Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CAM > 2. Roecker - Sleep Apnea > Flashcards

2. Roecker - Sleep Apnea Flashcards

1
Q

What defines hypopneas?

A

Events at least 10 second long where ventilation is reduced 50% or more from baseline despite continued breathing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How many obstructive sleep events are needed for a diagnosis by OSAHS?

A

At least 5 obstructed breathing events and excessive daytime sleepiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is supported by AASM?

A

OSAHS in pts with 15 or more obstructed breathing events per hour in patients w/o symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the main OSAHS mechanism?

A

Airway is sucked closed during inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are 4 factors contributing to OSAHS mechanism?

A

Muscle tone fails and airway narrows
Dilating muscles relax during sleep and fail to oppose negative pressure
Snoring may preempt air occlusion
Patient will untimely wake (but the brain doesn’t wake)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 3 disposing factors of OSAHS?

A

Obesity - seen in 50% of patients
Shortening of the mandible and/or maxilla
Hypothyroidism and acromegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Who is the common pt for OSAHS?

A

Most common in middle age men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the hallmark symptom of OSAHS?

A

Daytime sleepiness, may present like narcolepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are four other clinical symptoms of OSAHS?

A

Loud snoring
Witnessed breathing interruptions
Awakenings due to GPA spring or chocking
Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are OSAHS symptoms a result of?

A

Physiologic mechanism

Ex. Changes in intrathroacic pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some high risk conditions?

A

Obesity, heart failure, uncontrolled HTN, type 2 DM, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 4 preliminary questions for screening?

A

Daytime sleepiness?
Snoring?
Presence of high risk factors?
STOP-BANG?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is STOP in the STOP-BANG acronym? What is its purpose?

A 
S = snore loudly?
T = tired during the day?
O = observed stop breathing?
P = high blood pressure? 
Purpose is for the questions to ask
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is BANG in the STOP-BANG acronym? What is its purpose?

A 
B = body mass index (>35)
A = age (>50)
N = neck circumference (>40cm) 
G = gender (male) 
Objective measures (and predisposing factors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How it STOP-BANG evaluated?

A

3 or more questions indicates a high OSA risk
3 or more questions + symptoms = 84% accurate diagnosis
5 or more = severe sleep apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the apnea-hypopnea index?

A

Number of Aeneas dead hypopneas per hour of sleep

Diagnosed = 5/hour

17
Q

What is the oxygen desaturation index?

A

Frequency >3-4 oxyhemoglobin desaturations per hour of sleep

18
Q

What is the Epworth Sleepiness Scale?

A

Scores 8 activities and their potential to put the patient to sleep on a scale of 0 (unlikely) to 3 (very likely)

19
Q

What is included in objecting testing?

A

In-lab polysomnography

Home testing with portable monitors

20
Q

What is included in In-Labratory polysomnography? What is its purpose?

A

Watches the pt sleep and measure different readings on the pt. Confirmation of diagnosis w/ appropriate numbers of obstructive events in combo w/ symptoms

21
Q

What are some features of home testing?

A

Limited study because it has no EEG or EKG data
Not to be used as a standard in pts w/ major comorbidities
Reads airflow, respiratory effort, and oxygenation

22
Q

What are the 4 treatments of sleep apnea?

A
  1. Positive airway pressure
  2. Behavior modifications
  3. Oral appliances
  4. Surgery
23
Q

What is positive airway pressure? Where is its place in treatment of sleep apnea?

A

This is the treatment of choice!
Modified pressure to keep airway patent during inspiration
Applied though nasal, oral, or oronasal masks
Shown to benefit most OSAHS symptoms

24
Q

What is behavior modifications place in therapy of sleep apnea?

A

Should not be the only course of treatment

  • combination weight loss to BMI 25 or less and PAP machine can increase effectiveness
  • sleep positioning (using a positioning device), but will need to be evaluated to see if other options are more useful
25
Q

What is the role in therapy of oral appliances in sleep apnea?

A

Will enlarge the upper airway or decrease upper airway collapsibility, but not as effective as CPAP (but another option)

26
Q

What are the two oral appliances in sleep apnea?

A

MRA - mandibular repositioning appliance: pushes the jaw forward
TRD - tongue retaining devices: pushes the tongue forward
Both needed to be fitted to the pt by a professional

27
Q

Where is surgery’s role in therapy of sleep apnea?

A

Very aggressive approach, may be a bit much.
Includes tracheotomy, tonsillectomy or adenoidectomy
Surgeries in the jaw, nose, or tongue to widen airway

28
Q

What are the 3 adjunctive therapies of sleep apnea?

A
  1. Bariatric surgery
  2. Pharmacologic therapy
  3. Oxygen therapy
29
Q

When is pharmacologic therapy indicated in sleep apnea?

A
  1. Effective if the cause is hypothyroidism or acremegaly
    - thyroid hormone or anti-growth hormone
  2. Nasal corticosteroids for concurrent rhinitis
  3. Modafanil for excessive daytime sleepiness despite CPCP tx
30
Q

What is Modafanil’s use?

A

Indicated for excessive daytime sleepiness despite effective CPAP treatment for OSAHS

31
Q

Is oxygen therapy indicated in treatment of sleep apnea?

A

Oxygen is not recommended in primary OSAHS tx

32
Q

What are OSAHS complications?

A
  1. CV events - increase mean BP after arousal event
  2. Cerebrovascular events - 40% increase
  3. Diabetes mellitus - insulin resistance, independent of obesity
  4. Hepatic dysfunction - increased LFTs and fibrosis
  5. Airway obstruction after anesthesia
33
Q

What is central sleep apnea (CSA)?

A

Respiratory pauses caused by diminished respiratory effort, something happens to shutdown respiratory

34
Q

Where is recurrent CSA found?

A

Most commonly found in pts w/ HF or post-stroke

35
Q

Where is spontaneous CSA found?

A

Very rare classified w/ PaCO2 levels

36
Q

How does a CSA pt present?

A

Relatively unusual OSAHS

May have daytime sleepiness, but not as predominant

37
Q

How is CSA diagnosed?

A

Diagnosed w/ certainty only if chin electromyogram shows absence of muscle contractions in esophagus and respiratory muscles in response to apneic event

38
Q

What is the treatment of CSA?

A
  1. Treat the underlying disorder - usually after HF, make sure HF is treated appropriately
  2. Acetazolmide is used in spontaneous normocapnic CSA
39
Q

What defines an apnea?

A

Breath pause lasting at least 10 seconds

CAM (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions