Jasani: Sleep Apnea Flashcards
What are some key predisposing factors to sleep apnea?
Nasal obstruction
Tonsilar hypertrophy
Obesity
Describe the pathophysiology of sleep apnea.
sleep onset –> loss of neuromuscular compensation + decreased pharyngeal muscle activity –> airway collapses –> apnea –> hypoxia & hypercapnia –> increased ventilatory effort –> AROUSAL from sleep
During a hypopnea event, the airflow is reduced by how much?
50%
Using the Apnea Hypopnea Index (AHI), define sleep apnea.
AHI = number of apneas + number of hypopnea events PER HR
if AHI >or= 15 = APNEA
or if AHI >or= 5 AND any of these, = APNEA.
- excessive daytme somnolence (ESS>10)
- witnessed apneic events
- impaired cognition, mood disorder, insomnia
- documented HTN, CAD, CVA, CHF
Severity: 5-15, 15-30 (moderate), >30 (severe)
What other co-morbidities show a prevalence of sleep apnea?
**Drug-Resistant HTN
Obesity
CHF
Pacemakers
Describe the link between OSA and CVD.
Sympathetic activation due to the airway collapse in sleep (decreased O2 and increased CO2) will increase: RR, BP, HR and mental activity. arousal/wake up –> cardiac disease
Describe the metabolic disregulation as a complication of OSA.
Leptin is increased which leads to obesity and insulin resistance.
What heart complications come along with OSA? Tx?
Untreated OSA doubles (or quadruples) risk for A-fib and ventricular arrhythmias.
Tx: CPAP for CHF and to decrease risk of A-fib recurrence after cardio conversion
What is the risk factor for CV events in untreated OSA after 10 years?
2.87 times higher than norm risk of CV event (if AHI>15)
Does OSA affect DM?
Yes - impaired glucose tolerance and insulin resistance
Two main complications of OSA?
HTN and diabetes
What is the sleep history you will see in a patient with OSA?
- regular snoring
- overweight males with large neck
- relation to body position (happens on both back and side)
- awakening with choking and snorting
- correlation with weight gain
- nocturia (>or= twice/night
- dry mouth in the morning
- frontal HA in morning
- excessive daytime sleepiness (EDS)
- behavoiral changes
- gradual weight gain
- decreased libido, impotence/ED/low testosterone
What will the physical exam show in a patient with OSA?
Obesity, HTN Nasopharynx: nasal deviation Oropharynx: enlargements, overbite, crowded airway **Most important: Nec lCircumference - Males: >17 in - Females: >15.5 in
What are some co-morbities that have a high risk for OSA?
- *A-fib
- *Type 2 diabetes
- *high-risk driving population - check neck size
- obesity (BMI>35)
- CHF
List the STOP BANG questions you should ask a patient that you suspect has OSA.
Snoring Tiredness/fatigue Observed apnea Pressure (HTN) BMI (>35) Age (>50yo) Neck size Gender (male)
If or=3: high risk
