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Patho 2 (Path 311) > Mod 4 Sleep Disorders > Flashcards

Mod 4 Sleep Disorders Flashcards

1
Q

What is the definition of sleep according to Merck?

A

A reversible behavioural state w/varying degrees of unconsciousness and reactive inactivity

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2
Q

What are the 2 major sleep cycles?

A
  • Non-rapid eye movement (non-REM) sleep
  • Rapid eye movement (REM) sleep
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3
Q

What is Rapid Eye Movement (REM) Sleep?

A

Active or dreaming sleep

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4
Q

What is Non-Rapid Eye Movement (non-REM) Sleep?

A

Quiet or slow-wave sleep

  • Has 4 sub-stages
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5
Q

What are the 5 stages of sleep?

A
  • W: Wakefulness
  • N1: non-REM 1
  • N2: non-REM 2
  • N3: non-REM 3
  • R: REM
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6
Q

What are the 4 sub-stages of non-REM sleep?

A

N1, N2, and N3 (N3 has 2 levels)

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7
Q

What is non-REM Sleep?

A

Typically the first stage of sleep

  • Contributes to physical rest and may bolster the immune system and the digestive system
  • cycles of 60-90 mins
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8
Q

When is the majority of sleep spent?

A

N2

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9
Q

which stage of sleep has the largest cycle?

A

N2

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10
Q

Which stage of sleep is described as the more chaotic?

A

N1 and N2

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11
Q

Which stage of sleep is more regular?

A

N3

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12
Q

Why is non-rem Sleep important?

A

Interruptions in these stages of sleep can interfere with normal growth patterns, healing, and immune response, especially in kids.

  • N3 is crucial for development and growth.
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13
Q

How are stages of sleep determined?

A

Electrophysiological monitoring

  • EEG
  • EOG
  • EMG
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14
Q

Why is REM sleep important?

A

REM sleep contributes to psychological rest and long-ter emotional well being

  • may bolster memory
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15
Q

What is REM sleep signified by?

A

Increased EEG activity

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16
Q

How long does REM sleep last?

A

5-40 mins; lengthening as the sleep progresses.

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17
Q

What is REM Sleeps role in Sleep Disordered breathing?

A
  • Sleep related hypoventilation and apnea are frequent
  • Reduced response to hypoxia and hypercapnia
  • Profound atonia affecting arms, legs, intercostals and upper airway muscles (does NOT impact diaphragm)
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18
Q

Is non-REM sleep longer than REM sleep?

A

Yes, REM sleep is shorter than non-REM

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19
Q

What are abnormalities of respiratory pattern?

A

Pauses in breathing

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20
Q

What is Sleep-Disordered Breathing (SDB)?

A

A group of disorders characterized by pauses in breathing, or the amount of ventilation during sleep.

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21
Q

What are 3 types of Sleep Apnea?

A
  • Obstructive Sleep Apnea
  • Central Sleep Apnea
  • [Hypopnea, Upper Airway Resistance Syndrome (UARS)] -> Decreased # of breaths
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22
Q

What is the continuum of sleep Apnea?

A
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23
Q

What is Hypopnea?

A

Significant decrease in breathing w/o complete cessation of airflow.

  • Decreases in SpO2 and/or sleep arousal are key features
  • **30% decrease in airflow w/4% desat
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24
Q

What is Upper Airway Resistance Syndrome (UARS)

A

Increased airway resistance results in extra effort to breathe

  • can cause arousals and increase in BP
  • Decreased # of breaths
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25
Q

What is the continuum of Upper Airway Resistance Syndrome?

A

Snoring -> UARS -> OSA

(Least severe - Most severe)

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26
Q

What is the clinical definition of Apnea?

A

The cessation of breathing for 10 seconds or longer (may even exceed 100 seconds!)

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27
Q

When is Sleep Apnea diagnosed?

A

When more than 5 apneas per hour are occurring, over a 6 hour period

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28
Q

When can Apneas occur?

A

In either non-REM or REM sleep

  • More frequent and more severe in REM and when in a supine body position
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29
Q

When is sleep apnea most severe?

A
  • During REM
  • When in a supine body position
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30
Q

Age group affected by Apnea?

A

All age groups

  • it may play a role in SIDS for infants
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31
Q

What is Obstructive Sleep Apnea caused by? (OSA)

  • Categories?
A

Caused by small or unstable pharyngeal airway

  1. Anatomical (Excess soft tissue)
  2. Neurological (Decreased muscle tone)
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32
Q

What is the most common type of sleep apnea?

