Obstructive Sleep Apnea & Obesity Hypoventilation Syndrome Flashcards
How long must breath cessation be to be considered apnea?
At least 10 seconds
How much must your oxygen saturation drop in the absence of apnea to be considered abnormal?
At least 4%
Type of apnea where ventilatory effort is absent for the duration of the apneic episode.
Central Apnea
Type of apnea where ventilatory effort persists throughout the apneic episode, but no airflow occurs because of the transient obstruction of the upper airway.
Obstructive Apnea
What are some serious complications of Sleep Apnea?
Cardiac Arrhythmias
HTN
Right-sided heart failure
Secondary Erythrocytosis
Partial airflow obstruction often resulting in arousal from sleep.
Hypopnea
Number of apneas and or hypopneas per hour of sleep.
Apnea-hypopnea Index
Patient-reported questionnaire which may be used to assess patient’s perception of sleepiness.
Epworth Sleepiness Scale
Scoring system used in patients with Sleep Apnea that looks for low visibility of the posterior pharynx when the patient opens their mouth.
Modified Mallampati Score 3-4
Obstructive Sleep Apnea risk factor that occurs when the top incisor teeth are ahead of the bottom incisors.
Retrognathia
(Increased Overjet)
What is the Gold Standard diagnostic test for sleep apnea?
In-lab Polysomnography
How many events must be observed within an hour during a Polysomnography to diagnose Sleep Apnea?
5 or more with symptoms
15 or more without symptoms
A respiratory disturbance index (RDI) score of what would indicate Mild Sleep Apnea?
5 or more events
A respiratory disturbance index (RDI) score of what would indicate Moderate Sleep Apnea?
15 or more events
A respiratory disturbance index (RDI) score of what would indicate Severe Sleep Apnea?
30 or more events
In patients with Obstructive Sleep Apnea and HTN, what should you screen for?
Primary Aldosteronism
What is the treatment of choice for patients with Obstructive Sleep Apnea?
CPAP
What medication can be used to improve daytime sleepiness?
Modafinil
Chronic condition characterized by:
Obesity
Daytime hypoventilation
Sleep-disordered breathing
Obesity Hypoventilation Syndrome
What causes Obesity Hypoventilation Syndrome?
Failure of normal compensatory mechanism to counterbalance consequences of excess weigh on the respiratory system.
What are two risk factors for Obesity Hypoventilation Syndrome?
Obesity (especially BMI over 40)
Pre-existing Obstructive Sleep Apnea
What are the diagnostic criteria for Obesity Hypoventilation Syndrome?
BMI of 30 or more
Hypoventilation during awake hours
- Hypercapnia ≥ 45 mm Hg
What are some symptoms seen in OHS consistent with nocturnal hypoventilation?
Waking Headaches
Peripheral Edema
Hypoxemia (O2 less than 94%)
Unexplained Polycythemia
What might you see on physical exam of a patient with OHS?
BMI ≥ 30
Shallow and Rapid Breathing
Neck Circumference ≥ 40cm
Jugular Venous Distention
Peripheral Edema
What are the treatment goals for OHS patients.
Reduce Weight
(normalize breathing and improve respiratory drive)
What is the first line treatment for OHS?
CPAP