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36 Cards in this Set
- Front
- Back
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Sleep Apnea
Epidemiology |
OSA individual and public morbidity and mortality
Prevalence study 9.1%M 4%F (AHI>15) 24%M and 9%F (AHI>5) 3 million men and 1.5 million women 12 fold increase in diagnosis 1990-1998 1990 ----16B direct and 150B indirect cost |
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Normal Sleep Breathing Physiology
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Frequency Increases
Tidal Volume Decreases MV Decreases PCO2 Increases PaO2 Decreases |
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Normal Sleep Cardiac Response
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NREM - Increases parasympathetic tone
Bradycardia - 5-10% Cardiac Output - Decreases Blood Pressure - Decreases Arrhythmias - Sinus exit block, pauses, bradycardia, 1st degree AV block, Wenckebach. |
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Sleep Physiology
(other than resp or CV) |
Gastric acid secretion is maximal 10pm and 2am
Swallowing frequency decreases during sleep Hormonal Association (Leptin, GH) Thermal regulation is inhibited during REM Shiver or sweat during NREM |
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Advanced stage sleep disorder
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go to sleep before 9
tx by shining light in eyes… suppresses melanin release |
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Delayed stage sleep disorder
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go to bed after 9
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Apnea
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Cessation of breath for 10 seconds
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Hypopnea
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Flow reduction of 50%
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AHI
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Number of events per hour
Sleep deprived b/c of sleep fragmented, hypoxemia, hypercapnia, which lead to increase Pulm. Art. Pressure, increased systemic hypertension, coronary artery disease, strokes, renal failure |
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UARS
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Upper airway resistance syndrome
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RDI
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Respiratory disturbance index
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RERA
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Respiratory event related arousals
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Central Apnea
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no effort
no flow |
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Obstructive Apnea
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effort
no flow (Closed anywhere from nose to vocal snores) |
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Mixed Apnea
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combination of central and obstructive apneas
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Risk Factors for Sleep Apnea
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Reduced airway size
- Obesity (central), male Craniofacial features - Retrognathia, Micrognathia, Macroglossia, etc - Modified Mallampati Reduce Neuromuscular Output Gender Differences Racial Differences |
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name something that causes macroglossia
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amyloid deposition to tongue
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Retrognathia
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state in which the mandible is located posterior to its normal position in relation to the maxillae
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Clinical Manifestations of Sleep Apnea
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Restless Sleep - 100%
Snoring - 94% Excessive Daytime Somnolence - 78% Cognitive impairment - 58% Personality changes - 48% Am cephalgia (headache) - 36% Nocturia (b/c increased ANP) - 30% Insomnia - 10% |
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Epworth Sleepiness Scale
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questionaire to assess for sleep apnea
Value greater than 9 = pathologically fatigued |
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sleep apnea sequelae
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Hypertension and Cardiovascular Morbidity
Pulmonary hypertension CNS Renal Sudden Death |
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OSA and HTN relationship
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70-90% of patients with OSA are hypertensive.
30-35% of patients with primary diagnosis of hypertension has OSA. - The risk of hypertension rises linearly with AHI - Even low levels of SDB increase the risk of hypertension - Effects of SDB on blood pressure are most pronounced in under 50 |
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History for Sleep Apnea
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Sleep time
Perceived sleep latency Sleep paralysis or hallucinations Nocturnal arousals Reason for arousals Wake time Total sleep time Am headaches Restorative sleep |
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Physical Exam for Sleep Apnea
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Vital signs
Evaluate body habitus If sleeping observe Asses for: - Maxillofacial abnormalities - Speech and tongue - Oro / Hypopharynx - Bedside Exam - Measure neck circumference |
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Diagnostic Studies for Sleep Apnea
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Overnight pulse oximetry (not the most accurate)
Polysomnography Sleep laboratory and home studies Multiple Sleep Latency Test |
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Multiple Sleep Latency Test
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You take 5 naps of 2 hour duration
Look for falling asleep within 8 minutes and having REM sleep If occurs twice then you have narcolepsy (tx is ritalin…stimulants) ... do it after an overnight polysomnography, so you know they aren't drug seekers |
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Sleep Apnea Severity
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Monitor AHI:
Normal less than 5 per hour Mild 5 – 15 per hour (may treat) Moderate 15-30 per hour (treat) Severe greater than 30 (Treat… worry about CV risk..CAD, stroke, sudden cardiac death) |
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Polysomnography
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Electroencephalogram
Electrocardiogram Electromyelogram (madible tone) Electrooculogram Pulse Oximetry Position Monitor Thermistors (nasal and oral): airflow |
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Sleep Apnea
treatment of choice |
CPAP
- increase FRC - improves V/Q ratio - decreases activity of the upper airway muscles * effective, but poor compliance |
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Medical Therapy for Sleep Apnea
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Sleep Hygiene (only sleep in bed, same bedtime and awake time)
Weight Loss Dental appliances CPAP BIPAP Do not work: - REM suppressing medications - Respiratory drive stimulants - Oxygen Therapy - Nasal Canula & Transtracheal |
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Surgical Therapy for Sleep Apnea
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DO NOT DO...WAY BETTER TO TREAT MEDICALLY
Tracheostomy UPPP (uvulopalatopharyngoplasty) MMHO ( Maxillary, Mandibular, Hyoid Advancement ) Gastroplasty and Roux en Y (this can work in morbid obesity) |
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What does I SNORED stand for?
Why is it used? |
Insomnia/insufficient sleep?
Snoring? Not breathing? Obese/older? Restorative/refreshing sleep? Excessive daytime sleepiness? Drugs (sedatives/hypnotics, alcohol)? the 7 components of a sleep history |
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What are the non-rem stages of sleep?
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stages 1- 4
stage 1: slow rolling eye movements (prosac eyes) stage 2: characterized by sleep spindles and K complexes stage 3: slow waves stage 4: slow waves |
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Rem Latency
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it takes 90 - 100 minutes to attain REM sleep after you go to sleep
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Sleep Latency
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How quickly you fall asleep… should take 15 minutes
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Which stages of sleep are restorative?
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slow waves: stages 3 and 4
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