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PVRS > obseity and sleep apnea > Flashcards

obseity and sleep apnea Flashcards

1
Q

what is OSA

A

apnea in the presence of respiratory effort

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2
Q

What is CSA

A

apnea in the absence of respiratory effort

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3
Q

what is mixed apnea

A

: 1st central, then

obstructive

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4
Q

Classification of BMI

A

Ideal weight: BMI 18.5-24.5
Overweight: BMI >25; obese: BMI >30
Morbid Obesity > 50
Underweight: BMI<18.5

BMi isn’t used for children

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5
Q

defintion of Sleep apnea

A

complete cessation of airflow for more than 10 sec. with or without presence of respiratory effort

Less than 10 apneic episodes/hr sleep is considered normal

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6
Q

definition of sleep hypopnea

A

> 30% reduction in airflow without cessation of breathing) in conjunction with a 1) 2% decrease in SpO2 desaturation or 2) arousal from sleep

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7
Q

defintion of respiratory effort related arousal

A

increasing respiratory effort for 10 seconds or longer leading to an arousal from sleep but one that does not fulfill the criteria for a hypopnea or apnea

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8
Q

what is Sleep apnea syndrome (SAS)

A

repeated episodes of apnea and/or hypopnea during sleep

  • clinically significant hypoxemia
  • sleep fragmentation
  • daytime somnolence
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9
Q

how to diagnosis sleep apnea

A

A history from the patient and/or the patient’s bed partner; noting the presence of:

  • Snoring
  • Sleep fragmentation
  • Periods of apnea during sleep
  • Non refreshing sleep
  • Persistent daytime sleepiness

follow by upper airway and PFT assessment

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10
Q

What anatomical changes can contribute to sleep apnea?

A

Abnormalities in the posterior pharynx include
A large uvula
Enlarged tonsils
A long soft palate
Redundant lateral pharyngeal walls
Macroglossia (enlarged tongue)
Presence of an overbite of the upper teeth with a posterior placement of the mandible

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11
Q

what does the patient blood work show in the diagonis of sleep apnea

A

Polycythemia
Reduced thyroid function
Bicarbonate retention

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12
Q

what test can confirm sleep apnea

A

Polysomnography (PSG)

In home portable monitoring

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13
Q

what is the relationship between pharyngeal tone and sleep

A

When awake pharyngeal tone is maintained by increased activity of the upper airway dilator muscles

sleep onset (REM) decrease this muscle activity

results in narrowing/closure of upper airway during
sleep

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14
Q

what is the result of upper airway narrowing without closure

A

snoring and hypopnea

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15
Q

what is the result of upper airway closure

A

apnea

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16
Q

under what condition does a snorer convert to apneic?

A

addition of alcohol
extreme fatigue
supine posture,
weight gain

17
Q

wht are the risk factors for OSA

A

Things that cause a small or unstable pharyngeal airway

  • onset of sleep
  • upper body obesity
  • tonsillar hypertrophy
  • crowded hypopharynx, recessed chin (retrognathia or (micrognathia)
  • link with allergies, sinusitis (upper airway edema)
18
Q

what is the cardiopulmonary comprise due to?

A

hypertension due to:
1)intermittent hypoxemia and SNS activation
2)

hypoxemia (leads to pulmonary hypertension)

nocturnal arrhythmias ( b rady tachy syndrome,
bradycardia, a flutter, V tach , Atrioventricular
block (second degree, PVC, SVT

19
Q

what is the complication of OSA?

A

Linked to increased risk of:

MI
CHF (left or right)
stroke
cheyne stokes breathing often occurs in
patients with CHF (  chemoreceptor
response) or stroke
20
Q

what measurement is included in a polysomnography record

A
  1. sleep stage and sleep disturbance
    assessment (EEG, chin EMG, EOG, limb moment)
  2. assessment of airflow
  3. respitrace: thoracic & abdominal movements
  4. cardiac monitoring : ECG & BP (pre/post)
  5. SpO2
  6. pCO 2 either with capnography or TcPCO 2
  7. apnea during REM
    - Increase in frequency & severity
    - Arousals prevent entry into REM properly
21
Q

formula of the apnea hypopnea index (AHI)

A

of apneas and hypopneas / TST (hrs)

aka respiratory disturbances index (RDI)

22
Q

how to classify AHI?

A 
<5 events is normal,
> 10 events is diagnostic
> 20 30 events is moderate
>40 events is moderate severe SAS
>50 events is severe
23
Q

what should the patient know about if they are dx with OSA?

A 
educated about the risk factors
natural history
long term consequences of OSA.
consequences of driving an automobile or
operating other equipment or tools while
sleepy.
24
Q

What are the treatment of OSA

A 
Nasal CPAP (1st line of therapy) 
Avoid alchohol and drug
exercise
changing sleep position and pillow
surgical
dental
25
Q

how does CPAP help with OSA

A

involves the relief of airway obstruction by the use of constant
pressure by nasal mask or pillow

  • splints the airway open
  • need sleep study necessary to determine
    appropriate level of pressure
26
Q

what is the contraindiation of CPAP

A

bullous lung disease
severe left heart failure
hypotension

27
Q

complication of CPAP

A 
patient compliance
abrasions
sinus/ear infections
eye irritations
Nasal dryness
Rhinitis
28
Q

what is CSA

A

waning of respiratory drive;

both VT and RR

29
Q

what cause CSA

A
  • lower brainstem lesions,
  • post polio syndrome, encephalitis,
    neurodegenerative diseases (MD, MG,
    GBS)
  • stroke
  • C spine surgical complications
  • primary hypoventilation syndrome (Ondine’s sydrome)
30
Q

what is the deal with CSR CSA

A

cheyne stoke respiration with central sleep apnea occurs frequent;y in patient with HF because of respiratory control system instability

vetilation is due to the metabolic change rather than the behaviour respiratory control during sleep

Primary stimulation for ventilation is Paco2

31
Q

what cause CSR CSA

A

apnea in premature
Cerebral vascular accident (Stroke)
high atitude breathing

32
Q

what are Clinical Features of CSA

A

Headaches due to ↑CO 2

snoring is uncommon

excessive daytime somnolence

central apneas begin in stage 1 sleep

33
Q

what is mixed or complex apnea

A

Central apnea occurs first followed by effort
to breathe, but airway obstruction inhibits gas
flow.

34
Q

what is the treatment for OSA

A

Treatment: usually OSA treatment methods

PVRS (17 decks)

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