Obstructive Sleep Apnea DSA Flashcards
Obstructive Sleep Apnea is characterized by what symptoms?
-
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.
What is significant about the airways in patients with OSA?
Narrow, which are vulnerable to collapse during sleep.
What is the reason for daytime tiredness in people with OSA?
- 1. Waking up in sleep
- 2. Hyopexemia
- 3. Hypercapnia
Untreated OSA can cause?
1. HTN
2. HF
3. Stroke
Sx of obstructive sleep apnea
- Snoring
- Waking up at night choking/gasping
- Insomnia
- Sweating at night
- ED
- Alterations in mood.
- Neurocognitive decline
PE of OSA patients
- 1. Obese
- 2. Large neck circumfrance
- 3. Nasal obstriction, enlarged tonsils
- 4. Narrow oropharynx
- 5. Macroglossia
- 6. Retro or migrognathia (small jaw)
What is the most common manifestation of OSA?
Excessive daytime sleepiness
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?
Epworth Sleepiness Scale
How often do patients report excessive daytime sleepiness?
NOT OFTEN bc they accomodate to it.
Which questionnaire has been shown to have a high sensitivity and negative predictive value for moderate to severe sleep apnea?
STOP-BANG questionnaire
What is the most important risk factor forobstructive sleep apnea?
Excess body weight
What is the test of choice/needed for the diagnosis of obstructive sleep apnea?
Polysomnography (PSG)
What test is often performed with PSG for sleep staging, assess other causes of apnea and confirm diagnosis?
Electroencephalogram
What does the PSG measure?
What value indicates OSA?
- AHI (apnea-hypopnea index): average number of apnea and hyopnea events/per.
- AHI >5: OSA
What determines severity of OSA?
- AHI
- Degree of sleepiness
- Prescense or absence of CV problems
What will a polysomnography show in a person with central sleep apnea which distinguishes it from obstructive sleep apnea?
Absence of respiratory effort during apnea
_________ can be conducted in the same session as PSG or in a separate study (split-night study).
CPAP (continuous positive airway pressure)
What other tests should be run if patient is experiencing:
- Hypoexemia
- Obesity hyoventilation syndrome (awake pCO2 is more than 45mmHg)
- Cardiopulmonary disease
- 1. Daytime awake pulse Ox
- 2. Arterial blood gases
- 3. CXR or electrocardiography
What are differential diagnoses for obstructive sleep apnea?
- Central sleep apnea
- Upper airway resistance syndrome
- Periodic limb movements of sleep
- Narcolepsy
- Obstructive/restrictive lung disease
- GERD
- Hypothyroidism
- Sinusitis
- HF
- Epilepsy
- Acromegaly
What differential can be seen in patients who are loud snorers and compain with excessive sleepiness, but have a normal AHI?
Upper airway resistance syndrome
What are the major goals of tx for obstructive sleep apnea?
- Improve daytime sleepiness and cognitive performance
- Prevent long-term sequelae
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?
- 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
If moderate to severe OSA persists despite interventions, or if the changes cannot be instituted, what tx should be started?
Nocturnal CPAP
Nocturnal CPAP has what effect on intraluminal airway pressure and FRC?
↑ intraluminal airway pressure and ↑ FRC (functional residual capacity)
What are 4 measures shown to improve adherence when using CPAP?
- Early pt education
- Follow-up
- Heated humidification
- Establishing a comfortable interface for the CPAP device
What is a solution for pt’s that aren’t able to adjust to a nocturnal CPAP prior to surgery?
- bi-level PAP (BiPAP)
- Mandibular assist device (oral devices that open posterior airway space, by protruding lower jaw or holding the tongue forward)
Which tx device may eliminate the need for CPAP in mild/moderate cases of OSA?
Mandibular assist device
What is the most common surgical intervention for OSA to remove obstruction to airflow?
Uvulopalatopharyngoplasty (UPPP)