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Apnea (Strauss) Flashcards

1
Q

What is key to understanding and treating Obstructive Sleep apnea?

A

It can be fatal if misdiagnosed or mistreated

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2
Q

Sleep related deaths most commonly occure between what hours?

A

Between 2-4 pm and 4-6 am. Matches circadian sleep pattern

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3
Q

No sleep for 24 hrs produces same cognitive impairment when operating an automobile as what blood alcohol level?

A

0.10%

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4
Q

What is the sound associated with the vibration of some anatomical area within the airway caused by a partial airway obstruction and pharyngeal flow limitation and is generally benign?

A

Snoring

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5
Q

Does snoring cause arousal during inspiration?

A

No

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6
Q

Snoring can be how loud?

A

69-80 dB, the same as a 737 at 100 ft

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7
Q

What is the pathophysiology of snoring and sleep related breathing disorders (SRBD)?

A

Tonus is decreased in airway with sleep so airway lumen decreases in diameter, which means the same volume of air must move through there faster, causing turbulence

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8
Q

The greater the speed of a gas or liquid the more / less pressure it exerts?

A

Less pressure it exerts (Bernouli’s Principle)

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9
Q

Why is Bernoulli’s principle important to snoring?

A

Because air going down the trachea is moving faster than air in the soft palate, the mouth is lower pressure due to speed, and the area above the palate is high pressure. This pressure differential will cause the soft palate to raise toward the area of high pressue and a snore is produced.

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10
Q

What is the danger with a small airway lumen and increased air speed?

A

Increased airspeed could cause the lumen to close completely

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11
Q

Is there a definite delineation between snoring and obstructive sleep apnea or is it a continuum?

A

Continuum

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12
Q

What are 9 complications of Obstructive Sleep apnea?

A
  1. Hypoxemia
  2. Hypercarbia
  3. Polycythemia
  4. Hypertension
  5. Depression
  6. Impotence
  7. Cerebrovascular accident (CVA) / stroke
  8. Arrythmias
  9. Sudden death
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13
Q

What is the link of hypoxemia and hypercarbia in obstructive sleep apnea?

A

Hypoxemia is low blood oxygen which would imply Hypercarbia which is high blood carbon dioxide

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14
Q

Why is there polycythemia in OSA?

A

Body increase red blood cells to compensate for low blood oxygen

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15
Q

What is a risk associated with polycythemia?

A

The blood is thicker due to increased red blood cells

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16
Q

Are snoring and OSA the same pathophysiology?

A

Yes. Airway constriction, speed of airflow, and airway collapse

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17
Q

What are 3 apnea patterns?

A
  1. Obstructive
  2. Central
  3. Mixed
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18
Q

What are 2 subtypes of obstructive apnea?

A
  1. Apnea

2. Hypopnea

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19
Q

Of the 2 subtypes of Obstructive apnea, which one is the most common type of OSA?

A

Obstructive apnea

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20
Q

In what type of apnea does airflow stops for longer than 10 secs due to closure of airway by obstruction, while the chest wall inspiratory effore is normal?

A

Obstructive apnea

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21
Q

What is the drop in oxygen saturation in obstructive apnea?

A

More than 2% drop

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22
Q

What does obstructive apnea terminate with?

A

Arousal (brain wakes body up to breath)

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23
Q

What is the least common type of apnea?

A

Central

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24
Q

What is the cause and duration of airflow stop in Central Apnea?

A

Lack of inspiratory effort due to lack of brain effort. Airflow stops for longer than 10 seconds

