L65

Question 1

Sleep apnea is a major risk factor for developing

Answer 1

HTN that don’t respond to meds
Obesity
Congestive heart
AFib // MI

Question 2

Define sleep apnea // hypopnea syndrome

Answer 2

Repetitive episodes of decreased airflow that occur during sleep
Reduced O2 sats
Enhanced autonomic activity
Results in arousals w/ sleep fragmentation

Question 3

What is the mallampati classification?

Answer 3

Have pt open their mouth, lean forward, stick tongue out
Class 1 = wide open mouth
Class 2 = uvula at tongue base
Class 3 = uvula partially obscured by tongue
Class 4 = tongue completely obscures uvula

Question 4

What are the 3 classifications of apnea events?

Answer 4

Obstructive = decrease or no airflow w/ chest wall movement (upper airway closed off)
Central = loss of effort to breathe, brain stem is not sending out breathing signals, no airflow or chest wall movement
Mixed - starts central ends up obstructive

Question 5

What is the body’s response during obstructive sleep apnea?

Answer 5

Brain stem sees lack of O2

Opens upper airway to remove the obstruction -> fire airway abductors (look at submentalis)

Question 6

What is the characteristic EKG of central apnea?

Answer 6

HR slows until arousal happens

Question 7

What change do you see to femoral artery pressure with repeated obstructive apneas?

Answer 7

Rise in femoral artery pressure

Indicates sympathetic response

Question 8

How is severity of apnea determined?

Answer 8

Apnea index // respiratory disturbance index
Number of events in each hr
> 30 per 1 hr = severe

Question 9

How does intermittent hypoxemia effect CV health

Answer 9

Leads to sympa stimulation

Might see O2 starvation -> oxidant stress -> release pro-inflam cytokines

Question 10

How does large inspiratory decreases in pleural pressure effect CV health

Answer 10

1. Increased venous return
2. Septum shifts L
3. RV dilates -> impaired LV ejection (decreased preload)
   Net CO goes DOWN during big inspirations - decrease BP = pulsus paradoxus

Question 11

How does EKG change during post-apnea arousal?

Answer 11

EKG goes to waking pattern

Question 12

Why do sleep apnea pts have HTN?

Answer 12

Hypoxemia and arousals -> increase sympathetic tone
Impaired baroreceptor sensitivity
Net high BP

Question 13

Explain how intermittent hypoxemia of apnea causes oxidant stress tissue damage.

Answer 13

Hypoxemia -> sympa
Increased BP
Parasympa stimulated -> reflex bradycardia
Tissue hypoxia 
Oxidant stress in tissue

Question 14

Why might apnea pts present with chest pain at night?

Answer 14

ST depression -> developing ischemia

Question 15

What are 2 factors that increase your likelihood for apnea?

Answer 15

1. Narrowed air passages: obesity or anatomic abnormalities

2. Loss of upper airway tone - REM sleep, suppressive drugs, alcohol, barbiturates

Question 16

Which airway muscle protrudes the tongue

Answer 16

Genioglossus

Question 17

Which airway muscle displaces hyoid arch anterior

Answer 17

Geniohyoid + sternohyoid

Question 18

What is the air pressure in the airway during normal inhalation

Answer 18

Negative pressure to pull air in

Question 19

What is pathophys of the airway for partial hypopnea/snoring

Answer 19

Loss of upper airway tone creases more negative pressures

Allows for easier collapse

Question 20

What is the pathphys of the airway for complete apnea

Answer 20

Huge loss of airway tone leads to such negative pressure that the airway collapses

Question 21

What happens to the airway during arousal

Answer 21

Actively open the airway by stimulating the muscles
Decrease the pressure in airway (less negative that the pressure that collapsed it)
Net inspiration

Question 22

What is continuous positive airway pressure (CPAP)?

Answer 22

Most common apnea treatment - sleep machine!
Think as splint for upper airway
Administered via nasal or oro-nasal mask

Question 23

What are the surgical options for apnea?

Answer 23

Uvulo-palato-pharyngo-plasty - aka cut out the uvula
Jaw advancement
Tracheostomy

Question 24

What are other non-surg options for apnea

Answer 24

Mandibular repositioning - pulls jaw forward to keep mouth open
One way valves in nostrils - breathe out against resistor so pressure in pharynx goes up

Question 25

What nerve would you stimulate to maintain tongue tone // stimulate abductors of the airway

Answer 25

Hypoglossal