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2. Pulmonology > 33_34_ Sleep related breathing disorders > Flashcards

33_34_ Sleep related breathing disorders Flashcards

1
Q

What are the signs and symptoms of sleep-related breathing disorders?

A
  • Nighttime symptoms include snoring, observed apneas, poor sleep quality, night sweating, and enuresis.
  • Daytime symptoms include sleepiness, morning headache, dry mouth, poor short-term memory, depression, poor mood, GERD symptoms, and decreased libido.
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2
Q

What is the importance of sleep history in diagnosing sleep-related breathing disorders?

A

Sleep history, including third-party reports, is important in diagnosing sleep-related breathing disorders as it helps in identifying symptoms that may not be apparent to the patient.

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3
Q

What are the laboratory tests used in diagnosing sleep-related breathing disorders?

A

Complete blood count may show polycythemia (↑Hb + Hct) and ABG may show ↑serum HCO3-.

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4
Q

What is polysomnography (PSG)?

A

Polysomnography (PSG) is a sleep study that is performed in a sleep lab to assess physiologic variables including O2 saturation, nasal airflow, respiratory effort (thoracic/abdominal movements), sleep stages, and arousal events.

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5
Q

What are the recording methods used in polysomnography (PSG)?

A

The recordings are done via EEG (electroencephalography), EMG (electromyography), EOG (electrooculography), and ECG (electrocardiography).

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6
Q

What is the gold standard for diagnosing sleep-related breathing disorders?

A

Polysomnography (PSG) is the gold standard for diagnosing sleep-related breathing disorders.

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7
Q

What is hypopnea?

A
  • Reduction of oronasal airflow, peak signal drop >30%,
  • lasts more than 10 seconds
  • reduction of O2 saturation >4%
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8
Q

What is apnea?

A

Cessation of oronasal flow, peak signal drop >90%, lasts more than 10 seconds.

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9
Q

What is obstructive apnea?

A
  • Ineffective thoracic/abdominal movements can be observed during apnea,
  • airflow cessation is caused by airway obstruction.
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10
Q

What is central apnea?

A

No thoracic/abdominal movements can be observed during apnea.

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11
Q

What is the apnea-hypopnea index (AHI)?

A

Number of apnea/hypopnea events per hour of sleep.

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12
Q

What is the most common sleep-related breathing disorder?

A

Obstructive sleep apnea syndrome (OSAS), where airflow reduces due to upper airway obstruction.

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13
Q

What is the main sign of central sleep apnea?

A

Cheyne-Stokes breathing

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14
Q

What is sleep-related hypoventilation?

A

A condition where there is reduced breathing during sleep, including obesity hypoventilation syndrome (OHS), simultaneously with other diseases, drug-induced, congenital, primary/idiopathic (Ondine’s curse).

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15
Q

What is sleep-related hypoxemia?

A

A condition where there is low oxygen levels in the blood during sleep.

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16
Q

What is Obstructive Sleep Apnea Syndrome (OSAS)?

A

A sleep-related breathing disorder in which airflow decreases or ceases due to obstruction of the upper airways (oropharynx).

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17
Q

What are the main features of OSAS?

A
  • Lack of ventilation is associated with a decrease in PaO2 (intermittent hypoxia) +/- increase in PaCO2.
  • Episodes are terminated by different levels of arousal (sleep fragmentation) and a sudden increase in SYM activity.
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18
Q

What are the morphological factors that can cause OSAS?

A
  • Obesity (especially around the neck),
  • short neck,
  • retrognathia (mandible set back from maxilla),
  • micrognathia (mandible is undersized),
  • macroglossia,
  • large uvula,
  • tonsil hypertrophy,
  • nasal septum deviation.
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19
Q

What are the functional factors that can cause OSAS?

A
  • Chronic upper airway inflammation,
  • alcohol consumption,
  • smoking,
  • sedatives with muscle relaxing effect,
  • CNS diseases,
  • pharyngeal neuropathy/myopathy.
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20
Q

What are the clinical features of OSAS during nighttime?

A

Snoring, sweating, palpitations, enuresis, observed apneas, bad sleep quality.

enuresis: involutary peeing during sleep

21
Q

What are the clinical features of OSAS during daytime?

A

Sleepiness, fatigue, memory impairment, morning headache, depression, GERD symptoms, decreased libido.

22
Q

What are the immediate consequences of apnea?

A
  • Hypoxia, hypercapnia, vagotonia, bradycardia, decreased blood pressure, decreased cardiac output during apnea.
  • Increased sympathetic tone, arousal, increased blood pressure, tachycardia, and stress reaction upon apnea termination.
23
Q

What are the clinical consequences of apnea?