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25
How does Central Apnea terminate?
Arousal from sleep
26
Will a splint or surgery fix central apnea?
No
27
How will mixed apnea present?
Central (brain) effect on ventilatory effort, but even after central effort begins obstruction prevents ventilation (airway collapse)
28
How does Mixed Apnea terminate?
Arousal
29
Obstructive Hypopnea, while having diminished airflow, will have continuous flow at what percentage?
Less than 66%
30
What is the drop in oxygen saturation in obstructive hypopnea?
More than a 2% drop in oxygen (same as obstructive apnea)
31
How does obstructive hypopnea terminate?
Arousal
32
What will happen to the ventilatory effort in obstructive hypopnea?
Will be unchanged or increased
33
What is the term for when sleep terminates with arousal due to some respiratory abnormality, but the events do not meet the criteria for obstructive apnea or obstructive hypopnea?
Respiratory effort related arousal (RERA)
34
Respiratory Effort Related Arousal (RERA) is associated with what other airway syndrome?
Upper Airway Resistant Syndrome (UARS)
35
Upper Airway Resistance Syndrome (UARS) has what symptoms?
Snoring symptoms and Excessive Daytime Sleepiness (EDS)
36
Why is Upper Airway Resistance Syndrome (UARS) often misdiagnosed?
Not seen on the polysomnography (PSG), there is no brain activity show it
37
Is pediatric OSA the same as adult OSA?
No
38
What is the most common cause of pediatric OSA?
1. Tonsils 2. Adenoids 3. Syndromes
39
What apnea type has a heavy involvement in pediatric OSA?
Central apnea
40
Who should evaluate a child for pediatric OSA?
ENT
41
What percentage of the US population snores?
20%
42
What percentage of the US population has sleep apnea?
1-2%
43
What is the gender predilection for OSA?
Males more than females
44
What is the age predilection for OSA?
Older more than younger
45
What is the weight predilection for OSA?
Obese more than thin
46
What is the anatomical site for OSA?
Pharyngeal airway
47
If a patient has OSA, will they have apneic events while awake?
No, only occurs while asleep
48
What are 3 problems the pharyngeal airway can have leading to OSA?
1. Abnormal size 2. Abnormal configuration 3. Abnormal compliance
49
What are 2 causes of airway constriction and OSA?
1. Anatomic abnormality | 2. Compliance abnormality (e.g. loss of muscle rigidity or excessive floppy tissues)
50
A large tongue base, long soft palate, shallow palatal arch, narrow mandibular arch, and mandibular deficiency are all examples of what type of cause of airway constriction?
Anatomic abnormality
51
What are 3 functions of the pharynx?
1. Food propulsion 2. Vocalization 3. Airflow
52
Food propulsion and vocalization both require what property of the pharynx?
Compliance
53
Airflow requires what property of the pharynx?
Stiffness
54
What makes up the difference between this compliance and stiffness?
Muscles
55
If muscles in the pharynx lose tone, what will happen to the airway?
Collapse, apnea
56
Is airway latency maintained in a person during NonREM (NREM) sleep?
Yes, but the upper airway dilating muscles, chest wall stabilizing muscles, and the diaphragm decrease in tone
57
Is airway latency maintained in a REM sleep person?
No, decreased or lost
58
What do we think causes apnea termination: chemical or mechanical?
Chemical (PaO2, PaCO2, pH)
59
What is an easy method for the dentist to identify patient with possible sleep apnea?
Screen them
60
What are 2 primary OSA symptoms to ask about?
1. Excessive daytime somnolence / sleepiness | 2. Excessively loud snoring with intermittent silent periods terminated by a loud snort
61
Person stating they have restless, disturbed sleep, awkening feeling tired, morning headaches, loss of mental acuity and memory, or personality changes might be suspected of what?
OSA
62
How often and by whom should an OSA screening questionnaire be filled out by dental patients?
Both sleep partners fill it out once a year
63
What is the most common screening form that asks a series of questions about likelihood of falling asleep with a scale of 1-3 for each answer?
Eppworth Sleepiness Scale
64
What score on the Eppworth Sleepiness Scale is considered normal?
Less than 11
65
What are physical features dentist should look for when clinically evaluating pts for OSA risk?
1. Short 2. Obese 3. Short, fat neck 4. Large airway anatomy 5. Skeletal facial deformaties (C II occlusion, long face syndrome)
66
This is the neck measurement for males that is pathoneumonic for OSA?
17 inches
67
What is the neck measurement for females that is pathoneumonic for OSA?
16 inches
68
What is the only real way to definitely diagnose OSA?
Sleep study / polysomnography
69
Is a home sleep study a valid way to diagnose OSA?
Yes. Literature endorses this.
70
What is the term for apneas or hypopneas recorded incidentally, but having no symptoms?
Asymptomatic OSA
71
What is the term for having significant daytime symptoms (excessive daytime somnolence) with less than 5 apneas per hour or less than 15 hypopneas and hour)?
Pathologic snoring or Upper Airway Resistance Syndrome (UARS)
72
Mild to Moderate OSA has how many apneas / hour?
5-20 apneas / hour
73
Will mild to moderate OSA have daytime symptoms (excessive daytime somnolence)?
Yes
74
Moderate OSA will have how many apneas / hour?
More than 20
75
Severe OSA will have how many apneas / hour?
More than 40
76
What non-sleep symptoms will Moderate to Severe OSA pts show?
1. Daytime symptoms | 2. Cardiorespiratory effects
77
What is the object of OSA treatment?
Decrease the collapsibility of the pharyngeal airway and decrease the speed of airflow by increasing volume
78
What are 5 treatment options for OSA?
1. Behavioral 2. Pharmacology 3. Mechanical 4. Surgical 5. Combo
79
What is the easiest way to treat OSA?
Behavioral. Lose 10% of body weight.
80
What drugs should be avoided in OSA patients?
CNS depressants
81
Should oxygen be given to an OSA patient for sleeping with and why?
No, does not help and will prolong apneic event
82
In what OSA level could pharmacological treatment be the sole treatment?
Mild OSA only
83
What mechanical device is use to act as a pneumatic splint to prevent airway collapse?
Continuous positive airway pressure (CPAP)
84
Do dentists diagnose OSA?
No, we screen and can do therapy after diagnosis by an MD
85
What are signs in a child of possible OSA?
1. ADHD 2. Chronic fatigue 3. Tonsillar hypertrophy 4. Transverse maxillary deficiency or crossbite
86
What is the purpose of the oral appliance in OSA treatment?
Advance lower jaw to open airway
87
With an adjustable oral appliance how is the pt adjusted into it for OSA?
Patient gets used to it in CO, then slowly advance until apnea ceases or pt complains of TMJ pain
88
What are dental specialties that can assist in the treatment of OSA?
1. Pediatrics 2. Prosthodontist 3. Orthodontist
89
When is a tracheostomy indicated as a treatment for OSA?
Life threatening OSA and other management forms are ineffective
90
When is a tonsillectomy indicated for OSA?
When tonsils are hypertrophic or ptotic (drooping)
91
Pillar implants to stiffen the soft palate, though expensive are only indicated for what level of OSA?
Mild OSA
92
What is now the gold standard for OSA surgery?
Telegnathic surgery. Bring the entire face forward.
93
Is telegnathic surgery the same thing as orthognathic surgery?
No but it sure looks like it
94
Patients with OSA have what chance of having an automobile accident versus a normal person?
8 times

xD3 Oral Surgery Ex 3 (4 decks)

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