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Advanced Principles > Obstructive Sleep Apnea > Flashcards

Obstructive Sleep Apnea Flashcards

1
Q

What percentage of patients with OSA are undiagnosed?

A

80-95%

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2
Q

What are the major risk factors for OSA?

A 
Male
Middle Age
Obesity (BMI >30)
Alcohol consumption
Drug-induced sleep
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3
Q

What are the two major factors that cause sleep apnea?

A

Mechanical obstruction of upper airways
Loss of respiratory drive
BOTH

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4
Q

What does a sleep apnea cycle look like?

A

Oxygen desaturation
sympathetic arousal
Awakening, leading to fragmented sleep

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5
Q

What type of sleep is missing when a patient has untreated sleep apnea?

A

REM sleep

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6
Q

What contributes to the loss of tongue tone which leads to an occluded airway?

A

Genioglossus muscle becomes relaxed

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7
Q

What two components contribute to the classification of obstructive sleep apnea?

A

Cessation of air flow but maintain respiratory effort
Abnormal relaxation of the genioglossus and pharyngeal muscles which cause the tongue to fall backwards obstructing the airway

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8
Q

What two components contribute to the classification of central sleep apnea?

A

Cessation of BOTH air flow and respiratory effort

There is a problem in the ventilatory center of the medulla

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9
Q

What two components contribute to the classification of Pickwickian syndrome?

A

Severe chronich OSA leads to cor pulmonale

Related to morbid obesity

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10
Q

What symptoms are associated with Pickwickian syndrome?

A 
Hypersomnolence
Severe hypoxia/hypercarbia
Pulmonary HTN
RV enlargement
Hypervolemia
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11
Q

Why do patients with obstructive sleep apnea complain of morning headaches?

A

Nocturnal CO2 retention and cerebral vasodilation

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12
Q

How is the severity of sleep apnea determined?

A

Number of apneas per hour of sleep

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13
Q

How many apneic episodes per hour would be considered mild sleep apnea?

A

5-15

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14
Q

How many apneic episodes per hour would be considered moderate sleep apnea?

A

15-30

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15
Q

How many apneic episodes per hour would be considered severe sleep apnea?

A

Greater than 30

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16
Q

How long does the patient have to stop breathing before it is considered apnea?

A

Minimum of 10 seconds cessation of breathing

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17
Q

What is hypopnea?

A

Defines by greater than 50% decrease in airflow or oxygen desaturation of greater than 4% for 10seconds or greater

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18
Q

What causes arousal of the patient after experiencing apnea?

A

Either due to the muscle work or the extreme pressure gradient and or hypoxemia

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19
Q

How are the respiratory muscles affected by OSA?

A

Diaphragm and axillary respiratory muscles become completely desynchronized

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20
Q

What occurs during the arousal phase of OSA?

A

Muscle tension is restored and free air exchange is resumed

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21
Q

About how many times can this cycle occur in a patient with severe OSA in one night?

A

300-400 times

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22
Q

What is the gold standard for diagnosing sleep apnea?

A

Polysomnography

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23
Q

How does CPAP help in OSA?

A

Attenuates hemodynamic responses induced by apnea including BP surges and increased SNS activity

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24
Q

How is the level of positive pressure required determined for each patient?

A

Sleep study

25
Q

When would supplemental O2 be required for OSA?

A

Severe arterial oxygen desaturation

26
Q

What is the name of the procedure done for OSA that removes the tonsils, part of the soft palate and the uvula?

A

Uvulopalatopharyngoplasty UPPP (UP3)

27
Q

What is the end goal of the UP3?

A

To enlarge the airway

28
Q

What is another type of surgery to treat OSA using heat to causing scaring of the tissue?

A

Diathermy Palatoplasty

29
Q

What is the end goal of a diathermy palatoplasty?

A

Cause scaring that will contract the tissue and prevent the airway from falling

30
Q

What is a major complaint with both surgeries for OSA?

A

Pain

31
Q

About how many patients with OSA have HTN?

A

About 40%

32
Q

How does OSA affect awake patient that are normally normotensive?

A

Increased sympathetic tone
BP variability
Decreased HR

33
Q

Why do a lot of obese patient have an elevated aldosterone level?

A

Indicated RAAS activated from SNS activated by OSA

34
Q

How does OSA affect the body’s immune response?

A

Increases level of pro inflammatory cytokines
Activated coagulation factors
Increased cholesterol levels

35
Q

What percentage of stoke patients have OSA?

A

70%

36
Q

What percentage of patients with Afib have OSA?

A

50%

37
Q

What is the thought behind OSA causing Afib?

A

Dramatic shifts in cardiac transmural pressures and chamber dimensions caused by forceful ventilatory efforts against an obstructed airway

38
Q

How does OSA affect pregnancy?

A

May be associated with:
Low birth weight
HTN and possible pre eclampsia

39
Q

How does pregnancy predispose a female to OSA?

A

Pregnancy induced changes in the upper airway

40
Q

What gender predominately has OSA?

A

1/3 Males and half as many females

41
Q

What percentage of people are actually aware they have sleep apnea?

A

20%

42
Q

What comorbidities have a strong correlation with OSA?

A

GERD
AF
HTN

43
Q

What screening tool is best to use based on sensitivity and specificity on patients that may have OSA?

A

STOP BANG

44
Q

What does the pneumonic STOP BANG stand for?

A 
Snoring
Tired during day
Observed stop breathing
Pressure (BP)
BMI greater than 35
Age greater than 50
Neck circumference
Gender male
45
Q

What is considered a high risk patient after the STOP BANG tool has been used?

A

Yes to three or more

46
Q

What is considered a low risk patient after the STOP BANG tool has been used?

A

Less than three

47
Q

What are good tools to utilize in order to estimate peri-operative risks in patients with OSA?

A

History
Sleep study
Type of surgery the patient is undergoing
Questionnaire

48
Q

Why should we avoid preoperative sedatives in patients with OSA?

A

Very sensitive to CNS depressants:
Suffer from sleepiness
Elevated SNS tone

49
Q

Why might a patient with OSA be polycythemic?

A

May result from chronic hypoxia

50
Q

What disease process can develop if OSA left untreated causes frequent periods of apnea and hypercarbia?

A

Cor Pulmonale

51
Q

What considerations should the anesthetist take prior to intubating a patient with OSA?

A

The patients are often difficult to mask ventilate and trachea can be more difficult to intubate

52
Q

Why are opioids use limited in patients with OSA?

A

Opioids take away the arousal characteristic in the cycle

53
Q

How should patients with OSA be extubated?

A

Awake, communicating and breathing spontaneously with adequate TV and SpO2

54
Q

What factors might be considered prior to extubating a patient with OSA?

A 
Ease of mask ventilation
East of tracheal intubation
Nasal packing (can't use nasal airway)
55
Q

What is one way that an anesthetist can extubate a patient with OSA with an insurance policy?

A

Leave the airway exchanger in until the patient is fully awake and doing well in the PACU

56
Q

What position should the OSA patient be placed in while extubating?

A

Semi-upright, lateral or prone preferable to supine

57
Q

Why shouldnt we extubate an OSA patient that isn’t fully reversed?

A

Weak diaphragm = weak small airway muscles = obstruction

58
Q

Why should we minimized post operative supplemental O2?

A

It may be used as their drive to breath if chronically hypoxic

59
Q

How much longer should OSA patient be monitored compared to patients without OSA?

A

3hrs longer

Advanced Principles (16 decks)

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