Chapter 8 - OSA - Exam 2 Flashcards
what is obstructive sleep apnea
characterized by partial or complete upper airway obstruction during sleep
recurrent and repetitive upper airway obstruction
reduced ventilation or apnea during sleep
pathology of osa
airflow obstruction occurs because
1. narrowing of the air passages with relaxation of muscle tone during sleep and/or
2. the tongue and soft palate falling backward and partially or completely obstruct the pharynx
how long can obstruction of airway last during osa
10 to 90 seconds
what happens during the apnea period in osa
hypoxemia and hypercapnia
what is hypoxemia
decreased PaO2 or SpO2 in blood
what is hypercapnia
increased PaCO2
these changes in O2 or CO2 cause what action to happen
stimulates ventilation and cause brief arousals. arousals are often under the threshold of awakening, therefore patients might not remember apnea the next day
what happens when the patient is aroused after apnea
patient resumes regular ventilation with a startle response, this includes snorts and gasps which causes the tongue to move forward and the airway to open
apnea and arousal cycles occur _________through out the night
repeatedly
what is the single cause for OSA
trick question there is no single cause, there are multiple factors that infuence airway patency and airway muscle tone
what are risk factors for osa
obesity, 65+ age, neck circumfrance >16 inches, male, postmenopausal women
what are the 3 S’s
snoring, sleepiness, and spouse
treatment of osa
weight loss, cpap, bipap, avoid ETOH
tonsillectomy or uvulopalatopharyngoplasty, or nasal septoplasty.
life threatening patient may need tracheostomy
how is osa clinically diagnoised
sleep study, home study
severe apnea can be associate with ___ to ____ apneic event per hour of sleep
30 to 50
_____ therapy can be effective by reducing gravity’s effect on the airyway
positional
teach patient to avoid ______ or drinking ________ 3 to 4 hours before sleep
sedatives, alcoholic
teach the patient the dangers of ______ or using heavy equipment due to profound sleepiness
driving
_________ is common for people with osa
insomnia
the diagnosis of sleep apnea is based on calculation of the ___________ index
apnea-hypopnea.
this is an hourly average of apneic events of hypopneas of at least 10 seconds duration
osa is defined as an AHI greater than ____ events per hour with a 3-4% decrease in oxygen saturation
5
tools used to screen for osa are the Berlin and teh ______ _______ questionaiares
STOP BANG
how does a cpap work
cpap “continuous postive airway pressure”
patient applies a nasal or oral-nasal mask that is attached to a blower,
the blower is adjusted to maintain enough positive pressure in the airway during inspiration and expiration to prevent airway collapse
when patients with a history of osa are hospitilized, be aware that giving wht may worsen OSA symptoms
opioid analgesics and sedating medications that cause respiratory depression
for patient with mild osa, _____ appliances may be preferable to positive airway pressure
oral
oral appliances bring the mandible and tongue _____ to enlarge airway
forward
patients using cpap may report _________ as a problem using it
nasal stuffiness
which condition involves a brings and sudden loss of skeletal muscle tone or weakness
cataplexy
which method is used to diagnose insomnia
self report
which patient finding is a risk factor for sleep apena?
a. age 44
b. bmi 32 kg
c. neck circumference 18 inches
d. occasional consumption of alcohol
e.postmenopausal women
b,c,e
