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xD3 Oral Surgery Ex 3 > Apnea (Strauss) > Flashcards

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
Q

How does Central Apnea terminate?

A

Arousal from sleep

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26
Q

Will a splint or surgery fix central apnea?

A

No

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27
Q

How will mixed apnea present?

A

Central (brain) effect on ventilatory effort, but even after central effort begins obstruction prevents ventilation (airway collapse)

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28
Q

How does Mixed Apnea terminate?

A

Arousal

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29
Q

Obstructive Hypopnea, while having diminished airflow, will have continuous flow at what percentage?

A

Less than 66%

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30
Q

What is the drop in oxygen saturation in obstructive hypopnea?

A

More than a 2% drop in oxygen (same as obstructive apnea)

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31
Q

How does obstructive hypopnea terminate?

A

Arousal

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32
Q

What will happen to the ventilatory effort in obstructive hypopnea?

A

Will be unchanged or increased

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33
Q

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?

A

Respiratory effort related arousal (RERA)

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34
Q

Respiratory Effort Related Arousal (RERA) is associated with what other airway syndrome?

A

Upper Airway Resistant Syndrome (UARS)

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35
Q

Upper Airway Resistance Syndrome (UARS) has what symptoms?

A

Snoring symptoms and Excessive Daytime Sleepiness (EDS)

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36
Q

Why is Upper Airway Resistance Syndrome (UARS) often misdiagnosed?

A

Not seen on the polysomnography (PSG), there is no brain activity show it

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37
Q

Is pediatric OSA the same as adult OSA?

A

No

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38
Q

What is the most common cause of pediatric OSA?

A
  1. Tonsils
  2. Adenoids
  3. Syndromes
39
Q

What apnea type has a heavy involvement in pediatric OSA?

A

Central apnea

40
Q

Who should evaluate a child for pediatric OSA?

41
Q

What percentage of the US population snores?

42
Q

What percentage of the US population has sleep apnea?

43
Q

What is the gender predilection for OSA?

A

Males more than females

44
Q

What is the age predilection for OSA?

A

Older more than younger

45
Q

What is the weight predilection for OSA?

A

Obese more than thin

46
Q

What is the anatomical site for OSA?

A

Pharyngeal airway

47
Q

If a patient has OSA, will they have apneic events while awake?

A

No, only occurs while asleep

48
Q

What are 3 problems the pharyngeal airway can have leading to OSA?

A
  1. Abnormal size
  2. Abnormal configuration
  3. Abnormal compliance
49
Q

What are 2 causes of airway constriction and OSA?

A
  1. Anatomic abnormality

2. Compliance abnormality (e.g. loss of muscle rigidity or excessive floppy tissues)

50
Q

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?

A

Anatomic abnormality

51
Q

What are 3 functions of the pharynx?

A
  1. Food propulsion
  2. Vocalization
  3. Airflow
52
Q

Food propulsion and vocalization both require what property of the pharynx?

A

Compliance

53
Q

Airflow requires what property of the pharynx?

54
Q

What makes up the difference between this compliance and stiffness?

55
Q

If muscles in the pharynx lose tone, what will happen to the airway?

A

Collapse, apnea

56
Q

Is airway latency maintained in a person during NonREM (NREM) sleep?

A

Yes, but the upper airway dilating muscles, chest wall stabilizing muscles, and the diaphragm decrease in tone

57
Q

Is airway latency maintained in a REM sleep person?

A

No, decreased or lost

58
Q

What do we think causes apnea termination: chemical or mechanical?

A

Chemical (PaO2, PaCO2, pH)

59
Q

What is an easy method for the dentist to identify patient with possible sleep apnea?

A

Screen them

60
Q

What are 2 primary OSA symptoms to ask about?

A
  1. Excessive daytime somnolence / sleepiness

2. Excessively loud snoring with intermittent silent periods terminated by a loud snort

61
Q

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?

