 17 male, or > 15 female. BMI > 27 PSG |
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what percentage of the population has OSA?
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25% of men and 9% of women have AHI's > 5 (ages 2% and 4% for AHI > 15
most people are undiagnosed |
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are people with allergic rhinitis higher risk for OSA? what's the significance?
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yes. higher risk due to turbinate swelling. doesn't play a major role in most patients with osa.
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what physical characteristics of the body are higher risk for osa?
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obesity
increased neck circumference black (worse AHI's) |
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What role does ANP play (atrial natriuretic peptide)?
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the negative pressure on the walls of the airway are transmitted to the right atrium (whole thorax), which cause the release of ANP. this results in nocturnal enuresis or nocturia which arouses the patient and increases sleep fragmentation
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when measuring neck circumference, where do you measure?
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at the cricothyroid membrane
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what other things do you need to test for when a patient presents with newly diagnosed OSA?
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HTN
Hypothyroidism depression |
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how do you assess for maxillary and mandibular retrusion?
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To assess the patient for maxillary retrusion, a line dropped from the nasion to the subnasale should be perpendicular to the Frankfurt plane.
To assess the patient for retrognathia, a line bisecting the vermillion border of the lower lip with the pogonion should be perpendicular to the Frankfurt plane as well. If the pogonion is retroposed more than 2 mm, retrognathia is suspected. A lateral cephalometric x-ray helps evaluate this area with precision. |
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when does a patient need CPAP?
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AHI > 30.
AHI 5-30 with symptoms Compliance is such that 85% of patients use it 4-5 hrs per night after 6 months of use |
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weight loss in OSA. does it work? what helps?
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moderate weight reductions improve airway function.
working with dietician helps bariatric surgery as last resort |
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what substances should people with OSA avoid?
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sedatives, alcohol, nicotine, and caffeine
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what positions should they avoid?
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supine
tennis ball shirt or pillow arrangement |
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when a patient presents to your office with OSA interested in surgery, how do you evaluate them?
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PE. (eval for max and mandibular retrusion)
NP Scope with muller maneuver Cephaometric X-rays PSG |
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what are the three types of upper airway obstruction?
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Type I - palatal "oropharyngeal obstruction"
Type II - oropharyngeal and hypopharyngeal obstruction Type III - hypo only Treatment is address appropriately UPPP for oropharynx Genioglossus advancement for hypopharynx |
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what effect does AHI have on snoring? On type I patients? On type II or III patients? patients with really high BMI or AHI?
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Snoring - 90% effective
Type 1 - 53% of patients will have a 50% reduction in AHI Type 2-3 patients - less effective High AHI or BMI - less effective Allow 6 months after surgery to reasess. |
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what dues UPPP entail?
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conservative excision of soft palate and uvula. removal of tonsils if present. (back cuts to create a square and release tension if you're Chio). then suture.
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what is a genioglossus advancement? when is it needed? how effective is it?
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Block genioplasty - bone window in midline mandible for advancement of the genioid tubercle.
Mortise genioplasty - 0- PDS suture suspension of the hyoid anchored to the mandible needed for Type II and III obstruction and any patient with an AHI > 30. Type II 60-65% success Type III 66-80% success reduction in AHI Both groups have significant improvements in overnight oxygen desaturation |
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what is phase II surgery? (powell-riley protocol)
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the next step if the above measures are not successful.
Involves Maxillomandibular osteotomy - those adherent to the protocol have a 95% success rate, but many patients drop out. |
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LAUP - laser assisted uvuloplasty. Who's your target patient? how well does it work?
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AHI < 30. or snoring.
80-90 % effective for snoring. 50% effective for OSA CO2, Argon, or KTP laser reduction of palate and uvula. 1-3 sessions in office with local anes. should not be done in patients with big tonsils and redundant pharyngeal mucosa. |
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when should you push for a trach?
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corpulmonale, obesity hypoventilation syndrome, nighttime arrhythmias or disabling excessive daytime sleepiness who refuse CPAP and surgical intervention
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what causes nocturnal enuresis?
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negative chest pressure pulls on the atria which causes a release in ANP, causing nocturnal diuresis
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what is the relationship of OSA and ADHD?
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correlation is not well defined. Treating the OSA does improve ADHD symptoms.
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what percentage of children have primary snoring? what percentage have OSA?
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3-12%
2-3% between 6 mo and 18 years |
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name 5 syndromes that are associated with anatomic abnormalities that contribute/cause OSA?
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Down syndrome
Crouzon syndrome Apert syndrome Pierre Robin Sequence Tracher Collins syndrome Beckwith-Wiedemann all have some midface or mandibular hypoplasia or have macroglossia or nasal obstruction also consider choanal atresia |
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what asthma like symptoms are also associated with sleep disordered breathing?
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chronic cough OR 9
persistent wheeze OR 7 Sinus congestion 5 Asthma 4 |
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what is a normal PSG in a non OSA child?
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AHI 1 +/- 0.5.
Insterestingly, PSG's can be normal in kids with high sleep fragmentation |
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what are the indications for a PSG in a child?
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Differentiating primary snoring from OSA-related snoring.
Evaluate EDS, corpulmonale, failure to thrive, or polycythemia in the snoring child. Uncertainty about whether results of exam are sufficient to warrant surgery. Children with laryngomalacia with worsening symptoms during sleep. Obesity in children associated with unexplained hypercapnia, snoring, or disturbed sleep. Child with sickle cell anemia and symptoms of OSA or sleep-related vasoocclusive crises. If weight loss or CPAP is selected as primary therapy (in order to titrate). |
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besides the normal cardiopulmonary sequela we see in adults, what other problems manifest in children with OSA?
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failure to thrive, poor growth, short stature, learning disabilities, mental retardation, behavioral problems, and attention deficit/hyperactivity disorder
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