Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PSBIM Harrison 21st Edition > Obstructive Sleep Apnea > Flashcards

Obstructive Sleep Apnea Flashcards

1
Q

Common sites of Airway Collapse

A
  1. **Soft Palate **(MOST COMMON)
  2. Tongue base
  3. Lateral pharyngeal walls
  4. Epiglottis

LEST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

OSA may be most severe during

A

Rapid Eye Movement (REM) sleep
When neuromuscular output to the skeletal muscles is particularly low and in supine position due to gravitational forces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes daytime sleepiness and impaired daily function

A

Obstructive sleep apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes Hypertension and is strongly associated with cardiovascular disease in adults and behavioral problems in children

A

Obstructive sleep apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Can occur as a primary condition (response to high altitude), or secondary to medical condition (e.g. heart failure) or medication (e.g. opioids)

A

Central sleep apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Report frequent awakenings and daytime fatigue

A

Central Sleep Apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Central Sleep Apnea is associated with increased risk for ______ (2)

A

Heart failure
Atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

OSA is defined on the basis of ______ and ______ and sleep study findings

A
  1. Nocturnal Breathing disturbances
    -snoring
    -snorting
    -gasping
    -breathing pauses
  2. Daytime Sleepiness or Fatigue DESPITE sufficient opportunity to sleep

SLEEP STUDY FINDINGS
Five or more episodes of Apnea or Hypopnea per hour of sleep during sleep study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

OSA may be diagnosed in the absence of symptoms if the AHI is _____

A

≥15 episodes/hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Definition of APNEA

A

Cessation of airflow for ≥10 seconds during sleep, accompanied by:

OBSTRUCTIVE: Persistent respiratory effort
CENTRAL: Absence of respiratory effort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Definition of HYPOPNEA

A

A ≥30% reduction in airflow for at least 10 s during sleep that is accompanied by either a ≥3% desaturation or an brain cortical arousal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Partial obstruction that does not meet the criteria for hypopnea but provides evidence of increasing inspiratory effort (usually through pleural pressure monitoring) punctuated by an arousal

A

Respiratory effort–related arousal (RERA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A partially obstructed breath, typically within a hypopnea or RERA, identified by a flattened or scooped out inspiratory flow shape

A

Flow-limited breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Airway patency is dependent on the stabilizing influence of the _______-

A

Pharyngeal dilator muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Airway lumen may be narrowed by enlargement of soft tissue structures (tongue, palate, uvula) due to ___ (3)

A
  1. fat deposition
  2. increased lymphoid tissue
  3. genetic variation
    -mandibular retroposition
    -micrognathia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

___________ may trigger mouth opening during sleep, which breaks the seal between the tongue and the palate and allows the tongue to fall posteriorly and occlude the airway

A

High-level nasal resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

__________ during sleep results in central nervous system arousal

A

Increasing CO2 level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

This can preempt the CO2-mediated process of pharyngeal muscle compensation and prevent airway stabilization

A

A low arousal threshold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

May prevent appropriate termination of apneas, prolonging apnea duration and exacerbating oxyhemoglobin desaturation.

A

. A high arousal threshold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Major risk factors for OSA

A

MOA
1. Obesity
2. Male sex
3. Older age

Additional risk factors:

-mandibular retrognathia
-micrognathia
-a positive family history of OSA
-sedentary lifestyle
-genetic syndromes that reduce upper airway patency (e.g., Down syndrome, Treacher-Collins syndrome)
-adenotonsillar hypertrophy (especially in children)
-menopause (in women)
-various endocrine syndromes (e.g., acromegaly, hypothyroidism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Approximately 40-60% of cases of OSA are attritutable to ___

A

Excess weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Obese individuals are at a ______ risk for OSA than their normal weight counterpart

A

fourfold or greater risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A 10% weight gain is associated with _____ increase in AHI

A

> 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Prevalence of OSA is twofold higher among men than women. Factors that predispose men to OSA include ___ (2)

A
  1. Android pattern of obesity
  2. Relatively greater pharyngeal length, which increases collapsibility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

TRUE OR FALSE

Premenopausal women are relatively protected from OSA by the influence of sex hormones on ventilatory drive.

