breathing and breathing disorders in sleep

Question 1

What is Cheyne stokes breathing?

Answer 1

periodic respiration, with cycles of respiration that are increasingly deeper then shallower with possible periods of apnoea.

Question 2

What is Chayne Stokes breathing associated with?

Answer 2

bilateral cerebral hemisphere dysfunction or posterior forebrain structures including the thalamus

Question 3

what is hyperventilation associated with?

Answer 3

midbrain lesions

Question 4

what is aneusis and what is it associated with?

Answer 4

it is a deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release

assoc with pons lesions

Question 5

what is cluster breathing and what is it assoc with?

Answer 5

groups of quick, shallow inspirations followed by regular or irregular periods of apnea

assoc with medulla lesions

Question 6

what is ataxic breathing and what lesion is it assoc with?

Answer 6

irregularity of breathing, with irregular pauses and increasing periods of apnea

assoc with lower medulla lesions

Question 7

Stage N1 sleep

Answer 7

• theta
• light sleep
• mild decrease in respiratory muscle control
• periodic breathing pattern

Question 8

Stage N2

Answer 8

• sleep spindles and K complexes
• deeper sleep
• mild decrease in respiratory muscle control
• periodic breathing pattern

Question 9

stage N3

Answer 9

• delta (lowest frequency, highest amplitude)
• deepest, non-REM sleep (slow-wave sleep)
• more decrease in respiratory muscle tone
• regular/steady breathing pattern

Question 10

phasic REM

Answer 10

rapid eye movements, muscle twitches, and respiratory variability
-irregular, periodic breathing pattern with occasional central apneas

Question 11

tonic REM

Answer 11

no eye movement

• mostly regular breathing pattern
• overall: rapid eye movements, atonia except for diaphragm, EOM and a select few other muscles

Question 12

how do breathing intervals, minute ventilation, response to O2 and CO2 change during sleep?

Answer 12

breathing interval is slower

minute ventilation declines

response to O2 desat declines

response to CO2 decreases

Question 13

if a patient loses airflow, but is still trying to breathe during sleep, they have?

Answer 13

Obstructive sleep apnea

Question 14

why is snoring prominent in OSA?

Answer 14

because of the turbulent flow caused by obstruction

Question 15

screening for OSA, what questionnaire would you use

Answer 15

STOP BANG (score of greater than 3)

• Snoring
• Tired
• Observed apnea
• pressure
• BMI (> 35)
• Age (>50)
• Neck Size (>17 in/40cm)
• Gender (male)

Question 16

How is the diagnosis for OSA made?

Answer 16

polysomnography

esophageal pressure is gold standard

Question 17

How is the severity of OSA measured?

Answer 17

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

Question 18

who gets treated

Answer 18

adults AHI>10

children AHI>5

Question 19

treatment of mild OSA with no daytime symptoms

Answer 19

weight loss, avoid alcohol, sleep on side

Question 20

treatment of OSA with symptoms

Answer 20

CPAP- first line treatment

Question 21

if a patient loses airflow at night, but is not “trying to breathe,” they would have

Answer 21

central apnea

Question 22

central apnea is most commonly a _____ issue (specifically a lesion of ______), but can be secondarily related to _______

Answer 22

brain

medulla/pons

medication (narcotics)

Question 23

the causes of Cheyne Stokes breathing

Answer 23

problems with CNS (slowed response to O2 and CO2) and heart failure

Question 24

potential consequences of forebrain damage

Answer 24

apraxia for deep breathing and breath hold

• post hyperventilation apnea
• Cheyne-Stokes respiration
• epileptic respiratory inhibition
• pseudobulbar laughing or crying