Breathing disorders and sleep

Question 1

What stage has the most snoring

Answer 1

N3

Question 2

Catathrenia
- inspiration or expiration
- side effect of what medicine
- what does it look like on a PSG

Answer 2

Expiration
Sodium Oxybate
CSA

Question 3

What sleep disorder does high altitude cause and why

Answer 3

Periodic breathing (CSA) due to increased ventilatory chemoresponsiveness
- this causes daytime hyperventilation causing hypocapnea
- this in turn causes sleep time hypoventilation and periodic breathing

Question 4

How does Pcrit relate to airway collapse and what stage is it highest?

Answer 4

Pcrit is the critical pharyngeal closing pressure
The higher Pcrit, the higher the chance of airway collapse
Highest during REM

Question 5

At what stage of sleep is CSA of prematurity worse

Answer 5

REM sleep

Question 6

What is the length of the apnea cycle in high altitude periodic breathing

Answer 6

20-40 seconds

Question 7

What sleep stage is increased in high altitude periodic breathing?

Answer 7

N1

Question 8

Criteria for OHS

Answer 8

obesity BMI>30kg/m2. Hypoventilation while awake measured by PaCO2 >45, ETCO2 or transcutaneous CO2 >45, and there should be absence any pulmonary pathology, or CNS disease, medication use or congenital or idiopathic central alveolar hypoventilation syndrome.

Question 9

When does primary CSA of prematurity resolve?

Answer 9

43 weeks conceptional age

Question 10

congenital central alveolar hypoventilation syndrome (CCHS)
- dominant or recessive
- gene responsible

Answer 10

Dominant
PHOX2B

Question 11

congenital central alveolar hypoventilation syndrome (CCHS)
- associated with what cardiac issues?
- associated with what GI sisues

Answer 11

arrhythmias, may need pacemaker
Hirschsprung disease

Question 12

rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD)
- what age does it start
- what hormone is high
- how does it affect the heart

Answer 12

Symptoms usually start at 18 months of age
Rapid weight gain
High prolactin
Arrhythmias

Question 13

What stage of sleep is CSR usually seen

Answer 13

Transition from wake to NREM

Question 14

Criteria to score CSR

Answer 14

Crescendo-decrescendo respirations that occur >3x for at least 40 seconds

Question 15

How is the length of CSR related to cardiac output

Answer 15

The longer the CSR length, the worse cardiac complications

Question 16

When does the arousal occur in OSA?

Answer 16

At apnea termination

Question 17

When does arousal occur during CSR?

Answer 17

Peak of crescendo pattern

Question 18

Leptin and OHS

Answer 18

Leptin is higher in ppl with OHS because leptin rises to increase ventilation

Question 19

Kussmaul Breathing

Answer 19

rapid deep breathing at consistent pace. Common example is DKA

think Kussmaul for dKa

Question 20

Apenustic Breathing

Answer 20

It is characterized by regular deep inspirations with an inspiratory pause followed by inadequate expiration
- caused by Pontine injury (stroke, trauma)

think aPneustic for Pons

Question 21

Biots Breathing

Answer 21

Ataxic breathing CSA, seen with opioid use

Question 22

Criteria for hypoventilation in adults

Answer 22

PaCO2 > 55mm Hg for 10 minutes
OR
An increase in PaCO2 greater than 10 mm Hg than baseline reaching > 50mm Hg for 10 minutes

Question 23

Area of pharynx with highest collapsibility in OSA

Answer 23

retropalatal area