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The contribution of skeletal features in OSA is most evident in _____

A

Non-obese patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

For a first-degree relative of a patient with OSA, the odds of having OSA is approximately ______ than that of someone without an affected relative.

A

twofold higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

OSA prevalence
Middle-aged adults: ______
Elderly: _______

A

Middle aged adults: 5-15%
Elderly: >20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Peak of lymphoid hypertrophy among

A

children between 3-8 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Prevalence of OSA is high among the following patients (3)

A

HAD

  1. Diabetes mellitus
  2. Hypertension
  3. Atrial fibrillation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

____ precipitates OSA symptoms

A

Weight gain

32
Q

Most common complaint in OSA

A

Snoring

Note: absence does not exclude OSA

33
Q

______ distinguishes OSA from Paroxysmal Nocturnal Dyspnea, Nocturnal Asthma and Acid reflux with laryngospasm

A

Absence of Dyspnea

34
Q

Most common daytime symptom

A

Excessive daytime sleepiness
(however many women report fatigue instead of sleepiness)

35
Q

TRUE OR FALSE

OSA alone is thought to cause right-sided heart failure.

A

FALSE

Evidence of cor pulmonale suggests a comorbid cardiopulmonary condition

36
Q

Gold standard for diagnosing OSA

A

Overnight Polysomnogram

37
Q

Causes of False-negative Sleep Study (3)

A

LIN

  1. Night-to-night variation in OSA
  2. Insufficient REM sleep
  3. Less supine sleep during testing
38
Q

If there is a high prior probability of OSA, a negative home study should be followed by ___

A

Polysomnogram

39
Q

The key physiologic information collected during a sleep study for OSA assessment includes : (4)

A

BB CO

  1. measurement of breathing (changes in airflow, respiratory excursion)
  2. oxygenation (hemoglobin oxygen saturation)
  3. body position
  4. cardiac rhythm.
40
Q

Mild OSA

A

AHI 5-14 events/hour

41
Q

Moderate OSA

A

15-29 events/hour

42
Q

Severe OSA

A

≥30 events/hour

43
Q

Expected result of Overnight BP monitoring in OSA

A

“nondipping” pattern (absence of the typical 10% fall of blood pressure during sleep compared to wakefulness)

44
Q

ABG finding suggesting coexisting cardiopulmonary disease or hypoventilation syndromes.

A

Waking hypoxemia or hypercarbia

45
Q

Seen in patients with severe nocturnal hypoxemia

A

Elevated hemoglobin

46
Q

Useful test in quantifying sleepiness and helping to distinguish OSA from narcolepsy.

A

A multiple sleep latency test or a maintenance of wakefulness test

47
Q

OSA-related respiratory events stimulate sympathetic overactivity, leading to _____

A
  1. Acute blood pressure surges during sleep and nocturnal
  2. Daytime hypertension
48
Q

OSA-related hypoxemia also stimulates release of acute- phase proteins and reactive oxygen species that exacerbates ______

A
  1. Insulin resistance and lipolysis a
  2. Augmented prothrombotic and proinflammatory state
49
Q

Inspiratory effort against an occluded airway causes large intrathoracic negative pressure swings, altering ______

A

Cardiac preload and afterload and resulting in cardiac remodeling and reduced cardiac function

50
Q

Hypoxemia and sympathetic-parasympathetic imbalance also may ____

A

Cause electrical remodeling of the heart and myocyte injury

51
Q

Treatment of OSA with nocturnal continuous positive airway pressure (CPAP) has been shown to reduce 24-h ambulatory blood pressure by ____

A

2–4 mmHg

52
Q

TRUE OR FALSE

OSA treatment with CPAP reduces cardiac event rates or prolongs survival.