A

Obstructive Sleep Apnea (OSA)

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33
Q

What is Obstructive Sleep Apnea (OSA)?

A

Characterized by episodes of complete collapse of the airway or partial collapse with an associated decrease in oxygen saturation or arousal from sleep.

  • This disturbance results in fragmented, nonrestorative sleep
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34
Q

What is Obstructive Sleep Apnea Anatomical (OSA) caused by?

A

Excess soft tissue because of:

  • Obesity (not everyone)
  • Tonsillar hypertrophy (mostly PEDS)
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35
Q

What is Neurological Obstructive Sleep Apnea (OSA) caused by?

A

Decreased muscle tone

  • While awake the pharyngeal tone is maintained by increased activity of the airway dilator muscles. This activity is lost during sleep and narrowing and/or closure of the airway results
  • cause is not well understood
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36
Q

How does Obstructive Sleep Apnea (OSA) present?

A

Pts initially appear quiet and still while sleeping.

  • Followed by an increased effort to inhale, often resulting in snoring
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37
Q

How do severe cases of Obstructive Sleep Apnea (OSA) present?

A
  • Suddenly awaken
  • Sit upright in bed
  • Gasp for air
  • people feel like they’re being suffocated
  • some patients aren’t sleep during the day and sometimes their score is over 100 an hour
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38
Q

Do symptoms of sleep apnea always indicate the severity of sleep apnea?

A

No, Symptoms of sleep apnea are not always an indication of the severity of the sleep apnea!

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39
Q

What is Enuresis?

A

Bed wetting.

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40
Q

What are hallmark signs/symptoms of Obstructive Sleep Apnea (OSA)

A
  • excessive daytime sleepiness
  • Hypertension
  • Nocturnal Enuresis (bed wetting)
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41
Q

What are risk factors associated w/Obstructive Sleep Apnea (OSA)?

A
  • Neck Size
  • Type 2 diabetes
  • Family hx (similar anatomical shapes of airways)
  • Smoking residue can make upper airways stickier
  • Older than 65 years
  • Men
  • post-menopausal women
42
Q

What is the “STOP BANG” questionnaire?

A

S = Snoring
T = Tiredness
O= Observed apneas/gasping
P = Pressure (as in high BP)

B = BMI
A = Age
N = Neck circumference
G = Gender

43
Q

Why are headaches associated with Sleep Apnea?

A

Trying to compensate for not breathing.

  • Low blood pressures = headaches
44
Q

What is observed apnea?

A

Bed partner seeing person not breathing

45
Q

How is the STOP BANG Questionare scored?

  • what is its purpose?
A

Screens individuals who may be at a higher risk of having obstructive sleep apnea (OSA). Helps w/further treatments.

  • Scored out of 8
  • Every yes = 1 point
  • If you answer yes to 3 ore more then you have a high risk of OSA
46
Q

What STOP BANG score suggests OSA?

A

If you answer yes to 3 or more then you have a high risk of OSA

47
Q

What are the consequences of untreated Obstructive Sleep Apnea (OSA)?

A
  • Hypertension (50%)
  • Cardiovascular disease (MI or stroke)
  • Diabetes
  • Neurocognitive and performance deficits
  • Automotive accidents
  • Deterioration in QOL, family life
48
Q

What is Central Sleep Apnea (CSA)?

A

Pts display a periodic breathing pattern.

  • Waxing and waning of respiratory drive
  • Cheyne-stokes is a severe type of periodic breathing, often associated w/CHF
  • Heterogenous group of disorders (Has several root causes)
  • your brain doesn’t send the signal to breath
  • there is no effort they just don’t breath for a long time
49
Q

When does Central Sleep Apnea (CSA) occur?

A

When resp. centers of the medulla fail to send signals to the respiratory muscles.

  • Characterized by cessation of airflow at the nose and mouth w/absence of diaphragmatic excursions.
  • your brain doesn’t send the signal to breath
  • there is no effort they just don’t breath for a long time
50
Q

Clinical disorders associated with central sleep apnea

A
  • CHF (cheyne stokes resp)
  • Metabolic alkalosis
  • Encephalitis (brain swelling)
51
Q

What is Mixed Sleep Apnea?

A

Combination of obstructive and central sleep apnea

  • usually begins as central sleep apnea, followed by ventilatory efforts w/o airflow (OSA)
52
Q

How is mixed sleep apnea handled clinically?

