Obstructive Sleep Apnea & Obesity Hypoventilation Syndrome

Question 1

How long must breath cessation be to be considered apnea?

Answer 1

At least 10 seconds

Question 2

How much must your oxygen saturation drop in the absence of apnea to be considered abnormal?

Answer 2

At least 4%

Question 3

Type of apnea where ventilatory effort is absent for the duration of the apneic episode.

Answer 3

Central Apnea

Question 4

Type of apnea where ventilatory effort persists throughout the apneic episode, but no airflow occurs because of the transient obstruction of the upper airway.

Answer 4

Obstructive Apnea

Question 5

What are some serious complications of Sleep Apnea?

Answer 5

Cardiac Arrhythmias
HTN
Right-sided heart failure
Secondary Erythrocytosis

Question 6

Partial airflow obstruction often resulting in arousal from sleep.

Answer 6

Hypopnea

Question 7

Number of apneas and or hypopneas per hour of sleep.

Answer 7

Apnea-hypopnea Index

Question 8

Patient-reported questionnaire which may be used to assess patient’s perception of sleepiness.

Answer 8

Epworth Sleepiness Scale

Question 9

Scoring system used in patients with Sleep Apnea that looks for low visibility of the posterior pharynx when the patient opens their mouth.

Answer 9

Modified Mallampati Score 3-4

Question 10

Obstructive Sleep Apnea risk factor that occurs when the top incisor teeth are ahead of the bottom incisors.

Answer 10

Retrognathia
(Increased Overjet)

Question 11

What is the Gold Standard diagnostic test for sleep apnea?

Answer 11

In-lab Polysomnography

Question 12

How many events must be observed within an hour during a Polysomnography to diagnose Sleep Apnea?

Answer 12

5 or more with symptoms
15 or more without symptoms

Question 13

A respiratory disturbance index (RDI) score of what would indicate Mild Sleep Apnea?

Answer 13

5 or more events

Question 14

A respiratory disturbance index (RDI) score of what would indicate Moderate Sleep Apnea?

Answer 14

15 or more events

Question 15

A respiratory disturbance index (RDI) score of what would indicate Severe Sleep Apnea?

Answer 15

30 or more events

Question 16

In patients with Obstructive Sleep Apnea and HTN, what should you screen for?

Answer 16

Primary Aldosteronism

Question 17

What is the treatment of choice for patients with Obstructive Sleep Apnea?

Answer 17

CPAP

Question 18

What medication can be used to improve daytime sleepiness?

Answer 18

Modafinil

Question 19

Chronic condition characterized by:
Obesity
Daytime hypoventilation
Sleep-disordered breathing

Answer 19

Obesity Hypoventilation Syndrome

Question 20

What causes Obesity Hypoventilation Syndrome?

Answer 20

Failure of normal compensatory mechanism to counterbalance consequences of excess weigh on the respiratory system.

Question 21

What are two risk factors for Obesity Hypoventilation Syndrome?

Answer 21

Obesity (especially BMI over 40)
Pre-existing Obstructive Sleep Apnea

Question 22

What are the diagnostic criteria for Obesity Hypoventilation Syndrome?

Answer 22

BMI of 30 or more
Hypoventilation during awake hours
- Hypercapnia ≥ 45 mm Hg

Question 23

What are some symptoms seen in OHS consistent with nocturnal hypoventilation?

Answer 23

Waking Headaches
Peripheral Edema
Hypoxemia (O2 less than 94%)
Unexplained Polycythemia

Question 24

What might you see on physical exam of a patient with OHS?

Answer 24

BMI ≥ 30
Shallow and Rapid Breathing
Neck Circumference ≥ 40cm
Jugular Venous Distention
Peripheral Edema

Question 25

What are the treatment goals for OHS patients.

Answer 25

Reduce Weight
(normalize breathing and improve respiratory drive)

Question 26

What is the first line treatment for OHS?

Answer 26

CPAP