(aka what we notice in everyday life)

A

Hypertension, arrhythmias, heart failure, pulmonary hypertension, atherosclerosis, diabetes, GERD, and nocturnal enuresis.

24
Q

What are the diagnostic methods for sleep apnea?

A

Sleep history, evaluation of comorbidities, screening for OSA using standardized screening questionnaires such as STOP-BANG, and sleep studies (PG, PSG).

25
Q

What is central sleep apnea (CSA)?

A

It is a sleep-related breathing disorder in which the drive to breathe periodically decreases or ceases due to impaired function of the respiratory center, caused by either hyperventilation (non-hypercapnic CSA) or hypoventilation (hypercapnic CSA).

26
Q

What are the predisposing factors for CSA?

A
  • Congestive heart failure,
  • atrial fibrillation,
  • neurological (mainly vascular) diseases with midline, brainstem involvement,
  • older age (>80y/o),
  • renal failure,
  • increased intracranial pressure.
27
Q

What are the clinical features of CSA?

A

Daytime sleepiness, repeated waking at night, morning headaches, snoring, and in some cases, Cheyne-Stokes breathing pattern (in HF patients).

28
Q

What is Cheyne-Stokes breathing?

A

Cyclic episodes of central apnea and hyperventilation with a crescendo-decrescendo breathing pattern.

29
Q

How many consecutive central apneas are required for Cheyne-Stokes breathing?

A

At least 3.

30
Q

What is the duration of an episode of Cheyne-Stokes breathing?

A

45-90 seconds.

31
Q

What is the gold standard test for diagnosing CSA

A

Polysomnography, ideally with esophageal pressure manometry.

32
Q

What is obesity hypoventilation syndrome (OHS)?

A

A type of sleep-related hypoventilation disorder defined by a BMI of >30kg/m2, diurnal hypercapnia and disordered breathing during sleep.

33
Q

What is Pickwickian syndrome?

A

Coexistence of OHS and OSA.

34
Q

What are the risk factors for OHS?

A

Same as those for obesity (lifestyle factors, genetic, metabolic).

35
Q

What is the pathophysiology of OHS?

A

Increased work of breathing due to obesity -> increased respiratory drive -> inability to maintain during REM sleep -> hypoventilation (increased PaCO2, decreased PaO2) during sleep -> repetitive hypoventilation causes depression of central respiratory centers -> diurnal hypercapnia.

36
Q

What is the treatment for OHS?

A

Weight loss.

37
Q

What is the significance of obesity in OSA?

A

Increases the collapsibility of the pharynx → obstruction, Impairs breathing during sleep → hypoventilation.

38
Q

What type of obesity is the most dangerous form in OSA?

A

Pharyngeal (neck) and abdominal adipose tissue accumulation.

39
Q

What is PAP therapy?

A

Positive airway pressure therapy is a treatment for respiratory events that uses pressure to keep airways open.

40
Q

What are the types of PAP therapy?

A

Bilevel PAP (BPAP) and Continuous PAP (CPAP).

41
Q

What are the benefits of CPAP therapy?

A

Improves quality of life, daytime sleepiness, hypertension, mood, anxiety, and depressive symptoms.

42
Q

What is position therapy?

A

A therapy recommended for position-dependent breathing problems that involves using a position pad to prevent sleeping in the supine position.

43
Q

What is the compliance rate for long-term position therapy?

A

Poor.

44
Q

What are intraoral devices?

A

Devices that prevent the jaw and tongue from sliding backwards, recommended for snorers and mild to moderate OSA.

45
Q

What are the common complaints during prolonged use of intraoral devices?

A

Hypersalivation, dry mouth, jaw pain, tooth sensitivity, permanent tooth retention, and occlusion abnormalities.

46
Q

What are some ENT surgical procedures for sleep apnea?

A

Septo-rhinoplasty, septum resection, FESS, adenectomy, tonsillectomy, uvulo-palato-pharyngoplasty (UPPP), mandibular osteotomy (MMA), epiglottopexy, and tracheotomy.

47
Q

What is the purpose of ENT surgical procedures for sleep apnea?

A

To address specific areas of the airway that may be causing obstruction during sleep.

48
Q

What is the success rate of surgery for sleep apnea?

A

Varies depending on the individual case and type of surgery, and should be discussed with a medical professional.

49
Q

Are there any other treatments for sleep apnea?

A

Yes, there are other treatments such as weight loss, avoiding alcohol and sedatives, and positional therapy.

2. Pulmonology (22 decks)

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