Chapter 15. Sleep Apnea and Sleep disorders Flashcards
Defined by five or more respiratory events per hour of sleep–apneas, hypopneas, or respiratory effort-related arousals- in association with excessive daytime somnolence; waking with gasping, choking, or breath holding; or witnessed reports of apneas, loud snoring, or both.
a. Upper Airway Resistance Syndrome
b. Obstructive Sleep Apnea
c. Snoring
d. Both A and B
A. characterized by respiratory effort-related arousals (RERAs), defined as a sequence of breaths over at least 10 seconds with increasing respiratory effort that terminates with an arousal.
B (Answer). or 15 or more predominately respiratory events per hour of sleep regardless of symptoms or comorbidities.
C. sound generated by the vibration of the pharyngeal soft tissues. It is often louder during inspiration than expiration. Not associated with symptoms of excessive daytime sleepiness or insomnia. PSG not required for diagnosis.
A cessation of airflow for at least 10 s
Apnea
Hypopnea definition
A reduction in airflow (≥30%) at least 10 s with
≥4% oxyhemoglobin desaturation
OR a reduction in airflow (≥50%) at least 10 s
with ≥3% oxyhemoglobin desaturation or an
electroencephalogram (EEG) arousal
Sequence of breaths for at least 10 s with
increasing respiratory effort or flattening of
the nasal pressure waveform, leading to an
arousal from sleep when the sequence of
breaths does not meet the criteria for an
apnea or a hypopnea
Respiratory effort-related arousal (RERA)
Events per hour for
1) Mild OSA
2) Moderate OSA
4) Severe OSA
AASM OSA Classification
1) 5-15 events/hour
2) 15-30 events/hour
4) 30 events or more per hour
Gold standard for diagnosis of OSA
Nocturnal Polysomnography
-include electroencephalogram, electrooculogram, submental electromyogram, electrocardiogram,
airflow, thoracoabdominal effort, and oximetry
Major area/s of obstruction associated with OSA
a. Nose
b. Larynx
c. Palate
d. Hypopharynx
Nose, Palate, Hypopharynx
Fujita patterns of obstruction by anatomic location
a. Retropalatal, Retrolingual
b. Nasopharyngeal, Oropharyngeal
c. Oropharyngeal, Hypopharyngeal
d. Both B & C
type I is collapse in the retropalatal region only;
type II is collapse in both retropalatal and retrolingual regions;
type III is collapse in the retrolingual region only
Major cause of OSA in children
Adenotonsillar hypertrophy
Contribution of obesity in OSA, except
a. Reduction in lung volume
b. Reduction in functional residual capacity
c. Reduction in pharyngeal upper airway size
d. Reduction in airway collapse
Ans. D
Obesity can significantly reduce lung volume, which results in a reduction of functional residual capacity. It has been observed that changes in lung volume significantly reduce pharyngeal upper airway size through the mechanical effect of tracheal and thoracic traction, referred to as tracheal tug, increasing the risk for airway collapse.
Most important muscle in maintaining airway patency in OSA
a. Tensor palatini
b. Genioglossus
c. Levator palatini
d. Palatoglossus
Ans. B
Metabolic syndrome
Obesity, insulin resistance, hypertension, dyslipidemia
A maneuver that generates negative pressure by inhaling against a closed glottis with the nose and mouth closed to trigger airway collapse a. DISE maneuver b Müller maneuver c. Toynbee maneuver d. Valsalva maneuver
Ans. B - done in awake endoscopy to evaluate area of collapse
Drug-induced sleep endoscopy (DISE) involves the
use of fiberoptic nasopharyngoscopy to evaluate the site of airway collapse during pharmacologically induced sleep.
Gold standard of treatment for moderate to severe OSA
CPAP
-acts as a pneumatic splint that prevents upper airway collapse by providing constant positice intraluminal pressure during inspiration and expiration
Medical treatment recommended for pediatric OSA in the presence of coexisting rhinitis and/or upper airway obstruction as a result of adenotonsillar hypertrophy
Intranasal steroids
Involves bilateral tonsillectomy, longitudinal incision of the superior pharyngeal constrictor, diagonal incision through the superior palatopharyngeus, Z-plasty closure of the superior aspect of the tonsillar fossa, and suturing of the anterior and posterior pillars together at the inferior aspect of the tonsillar fossa
a. Uvulopalatopharyngoplasty
b. Partial midline glossectomt
c. Lateral pharyngoplasty
d. Z pharyngoplasty
Ans. C
Involves bilateral tonsillectomy, transection of the inferior aspect of the palatopharyngeus, and superolateral rotation and figure-eight suturing of the mobilized muscle to the arch of the anterior soft palate
a. Uvulopalatopharyngoplasty
b. Expansion sphincter pharyngoplasty
c. Lateral pharyngoplasty
d. Z pharyngoplasty
Ans. B
Most commonly performed surgical procedure for OSA
a. Uvulopalatopharyngoplasty
b. Expansion sphincter pharyngoplasty
c. Lateral pharyngoplasty
d. Z pharyngoplasty
Ans. A
A tongue base procedure that creates a larger retrolingual airway by removal of a midline rectangular strip of the posterior half of the tongue.
a. RFA
b. Lingualplasty
c. Genioglossal advancement
d. Partial midline glossectomy
Ans. D
a.decreases upper airway collapse by
producing a volumetric reduction in tongue-base tissue via the generation of scar tissue. An insulated probe that delivers RF energy at 465 KHz
b. additional tongue tissue is removed posteriorly and laterally to that portion excised in PMG
c. the genial tubercle of the mandible, which is the anterior attachment of the genioglossus muscle, is mobilized by means of limited osteotomy. The segment is then advanced and fixed into place
at the inferior aspect of the osteotomy.
Represents the traditional gold standard of surgical management of OSA
Tracheotomy
Triad of (1) persistent difficulty with sleep initiation, duration, consolidation or quality, (2) despite adequate sleep opportunity, which (3) results in daytime impairment.
Insomnia
Diagnosis when insomnia persists for at least 1 month and includes at least one of the following:
improper sleep scheduling that includes frequent daytime naps; variable bedtime or wake time or excessive amount of time in bed; the routine use of narcotics, caffeine, or alcohol, especially before bed; participation in mentally or physically stimulating activities close to bedtime; frequent use of the bed for other activities, such as television watching or reading; or failure to maintain a comfortable sleep setting that includes appropriate temperature, lighting, and bedding.
Inadequate sleep hygiene
Recurrent apneas or hypopneas that
result from absent or reduced ventilatory drive
Central Sleep Apnea
Defined by arterial oxygen saturation of ≤88% in adult or ≤90% in children for >5 minutes during sleep, which can be sustained or fluctuate throughout the night without evidence of hypoventilation.
Sleep-related hypoxemia disorder
