DAY 5: BREATHING DISORDERS

Question 1

What are the mechanisms underlying OSA?

Answer 1

OSA often results from a combination of factors contributing to low neuromuscular tone in the upper airway during sleep. Compensatory mechanisms like loop gain (LG) involving chemoreceptors, lung function, and cardiovascular factors also play a role.

Question 2

How does OSA affect the cardiovascular system?

Answer 2

OSA is associated with cardiovascular changes, including increased sympathetic nervous system activity, inflammation, and endothelial dysfunction, which can contribute to cardiovascular disease risk.

Question 3

What metabolic changes are associated with OSA?

Answer 3

OSA can lead to metabolic changes such as insulin resistance, leptin resistance, increased lipolysis, and impaired lipoprotein clearance, potentially contributing to metabolic disorders like diabetes and obesity.

Question 4

What percentage of the general population is affected by OSA?

Answer 4

OSA is prevalent in 7-13% of the general population, and the numbers increase to 20-25% in primary care populations.

Question 5

What are some common risk factors for OSA?

Answer 5

Excessive body weight, fat distribution around the waist and thorax, and being male are significant risk factors for OSA.

Question 6

What is the gold standard test for diagnosing OSA?

Answer 6

Polysomnography is the gold standard test for diagnosing OSA. It involves monitoring various physiological parameters during sleep in a sleep laboratory.

Question 7

What are some questionnaires and tests used for OSA screening and diagnosis?

Answer 7

Common questionnaires like the Berlin, Stop-Bang, and Epworth scales are used for OSA risk assessment. Polysomnography and Home Sleep Apnea tests (HSAT) are diagnostic tools used to monitor breathing patterns and oxygen levels during sleep. Oximetry is also used to measure blood oxygen levels and support OSA diagnosis.

Question 8

What is Continuous Positive Airway Pressure (CPAP) therapy, and how is it used to manage OSA?

Answer 8

CPAP therapy is a common treatment for OSA that utilizes a mask delivering pressurized air to keep the upper airway open during sleep. It helps prevent airway collapse and breathing interruptions.

Question 9

How is mask pressure measurement used to manage OSA?

Answer 9

Mask pressure measurement is a tool to assess the collapsibility of the upper airway during sleep. By monitoring the mask pressure needed to prevent airway collapse, healthcare professionals can evaluate the stability of upper airway muscles and determine the nature of OSA.

Question 10

How can changing sleep positions help manage OSA?

Answer 10

Sleeping on the back (supine position) can worsen OSA due to gravity promoting airway collapse. Encouraging patients to sleep on their sides (lateral position) can reduce OSA severity. Techniques like using specially designed pillows or positional therapy devices can help promote side sleeping.

Question 11

What are positional therapy devices, and how do they work?

Answer 11

Positional therapy devices are worn on the body and provide gentle vibrations or prompts when the wearer rolls onto their back, encouraging them to return to the side sleeping position. They help manage OSA by preventing airway collapse during supine sleep.

Question 12

What is hypoglossal nerve stimulation, and when is it used to manage OSA?

Answer 12

Hypoglossal nerve stimulation is a surgical treatment for individuals with moderate to severe OSA who cannot tolerate or benefit from CPAP therapy. It involves implanting a device that stimulates the hypoglossal nerve to prevent airway collapse during sleep.

Question 13

How do hypoglossal nerve stimulation devices work, and what are some examples?

Answer 13

Hypoglossal nerve stimulation devices are surgically implanted and can be programmed or adjusted based on individual needs. There are several commercially available devices approved for the treatment of OSA, each stimulating the hypoglossal nerve to keep the airway open during sleep.

Question 14

What are the most common sleep disorders observed in individuals with Parkinson’s disease?

Answer 14

The most common sleep disorders observed in Parkinson’s disease include insomnia, restless legs syndrome (RLS), rapid eye movement sleep behavior disorder (RBD), and obstructive sleep apnea (OSA).

Question 15

What are some of the mechanisms underlying sleep disorders in Parkinson’s disease?

Answer 15

The mechanisms underlying sleep disorders in Parkinson’s disease include neurodegeneration, dopaminergic dysfunction, alpha-synuclein pathology, and medications used to manage motor symptoms.

Question 16

What is the significance of feedback gain in the regulation of sleep and breathing?

Answer 16

Feedback gain from circulation and chemoreceptors provides crucial information to the brain about blood oxygen, carbon dioxide levels, and changes in blood chemistry and pH to regulate breathing patterns during sleep.

Question 17

How does central sleep apnea (CSA) differ from other types of sleep apnea?

Answer 17

Central sleep apnea (CSA) is characterized by repetitive pauses in breathing during sleep caused by the brain’s failure to send appropriate signals to control breathing muscles. It differs from obstructive sleep apnea (OSA), where breathing interruptions result from upper airway blockages.

Question 18

What is the role of CPAP in managing central sleep apnea (CSA)?

Answer 18

Continuous Positive Airway Pressure (CPAP) therapy is a standard treatment for sleep apnea, including CSA. CPAP helps keep the upper airway open by delivering pressurized air through a mask, reducing CSA episodes by approximately 50%.

Question 19

What are the essential gain mechanisms involved in the regulation of sleep and breathing?

Answer 19

The essential gain mechanisms include feedback gain (circulation and chemoreceptors), plant gain (lung and chronic hyperventilation), and controller gain (brain). These mechanisms play crucial roles in regulating sleep and breathing patterns.