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
What four things does a home sleep test evaluate?
Nasal air flow, Pulse ox and HR, Body position
What does the in-lab sleep study evaluate?
Diagnostic (severe refractory HA r/o OSA)
Split night (diagnostic 2hours + 4 hours CPAP titration)
- AHI >or=15 in 2 h of sleep recordings
Mandatory Split Night
- AHI >5 with sx and/or comorbities
What is the treatment mainstay in OSA?
CPAP
How is CPAP compliance defined?
Use for at least 4h; use 70-80% of the night
What is APAP?
AutoCPAP: detects and RESPONDS to airway changes
Who is NOT a candidate for APAP?
CHF
COPD/other chronic lung diseases
Obesity hyperventilation syndrome (and other hyperventilation syndromes)
LACK of snoring
What is critical when starting your OSA patient on CPAP?
Mask Fitting.
Common problems of PAP?
Mask discomfort
Air leaks
Patient acceptance
What other options are there for patients who do not want to use CPAP?
dental appliances; good for Mild OSA (AHI
