breathing and breathing disorders in sleep Flashcards
What is Cheyne stokes breathing?
periodic respiration, with cycles of respiration that are increasingly deeper then shallower with possible periods of apnoea.
What is Chayne Stokes breathing associated with?
bilateral cerebral hemisphere dysfunction or posterior forebrain structures including the thalamus
what is hyperventilation associated with?
midbrain lesions
what is aneusis and what is it associated with?
it is a deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release
assoc with pons lesions
what is cluster breathing and what is it assoc with?
groups of quick, shallow inspirations followed by regular or irregular periods of apnea
assoc with medulla lesions
what is ataxic breathing and what lesion is it assoc with?
irregularity of breathing, with irregular pauses and increasing periods of apnea
assoc with lower medulla lesions
Stage N1 sleep
- theta
- light sleep
- mild decrease in respiratory muscle control
- periodic breathing pattern
Stage N2
- sleep spindles and K complexes
- deeper sleep
- mild decrease in respiratory muscle control
- periodic breathing pattern
stage N3
- delta (lowest frequency, highest amplitude)
- deepest, non-REM sleep (slow-wave sleep)
- more decrease in respiratory muscle tone
- regular/steady breathing pattern
phasic REM
rapid eye movements, muscle twitches, and respiratory variability
-irregular, periodic breathing pattern with occasional central apneas
tonic REM
no eye movement
- mostly regular breathing pattern
- overall: rapid eye movements, atonia except for diaphragm, EOM and a select few other muscles
how do breathing intervals, minute ventilation, response to O2 and CO2 change during sleep?
breathing interval is slower
minute ventilation declines
response to O2 desat declines
response to CO2 decreases
if a patient loses airflow, but is still trying to breathe during sleep, they have?
Obstructive sleep apnea
why is snoring prominent in OSA?
because of the turbulent flow caused by obstruction
screening for OSA, what questionnaire would you use
STOP BANG (score of greater than 3)
- Snoring
- Tired
- Observed apnea
- pressure
- BMI (> 35)
- Age (>50)
- Neck Size (>17 in/40cm)
- Gender (male)
How is the diagnosis for OSA made?
polysomnography
esophageal pressure is gold standard
How is the severity of OSA measured?
by the apnea hypogea index= A+H/ sleep time measures the index of events per hour
AHI 0-5= normal
AHI 5-15= mild
AHI 15-30= moderate
AHI>30= severe
who gets treated
adults AHI>10
children AHI>5
treatment of mild OSA with no daytime symptoms
weight loss, avoid alcohol, sleep on side
treatment of OSA with symptoms
CPAP- first line treatment
if a patient loses airflow at night, but is not “trying to breathe,” they would have
central apnea
central apnea is most commonly a _____ issue (specifically a lesion of ______), but can be secondarily related to _______
brain
medulla/pons
medication (narcotics)
the causes of Cheyne Stokes breathing
problems with CNS (slowed response to O2 and CO2) and heart failure
potential consequences of forebrain damage
apraxia for deep breathing and breath hold
- post hyperventilation apnea
- Cheyne-Stokes respiration
- epileptic respiratory inhibition
- pseudobulbar laughing or crying