A

Classified and treated as OSA

53
Q

What is Overlap Syndrome?

A

When OSA and COPD co-exist (lots of types)

  • bad prognosis
  • Hypoventilation at night causing high CO2 and bicarb going up
  • Worse ABG abnormalities than simple OSA
54
Q

How do you diagnose/predict Sleeping Disorders?

A

Many ways, the gold standard is the Epworth Sleepiness scale.

55
Q

What is Narcolepsy?

A

Chronic neuro condition that affects the brains ability to control sleep-wake cycles

56
Q

What is the Epworth sleepiness scale?

A
  • Used to measure excessive daytime sleepiness
  • Validated for OSA
  • Has patient rate how likely they are to fall asleep in different situations
  • Repeated after beginning treatment w/CPAP (or bipap) to see if symptoms have improved
57
Q

What do ranges on the Epworth Sleepiness scale indicate?

  • What is normal?
  • what is abnormal?
A
  • 0-9 is normal
  • 10-24 indicates need for expert med advice
  • (>16) indicates possibility of severe sleep apnea or narcolepsy
58
Q

What does a range of 0-9 indicate on the Epworth sleepiness scale?

A

Normal range

59
Q

What does a range of 10-24 indicate on the Epworth sleepiness scale?

A

Need for expert med advice

60
Q

What does a range of >16 indicate on the Epworth sleepiness scale?

A

Severe sleep apnea or narcolepsy

61
Q

What are the 2 ways Sleeping disorders are diagnosed?

A

Level 1 sleep study (PSG)

Level 3 Sleep Study (home or bedside)

62
Q

What are Level 1 study sleep studies?

A

Polysomnograms (PSG), You want a baseline blood gas before sleep to see how bad their sleep apnea is.

  • Done in hospital or sleep lab
  • Diagnoses all sleep disorders
  • able to sleep
  • uses 16 channels to gather info
63
Q

What do you want for a Level 1 sleep study (PSG)

A

You want a baseline blood gas before sleep to see how bad their sleep apnea is.

64
Q

How many channels are used to gather info for a level 1 sleep study (PSG)?

  • what are they?
A

16 Channels

SpO2, snoring, airflow, EMG, respiratory effort, limb movement, EOG, ECG, EEG

65
Q

What are Level 3 study sleep studies?

A

Level 3 is for uncomplicated straight up obstructive sleep apnea

  • osa only uncomplicated
  • remmers sleep recorder
  • Uses 6 channels to gather info
66
Q

How many channels are used to gather info for a level 3 sleep study (PSG)?

  • what are they?
A

6

  • SpO2, snoring, airflow, respiratory effort (optional), body position and heart rate
67
Q

What is the Apnea Hypopnea Index (AHI)?

A

Average number of apneas and hypopneas the Pt has per hour of sleep

68
Q

What are the Apnea Hypopnea Index (AHI) severity categories?

A

An AHI >15 is significant

  • Normal— < 5
  • Mild—5 to 15
  • Moderate—15 to 30
  • Severe— >30
69
Q

What is the Respiratory Disturbance Index (RDI)

  • What is a clinically significant event?
A

Total of everything the patient experiences at night

  • Any sleep disturbances
  • Number of apnea events/hour plus the number of hypopnea events/hours plus the number of resp-effort related arousals (RERA) per hour of sleep
  • RDI > 15 needs to be treated
70
Q

What a normal Apnea Hypopnea Index (AHI)?

A

Less than 5

71
Q

What a mild Apnea Hypopnea Index (AHI)?

A

5-15

  • mild aren’t treated for their sleep apnea
  • they’d have high epworth, so they’d likely still be treated
72
Q

What a moderate Apnea Hypopnea Index (AHI)?

A

15-30

  • needs to be treated
73
Q

What a severe Apnea Hypopnea Index (AHI)?

A

AHI > 30

74
Q

What are clinically significant scores for AHI and RDI?

A

Any score > 15

75
Q

What is the gold standard Sleep Studies?

A

PSG (aka level 1 sleep study)

  • Can detect OSA that HSAT misses
  • Done on all Pts suspected of having “complicated OSA” (or any unstable co-morbidity like hypertension or sleeping disorders like CSA)
76
Q

What do Home Sleep Apnea Tests (HSAT) tell us?

  • when are they used?
A

Gives RDI score

  • only used when Pt is suspected of having a uncomplicated OSA
  • Positive = OSA
  • Negative = Pt needs PSG to rule out OSA
  • Remmers (level 3)
77
Q

Do negative RDI scores from a Home Sleep Apnea Test (HSAT) rule out sleep apnea?

