OSA Flashcards
Sleep apnea
Temporary pause in breathing during sleep that last at least 10 seconds.
Should occur a minimum of five times an hour.
Central apnea
Occurs when both airflow and respiratory efforts are absent.
Absent of neural output from brain stem , lack of respiratory effort.
* More common in higher altitudes
* Neurological disease
Obstructive sleep apnea
Respiratory efforts persist although airflow is absent at nose and mouth.
Occurs when tongue and soft palate fall backwards obstruct pharnex partial complete
Mixed apnea
Both central and obstructive pattens
Apnea-hypopnea index
Maybe used to define and quantity severity.
Dividing the total number of events by total sleep times in hours.-capneathypoapnea)
Respiratory disturbance index
Apnea-hypopnea index plus the average number of snoring- related arousal per hour.
Consequences of OSA
Neurobehavioral and cardiovascular morbidity. CAD AFIB CHF SUDDEN CARDIAC ARESST
Epidemiology
30% male- most prevalent in male older than 50.
15% female- post menopause women
38,000 CV disease
#OSA mere comman
Causes
Upper airways malformation Oropharyngeal muscle dysfunction Abnormal respiratory drive Obesity ETOH Family HX Neck size >17 inches in males >16 inches in females
Pathophysiology
REM- de synchronized, low voltage, fast activity that occurs q. 90 minutes after 1-2NDEM.
NREM-
1)slow eye movements; sleep onset
2) slowing sleep spinal
3) low-frequency, high amplitude delta waves, no slow eye movement
OSA character
Loss of REM/NREM alternations ; sleep frequency
Slow REM steep
Subjective
Hypersomlence Morning headaches Neuropsychological Decreased concentration Personality changes Sexual dysfunction Loud snoring MVC Right side heart failure (CENTRAL)
Objective
Obesity Increased neck size Crowed oropharnex Enlarged soft plate HTN
Diagnostic
Subjective questions: Stanford sleepiness score (SSS) Epworrh sleepiness scared (ESS) (MSLT) Overnight sleep study Evaluate for other sleep disorders
Management (OSA)
Weight loss Avoid sediatives , ETOH CPAP/BIPAP/APAP Surgery-adnotonsiectomy Oral appliances Postional therapy
