Airway Obstruction, Ventilation, & Artificial Ventilation

Question 1

define apnea

Answer 1

cessation of breathing for more than 10 sec

Question 2

define hypopnea

Answer 2

dec in airflow accompanied by a dec in arterial oxygen saturation of 4 or more percent

Question 3

what is the apnea-hypopnea index (AHI)

Answer 3

an index that indicates the severity of sleep apnea

represented by the number of apnea and hypopnea events per hour of sleep

Question 4

what is a normal AHI

Answer 4

0-4

Question 5

what is a mild AHI

Answer 5

5-14

Question 6

what is a moderate AHI

Answer 6

15-19

Question 7

what is a severe AHI

Answer 7

30 or greater

Question 8

what are the signs and symptoms of sleep disordered breathing

Answer 8

obesity (cuz large neck)
loud or frequent snoring
silent pauses in breathing
choking or gasping sounds
daytime sleepiness or fatigue
unrefreshing sleep
insomnia
morning headaches
nocturne (waking at night to urinate but more because  your sleep apnea aroused you and you woke up and then think "oh I could use the bathroom")

Question 9

what is obstructive sleep apnea (OSA)

Answer 9

repetitive episodes of airflow reduction (hypopnea) or cessation (apnea) due to upper airway collapse during sleep

Question 10

what is the result of obstructive sleep apnea

Answer 10

blood oxygen concentration goes down

blood CO2 concentration goes up

Question 11

risk factors of obstructive sleep apnea

Answer 11

anatomically narrowed upper airways (micrognathia, macroglossia, obesity, tonsillar hypertrophy)
alcohol
sedatives
nasal obstruction like common cold
hypothyroidism
smoking

Question 12

treatment for obstructive sleep apnea

Answer 12

weight loss
continuous positive airway pressure (CPAP)
uvulopalatopharyngoplasty (UPPP)
tracheostomy

Question 13

how many patients stop using CPAP after one year

Answer 13

20 to 30%

Question 14

what is central sleep apnea

Answer 14

brain temporarily stops sending signals to the muscles of respiration
lack of abdominal and thoracic movement for 10 seconds or longer during sleep

Question 15

where is the issue with central sleep apnea

Answer 15

medullary centers (dorsal and ventral respiratory group)
pontine centers (pacemaker cells)

Question 16

what is secondary central sleep apnea due to

Answer 16

Cheyenne-Stokes breathing due to heart failure, stroke, kidney failure
high altitude periodic breathing
use of opioid drugs

Question 17

treatment of central sleep apnea

Answer 17

treat underlying disease

CPAP

Question 18

what is obesity-hypoventilation AKA Pickwickian Syndrome

Answer 18

a condition in which severely overweight people fail to breathe rapidly enough or deeply enough, resulting in low blood oxygen levels and high blood carbon dioxide (CO2) levels

Question 19

treatment of obesity-hypoventilation AKA Pickwickian Syndrome

Answer 19

weight loss (diet or more commonly gastric bypass)
CPAP
BIPAP
tracheostomy

Question 20

hyperventilation syndromes can be what or what

Answer 20

acute

chronic

Question 21

what is hyperpnia

Answer 21

increased depth and rate of breathing

Question 22

what is hyperpnia due to

Answer 22

sepsis
fever
hypoxemia
etc

Question 23

Is hyperpnia a hyperventilation syndrome

Answer 23

no it is NOT

it is a response (either physiologic or pathologic) of respiratory control mechanisms

Question 24

what is hyperventilation

Answer 24

inc in alveolar ventilation that leads to hypocapnia (reduced CO2 in blood)

Question 25

how does acute hyperventilation present

Answer 25

presents with hyperpnea, paresthesias, carpopedal spasm, tetany, and anxiety

Question 26

how does chronic hyperventilation present

Answer 26

presents with various nonspecific symptoms including fatigue, dyspnea, anxiety, palpitations, and dizziness

Question 27

treatment of hyperventilation syndrome

Answer 27

breathing through pursed lips or through the nose with one nostril pitched or rebreathing expired gas from a paper bag held over the face in order to decrease respiratory alkalemia and its associated symptoms or anxiolytic drugs may be useful

Question 28

do mechanical ventilators now a days use positive or negative pressure ventilation

Answer 28

postive

Question 29

breathing normally uses positive or negative pressure ventilation

Answer 29

negative

Question 30

indications for mechanical ventilation

Answer 30

acute respiratory failure
acute or chronic respiratory failure (like in hypercarbia/obesity hypoventilation syndrome
pulmonary edema
inability to protect airway such as in coma or seizures
neuromuscular dysfunction
stabilize chest wall after trauma

Question 31

what is an example of positive pressure mechanical ventilation that is non-invasive

Answer 31

BPAP (bi-level positive airway pressure)

Question 32

what are the two ways of invasive positive pressure mechanical ventilation

Answer 32

pressure cycled

volume cycled

Question 33

define pressure cycled

Answer 33

pressure is constant and volume will vary with patient’s lung compliance

Question 34

define volume cycled

Answer 34

volume is constant and pressure will vary with patient’s lung compliance

Question 35

problems associated with positive pressure ventilation

Answer 35

iatrogenic upper airway damage (tracheomalacia and ventilator associated pneumonia)
or lung parenchymal damage