CM: Sleep Disorders II Flashcards
What are obstructive sleep apnea, obstructive hypopnea and central sleep apnea?
obstructive apnea: cessation of airflow at least 10 sec, continued effort
hypopnea: reduced airflow at least 10 sec, associated w arousal, oxyhemoglobin desaturation, continued effort
central: cessation of airflow at least 10 sec, no respiratory effort
What are the cardiovascular complications of OSAHS?
systemic HTN (most common source of morbidity)
cardiac arrhythmias (a fib)
myocardial ischemia (MI, CHF)
cerebrovascular dz (stroke)
pulm HTN/cor pulmonale
due to repetitive bursts of sympathetic activity, loss of normal decrease in HR and BP during sleep
What are the metabolic complications of OSAHS?
increased glucose and insulin
leptin and insulin resistance
When are hypopneas clinically significant?
at least 4% desaturations
What is the criteria for diagnosing OSAHS?
criterion A or B plus C:
A = excessive daytime sleepiness not otherwise explained
B = two or more of following not otherwise explained: choking or gasping during sleep, recurrent awakenings, unrefreshing sleep, daytime fatigue, impaired concentration
C = overnight monitoring shows five or more obstructed breathing events per hr
What are the neuro-cognitive complications of OSAHS?
daytime sleepiness, motor vehicle accidents, work related accidents, neuropsychological performance, impaired quality of life, memory/cognitive impairment via intermittent nocturnal hypoxia
What are some things in the hx or physical that can clue you in to the diagnosis of OSAHS?
snoring, snorting, nasal congestion, smoking, family hx, menopause, nocturia
tonsillar hypertrophy, retro/micrognathia, RHF
What is the treatment of choice for OSAHS?
positive pressure administered via mask
What are some conditions that are risk factors for OSAHS?
*hypoT, acromegaly, amyloidosis, vocal cord paralysis, marfans, downs, neuromuscular disorders
What is the role of lifestyle changes in a pt with OSAHS?
weight loss if obese can help
avoiding sleep deprivation increases upper airway muscle tone
avoid alcohol and sedatives
if positional - lateral position or head of bed elevation can help
What is the role of positive pressure therapy in pts with OSAHS?
splints airway open during sleep
treatment effect virtually immediate
CPAP has lots of proven beneficial effects
What is the role of oral appliance therapy in pts with OSAHS?
modifies position of mandible and tongue (tongue retaining devices or mandible advancement devices)
second line: requires multiple adjustments that take time, not 100% efective, adherence can’t be measured
pts prefer to CPAP/BPAP
patent nasal airway is essential
best for snoring and mild apnea (not severe)
requires good oral hygiene and health status
side effects = TMJ discomfort, dental misalignment, and salivation
What is the role of surgical therapy in pts w OSAHS?
tracheostomy (bypass upper airway) or reconstruct it
for severe and life threatening OSAHS who can’t tolerate CPAP/BPAP
reconstruction better cosmetically but less positive results
