CVPR Week 6: Sleep Disordered Breathing Flashcards
Objectives
Physiologic changes during sleep
- Heart rate drops
- Breathing rate slows
- Blood pressure decreases
- Urine output decreases
Polysomnogram of various apnea
Two types of breathing events during sleep
- Apnea
- Hypopnea
Apnea description
Cessation of airflow >= 10 seconds
Hypopnea description
Decreased airflow >= 30% from baseline lasting >= 10 seconds associated with >= 4% oxyhemoglobin desaturation Or an arousal from sleep
Obstructive sleep apnea description and criteria
Sleep apnea cycle
Physiologic stressors of sleep apnea
4 listed
- Cyclic hypoxemia
- Strenuous respiration
- Sympathetic activation
- Reduced total sleep time
Central sleep apnea description and criteria
- A lack of effort to breathe
- Respiratory drive under metabolic control in NREM sleep
- Mu receptors sense CO2 in brainstem
- Breath is triggered by CO2 hitting threshold (individual)
Central sleep apnea dysregulation is due to?
4 listed
- Brain lesion
- Genetic
- Medication
- Poor cardiac function
Brain lesions that can lead to central sleep apnea
- Stroke
- anatomical
- vascular
- tumor
Genetic conditions that can lead to central sleep apnea
Odine’s Curse (“forget” to breathe)
Medication that can that can lead to central sleep apnea
narcotics block Mu receptors
Cardiac functioning that can lead to central sleep apnea
- CHF
- Atrial fibrillation
- Signal to brain is “old news”
Central sleep apnea is driven by?
CO2
Quick screening tool for Obstructive Sleep Apnea
STOPBANG
OSA AKA
Obstructive Sleep Apnea
Physical findings predisposing to OSA
11 listed
- BMI > 35
- Neck Circumference > 17
- chronic nasal congestion
- Nasal speech
- Obligate mouth breathing
- mandibular retrognathia
- Mid face hypoplasia
- Micrognathia
- Crowded dentition
- Overbite
- Crowded oropharynx
Crowded oropharynx
6 listed
Related to OSA
Case
Cardiovascular consequences of sleep apnea
Hypertension
loss of nocturnal dipping
Nocturnal dipping and CVD risk
- Normally blood pressure drops 10-20% when sleeping
- 5 mmHg loss of reduction increases CVD risk by 17%
- 10 mmHg loss of reduction increases CVD risk by 35%
Loss of nocturnal dipping
Cardiometabolic risks of sleep apnea
- OSA increases risk of hypertension 3-4 fold
- OSA prevents nocturnal dipping
- Blood pressure usually drops 10-20% during sleep
- OSA causes insulin resistance due to stress response
- Also true in non-diabetics
- OSA increases impulsive eating of foods rich in fats and carbohydrates
- Sugar us the only energy source that the brain uses
- Sleep deprivation increases impulsivity
Major red flag for OSA
Waking unrefreshed after sufficient sleep and taking day time naps is a major red flag for OSA
Snoring can also increase
relationship strain by bothering the partner more than the patient
Erectile dysfunction can be a symptom of?
Sleep apnea
Case key points
Nocutria in OSA
6 listed
Sympathetic surges in OSA
Case Mr HEart
Case Ms. Nellie
Prevalence of sleep apnea
Sleep stage dependent apnea
Measures of sleep apnea frequency
Treatment for OSA
Standard of treatment for OSA
Before and after PAP
Oral appliances for Sleep apnea
Surgical alternatives for OSA
Behavioral interventions for OSA