62
Q

How often and by whom should an OSA screening questionnaire be filled out by dental patients?

A

Both sleep partners fill it out once a year

63
Q

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?

A

Eppworth Sleepiness Scale

64
Q

What score on the Eppworth Sleepiness Scale is considered normal?

A

Less than 11

65
Q

What are physical features dentist should look for when clinically evaluating pts for OSA risk?

A
  1. Short
  2. Obese
  3. Short, fat neck
  4. Large airway anatomy
  5. Skeletal facial deformaties (C II occlusion, long face syndrome)
66
Q

This is the neck measurement for males that is pathoneumonic for OSA?

67
Q

What is the neck measurement for females that is pathoneumonic for OSA?

68
Q

What is the only real way to definitely diagnose OSA?

A

Sleep study / polysomnography

69
Q

Is a home sleep study a valid way to diagnose OSA?

A

Yes. Literature endorses this.

70
Q

What is the term for apneas or hypopneas recorded incidentally, but having no symptoms?

A

Asymptomatic OSA

71
Q

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)?

A

Pathologic snoring or Upper Airway Resistance Syndrome (UARS)

72
Q

Mild to Moderate OSA has how many apneas / hour?

A

5-20 apneas / hour

73
Q

Will mild to moderate OSA have daytime symptoms (excessive daytime somnolence)?

74
Q

Moderate OSA will have how many apneas / hour?

A

More than 20

75
Q

Severe OSA will have how many apneas / hour?

A

More than 40

76
Q

What non-sleep symptoms will Moderate to Severe OSA pts show?

A
  1. Daytime symptoms

2. Cardiorespiratory effects

77
Q

What is the object of OSA treatment?

A

Decrease the collapsibility of the pharyngeal airway and decrease the speed of airflow by increasing volume

78
Q

What are 5 treatment options for OSA?

A
  1. Behavioral
  2. Pharmacology
  3. Mechanical
  4. Surgical
  5. Combo
79
Q

What is the easiest way to treat OSA?

A

Behavioral. Lose 10% of body weight.

80
Q

What drugs should be avoided in OSA patients?

A

CNS depressants

81
Q

Should oxygen be given to an OSA patient for sleeping with and why?

A

No, does not help and will prolong apneic event

82
Q

In what OSA level could pharmacological treatment be the sole treatment?

A

Mild OSA only

83
Q

What mechanical device is use to act as a pneumatic splint to prevent airway collapse?

A

Continuous positive airway pressure (CPAP)

84
Q

Do dentists diagnose OSA?

A

No, we screen and can do therapy after diagnosis by an MD

85
Q

What are signs in a child of possible OSA?

A
  1. ADHD
  2. Chronic fatigue
  3. Tonsillar hypertrophy
  4. Transverse maxillary deficiency or crossbite
86
Q

What is the purpose of the oral appliance in OSA treatment?

A

Advance lower jaw to open airway

87
Q

With an adjustable oral appliance how is the pt adjusted into it for OSA?

A

Patient gets used to it in CO, then slowly advance until apnea ceases or pt complains of TMJ pain

88
Q

What are dental specialties that can assist in the treatment of OSA?

A
  1. Pediatrics
  2. Prosthodontist
  3. Orthodontist
89
Q

When is a tracheostomy indicated as a treatment for OSA?

A

Life threatening OSA and other management forms are ineffective

90
Q

When is a tonsillectomy indicated for OSA?

A

When tonsils are hypertrophic or ptotic (drooping)

91
Q

Pillar implants to stiffen the soft palate, though expensive are only indicated for what level of OSA?

92
Q

What is now the gold standard for OSA surgery?

A

Telegnathic surgery. Bring the entire face forward.

93
Q

Is telegnathic surgery the same thing as orthognathic surgery?

A

No but it sure looks like it

94
Q

Patients with OSA have what chance of having an automobile accident versus a normal person?

xD3 Oral Surgery Ex 3 (4 decks)

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