Obstructive Sleep Apnea Flashcards

1
Q

Pulmonary hypertension benchmark

A

Pulmonary arterial pressure is higher than 20 mmHg at rest (normal is 10-14 mmHg)

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

Symptoms of Obstructive sleep apnea

A

Shortness of breath
- most common

Chest pains

Palpitations

RHF signs

Syncope with exertion

Malaise

Cough/hemoptysis

Voice hoarseness due to impingement of the recurrent laryngeal nerve from pulmonary artery (super rare)

Signs:

  • S2 split w/ S3/4 heart sound
  • tricuspid regurgitation murmur
  • JVD
  • hepatomegaly w/ elevated liver enzymes
  • Ascites
  • similar to COPD on flow volume loops
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What benchmark of DLCO is required to start really thinking about pulmonary hypertension?

A

< 40% DLCO

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

Pathophysiology of PH

A

Causes are not completely understood
- thought to be possible narrowing of pulmonary arteries leading to increase pulmonary resistance

Important to diagnosis ASAP since untreated/diagnosed PH = cor pulmonale
- poor prognosis at this point; 5yr survival = 30%

remember to think massive PE as diagnosis If acute rapid PH is present and signs of cor pulmonale occur

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

Classes of pulmonary artery hypertension

A
Group 1: idiopathic (this is PAH)
- 85% is familial genetics with 75% of the 85% is due to loss of BMPR2 receptors 
Other causes in group 1
* drugs 
* connective tissue disorders 
* autoimmune infections (especially HIV)
* portal HTN 
* left-right congenital shunting 

Group 2: LHF (PH)

  • MOST COMMON CLASS OF PH
  • diagnosed with symptoms of LHF and ECG showing sings of RBBB, CHF and LVH
  • current data suggests OSA is here

Group 3: hypoxic vasoconstriction (PH)

  • WHO says THIS IS WHERE OSA IS LOCATED
  • COPD and altitude changes also occur here
  • this is also the group where cor pulmonale is most likely to occur

Group 4: chronic microemboli (PH)

  • VQ mismatches with VQ scan usually diagnosises this
  • perfusion portion = left side
  • ventilation portion = right side

Group 5: everything else (PH)

  • most common are
  • hemolytic anemia
  • systemic diseases such as sarcoidosis
  • metabolic disorders
  • all other congenital heart diseases other than left-right shunting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Definition of sleep apnea

A

Recurrent nocturnal cessation of breathing for at least 10 seconds

Lab finds of OSA

  • neck circumference > 17 inches = OSA
  • elevation RBCs and hematocrit w/ normal WBCs and platelets
  • ABG shows low O2 and possibly high CO2 (not always though)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Sequelae of OSA

A

2nd polycythemia

Systemic HTN

Cardiac arrhythmias

Sudden death

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

Two types of sleep apnea

A

Obstructive (OSA)

  • excessive parapharyngeal tissue
  • being obese
  • adenotonsillar hypertrophy
  • chronic hypoxia/ hypercapneic

Central

  • toxins
  • trauma
  • infections
  • stroke/ bleeding
  • advanced Heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment for obstructive sleep apnea

A

1st is always lifestyle choices

  • lose weight and change diet
  • modify sleeping position
  • avoid alcohol and sedatives

2nd is BiPAPor CPAP

  • BiPAP = use if pneumonia/HF or central causes are present w/ minimal CO2 retention
  • CPAP = use if retaining CO2

Alternative treatments (is 1st and 2nd dont work)

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

Treatment of PAH/PH

A

must determine primary cause 1st and treat that

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