Lecture 67 - Sleep Apnea Flashcards
what is sleep apnea?
repetitive episodes of decreased airflow that occur during sleep. Decreased airflow may associated with a reduction in blood oxygen saturation, and enhanced autonomic activity.
• Due to obstruction in the upper airway
• The events may terminate in arousals with resultant sleep fragmentation
what is the mallapati score?
risk stratification for OSA based crowding in the oropharynx
Symptms of sleep apnea?
• Loud Snoring -- snorting and gasping § Non-cyclical snoring § Ask the bed partner • Witnessed apneas • Daytime sleepiness • Non refreshing sleep • Morning headaches • Dry Mouth in the AM • Nocturia -- • Symptoms associated with weight gain
Sleepiness (excessive daytime sleepiness)
§ —> MVA, depression, loss of libido, poor memory, cognition, social problems (work/school), absenteeism
what is the definitive diagnostic test for sleep apnea?
what is being measured?
Polysomnogram
§ EEGs –
§ Electro-Oculo-Gram
§ EMGs – submentalis muscle, leg movements
§ Airflow – nasal cannula
§ Respiratory effort – rib cage / abd movement
what is Obstructive sleep apnea?
what is central sleep apnea?
OSA - cessation of respiratory flow with continued movement of the chest wall (resp effort). Indivative of an obstructive problem. Related to obesity
Central sleep apnea – cessage of respiration without movement of the chest wall (no resp effort)
indicative of a CNS problem
how can SA lead to HTN/CVD?
Sleep apnea hypoxia sympathetic activation (which can be sustained; possibly due to impairment of baro receptors) Rise in blood pressure Reflex parasympathetic stimulation Brady cardia Tissue hypoxia
factors favoring upper airway obstruction
Physically – narrow air passage (obesity, micrognathia, miacroglossia, tonsillar hypertrophy)
Neuro – Loss of upper airway tone (such as during REM, or patient is on EtOH + Benzos)
Options for treatment
Weigth loss; Positional therapy
CPAP
Other devices – Herps Device, one way valves for nostrils (breathing out through resistance opens up the airway)
Surgery – Adenotonsillectomy (kids); Jaw advancement (adults)
Hypoglossal nerve stimulation