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CPR Exam 2 > Obstructive Sleep Apnea DSA > Flashcards

Obstructive Sleep Apnea DSA Flashcards

1
Q

Obstructive Sleep Apnea is characterized by what symptoms?

A
  1. Recurrent episodes of partial (hyopnea) or complete (apnea) upper airway obstruction during sleep that causes
    • Hard to concentrate during day
    • Memory problems
    • Increase risk of MVA.
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2
Q

What is significant about the airways in patients with OSA?

A

Narrow, which are vulnerable to collapse during sleep.

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3
Q

What is the reason for daytime tiredness in people with OSA?

A
  • 1. Waking up in sleep
  • 2. Hyopexemia
  • 3. Hypercapnia
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4
Q

Untreated OSA can cause?

A

1. HTN

2. HF

3. Stroke

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5
Q

Sx of obstructive sleep apnea

A
    1. Snoring
    1. Waking up at night choking/gasping
    1. Insomnia
    1. Sweating at night
    1. ED
    1. Alterations in mood.
    1. Neurocognitive decline
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6
Q

PE of OSA patients

A
  • 1. Obese
  • 2. Large neck circumfrance
  • 3. Nasal obstriction, enlarged tonsils
  • 4. Narrow oropharynx
  • 5. Macroglossia
  • 6. Retro or migrognathia (small jaw)
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7
Q

What is the most common manifestation of OSA?

A

Excessive daytime sleepiness

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8
Q

Which validated questionnaire can be used to assess the level of somnolence during daytime activity to help determine need for diagnostic testing for sleep disorders?

A

Epworth Sleepiness Scale

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9
Q

How often do patients report excessive daytime sleepiness?

A

NOT OFTEN bc they accomodate to it.

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10
Q

Which questionnaire has been shown to have a high sensitivity and negative predictive value for moderate to severe sleep apnea?

A

STOP-BANG questionnaire

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11
Q

What is the most important risk factor forobstructive sleep apnea?

A

Excess body weight

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12
Q

What is the test of choice/needed for the diagnosis of obstructive sleep apnea?

A

Polysomnography (PSG)

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13
Q

What test is often performed with PSG for sleep staging, assess other causes of apnea and confirm diagnosis?

A

Electroencephalogram

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14
Q

What does the PSG measure?

What value indicates OSA?

A
  • AHI (apnea-hypopnea index): average number of apnea and hyopnea events/per.
  • AHI >5: OSA
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15
Q

What determines severity of OSA?

A
  1. AHI
  2. Degree of sleepiness
  3. Prescense or absence of CV problems
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16
Q

What will a polysomnography show in a person with central sleep apnea which distinguishes it from obstructive sleep apnea?

A

Absence of respiratory effort during apnea

17
Q

_________ can be conducted in the same session as PSG or in a separate study (split-night study).

A

CPAP (continuous positive airway pressure)

18
Q

What other tests should be run if patient is experiencing:

    1. Hypoexemia
    1. Obesity hyoventilation syndrome (awake pCO2 is more than 45mmHg)
    1. Cardiopulmonary disease
A
  • 1. Daytime awake pulse Ox
  • 2. Arterial blood gases
  • 3. CXR or electrocardiography
19
Q

What are differential diagnoses for obstructive sleep apnea?

A
  1. Central sleep apnea
  2. Upper airway resistance syndrome
  3. Periodic limb movements of sleep
  4. Narcolepsy
  5. Obstructive/restrictive lung disease
  6. GERD
  7. Hypothyroidism
  8. Sinusitis
  9. HF
  10. Epilepsy
  11. Acromegaly
20
Q

What differential can be seen in patients who are loud snorers and compain with excessive sleepiness, but have a normal AHI?

A

Upper airway resistance syndrome

21
Q

What are the major goals of tx for obstructive sleep apnea?

A
  • Improve daytime sleepiness and cognitive performance
  • Prevent long-term sequelae
22
Q

What are 4 lifestyle modifications which should be used in the tx of obstructive sleep apnea (i.e., obese, alcohol, sleep position, and OTC’s?

A
  • Obese? Lose 10% or more (may ↑ size of airway)
  • Avoid alcohol and sedatives 3-4 hrs prior to bed
  • Lateral decubitus sleeping position- on side- (keeps airways from collapsing)

- Intranasal steroid/decongestants

23
Q

If moderate to severe OSA persists despite interventions, or if the changes cannot be instituted, what tx should be started?

A

Nocturnal CPAP

24
Q

Nocturnal CPAP has what effect on intraluminal airway pressure and FRC?

A

↑ intraluminal airway pressure and ↑ FRC (functional residual capacity)

25
Q

What are 4 measures shown to improve adherence when using CPAP?

A
  • Early pt education
  • Follow-up
  • Heated humidification
  • Establishing a comfortable interface for the CPAP device
26
Q

What is a solution for pt’s that aren’t able to adjust to a nocturnal CPAP prior to surgery?

A
  • bi-level PAP (BiPAP)
  • Mandibular assist device (oral devices that open posterior airway space, by protruding lower jaw or holding the tongue forward)
27
Q

Which tx device may eliminate the need for CPAP in mild/moderate cases of OSA?

A

Mandibular assist device

28
Q

What is the most common surgical intervention for OSA to remove obstruction to airflow?

A

Uvulopalatopharyngoplasty (UPPP)

CPR Exam 2 (29 decks)

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