A

No, a level 1 is needed to rule it out for sure.

78
Q

What do waveforms and lines represent on a Polysomnography?

  • How do you read sleep studies?
A
  • Flat lines for airflow = apnea
  • Effort = obstructive sleep apnea
79
Q

Management of Sleeping Disordered Breathing?

A

The usual include

  • lifestyle modifications
  • physical interventions (positive airway pressure and oral appliances)
  • surgical interventions
80
Q

What are alternative treatments for sleep apnea?

A
  • Positional therapy
  • Pharmaceutical
  • Neurostimulation
  • Oropharyngeal exercises
81
Q

What are lifestyle changes would aid in the management of Sleep Disordered breathing?

A
  • Weight loss/maintain healthy BMI
  • Good sleep hygiene
  • Avoidance of alcohol
  • Work with physician to change/alter schedule of sedatives
  • Avoid excessive fatigue
  • Smoking cessation
82
Q

What methods could be used to admin Positive Airway Pressure for Sleep Disordered Breathing?

A
  • CPAP and APAP (auto-CPAP)
  • BiPAP
  • AVAPS/VPAP
83
Q

What is Auto-CPAP (APAP)

A
  • Auto-adjusting CPAP, within a set range
  • Thought to result in a lower failure rate
  • Special modes (“C-Flex”) may decrease the CPAP level during expiration to ease exhalation; “A-flex” does both inspiration and expiration
84
Q

What range of pressures can you use for APAP (auto-cpap)?

A

5-15 cmH2O

  • Machine adjusts water to make sure airways stay open
85
Q

What should you keep in mind when managing Sleep Disordered Breathing with CPAP?

A

level determined by repeated sleep studies while on CPAP

  • you increase pressures if problems don’t resolve
86
Q

When would you use BiPAP to manage Sleep Disordered Breathing?

A

When there is a component of hypoventilation.

  • Always set back up rate bc they are usually chronic
87
Q

What are 3 types of patients that would need bipap

A

Any that have a component of hypoventilation

  1. Neuromuscular Pts
  2. Nocturnal hypoventilation (Pickwickian Syndrome)
  3. CSA
88
Q

When would you use AVAPS/VPAP to manage Sleep Disordered Breathing?

A

Severe OSA or a central component

89
Q

why would you use AVAPS/VPAP to manage Sleep Disordered Breathing?

A

Allows volume targeting and minimal min volumes (like PRVC)

  • Need to set target Vt
  • Target Vt 500
  • Machine does what needs to get in (like PRVC)
90
Q

What is BUR and when do you need it?

A

BUR = Back up rate

  • Need to set on BiPAP
91
Q

Why do patients with COPD have better outcomes with BiPAP at night?

A
  • Clears CO2 at night
  • a lot of COPD exacerbations is bc they wake up at night and struggle to breath
  • BiPAP supports their breathing and clears CO2 over night while they sleep
92
Q

What mode of positive airway pressure is best suited for a patient with COPD?

A

BiPAP

  • helps them clear CO2 at night
93
Q

What oral appliances used for in Sleep Disordered Breathing?

A

Typically for snoring, UARS, mild-mod OSA

94
Q

What oral appliances can be used for sleep disordered breathing like snoring, UARS, and mild-mod OSA?

A
  • Tongue Retaining device (TRD)
  • Mandibular Advancement Device (MAD)
95
Q

How does a Tounge Retaining Device (TRD) work?

A

Holds the tongue forward

96
Q

How does a Mandibular advancement device (MAD) work?

A
  • holds the lower jaw forward to maintain
  • May be used in conjunction with CPAP
  • OTC and custom made
  • Looks like a mouth guard
97
Q

What are surgical interventions for the management of Sleep Disordered Breathing?

A
  • Nasal surgery (septoplasty, turbinate reduction…)
  • Tonsillectomy
  • UPPP (Uvulopalatopharyngoplasty)
  • Genioglossal advancement
  • Mandibular advancement
98
Q

what is positional therapy?

  • what methods are used?
A

The use of devices to encourage sleeping on the side (as snoring is worse on back)

  • effective w/positional SDB (only when supine)
  • Methods: Backpacks, shirts, tennis ball tech
99
Q

What is the success rate of Surgical Interventions for Sleep Disordered Breathing?

A

Varying levels of success, sometimes it doesn’t work

100
Q
A

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