A

FALSE

53
Q

TRUE OR FALSE

Treatment of OSA has been shown to reduce several markers of cardiovascular risk and improve insulin resistance and, in uncontrolled studies, is associated with a decreased recurrence rate of atrial fibrillation.

A

TRUE

54
Q

Patients with OSA has ____ increase in occupational accidents

A

twofold increase

55
Q

Management of OSA

A
  1. Reduce weight
  2. Optimize sleep duration (7–9 h)
  3. Regulate sleep schedules (with similar bedtimes and wake times across the week)
  4. Encourage the patient to avoid sleeping in the supine position
  5. Treat nasal allergies
  6. Increase physical activity
  7. Eliminate alcohol ingestion (which impairs pharyngeal muscle activity) within 3 h of bedtime
  8. Minimize use of opiate medications
56
Q

OSA: standard medical therapy with the highest level of evidence for efficacy.

A

Continuous Positive Airway Pressure (CPAP)

CPAP works as a mechanical splint to hold the airway open, thus maintaining airway patency during sleep.

57
Q

Specific treatment for nasal congestion

A

Provide heated humidification, administer saline/steroid nasal sprays

58
Q

Specific treatment for Claustrophobia

A

Change mask interface (e.g., to nasal prongs), promote habituation (i.e., practice breathing on CPAP while awake)

59
Q

Specific treatment for Difficulty exhaling

A

Temporarily reduce pressure, provide bilevel positive airway pressure

60
Q

Specific treatment for Bruised nasal ridge

A

Change mask interface, provide protective padding

61
Q

Specific treatment for Aerophagia

A

Administer antacids

62
Q

Oral appliances are most often used for treating patients with ______

A
  1. Mild/moderate OSA
  2. Do not tolerate CPAP
63
Q

Upper airway surgery for OSA is less efficacious than CPAP and is mostly reserved for the treatment of patients ___

A
  1. Snoring
  2. Mild OSA
  3. Cannot tolerate CPAP
64
Q

Most commonly performed surgery for OSA

A

Uvulopalatopharyngoplasty

65
Q

Indications of Upper Airway Neurostimulation (alternative treatment for OSA)

A
  1. Moderate to Severe OSA (AHI 15–65)
  2. BMI <32 kg/m2
  3. Absence of complete concentric collapse at the level of the velum documented by awake and drug-induced endoscopy (a predictor of response to surgery).
66
Q

Predictor of response of Upper airway neurostimulation

A

Absence of complete concentric collapse at the level of the velum documented by awake and drug-induced endoscopy

67
Q

TRUE OR FALSE

In OSA, Supplemental oxygen can improve oxygen saturation, but there is little evidence that it improves OSA symptoms or the AHI in unselected patients.

A

TRUE

68
Q

Caused by an increased sensitivity to pCO2, which leads to an unstable breathing pattern that manifests as hyperventilation alternating with apnea.

A

Central sleep apnea

69
Q

With prolonged circulation delay, there is a crescendo-decrescendo breathing pattern known as

A

Cheyne-Stokes breathing

70
Q

Risk factors for Central Sleep Apnea

A
  1. Congestive Heart failure
  2. Opioid (Dose-dependent)
  3. Hypoxia
71
Q

CPAP—particularly at high pressures—seems to
induce central apnea; this condition is referred to as

A

Complex sleep
apnea or treatment-emergent central sleep apnea

72
Q

An independent risk factor for the development of both heart failure and atrial fibrillation

A

Central Sleep Apnea

73
Q

Early marker of subclinical myocardial infarction

A

Central Sleep Apnea

74
Q

TRUE OR FALSE

Supplemental oxygen can reduce the frequency of central apneas, particularly in patients with hypoxemia.

A

TRUE

75
Q
A

PSBIM Harrison 21st Edition (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions