Lecture 67 - Sleep Apnea Flashcards

1
Q

what is sleep apnea?

A

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

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2
Q

what is the mallapati score?

A

risk stratification for OSA based crowding in the oropharynx

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3
Q

Symptms of sleep apnea?

A
• 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

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4
Q

what is the definitive diagnostic test for sleep apnea?

what is being measured?

A

Polysomnogram
§ EEGs –
§ Electro-Oculo-Gram
§ EMGs – submentalis muscle, leg movements
§ Airflow – nasal cannula
§ Respiratory effort – rib cage / abd movement

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5
Q

what is Obstructive sleep apnea?

what is central sleep apnea?

A

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

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6
Q

how can SA lead to HTN/CVD?

A
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
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7
Q

factors favoring upper airway obstruction

A

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)

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8
Q

Options for treatment

A

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

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