OSA

Question 1

what is OSA?

Answer 1

involuntary cessation of breathing during sleep d/t physical airway obstruction

Question 2

no. of events/hour to be mild vs moderate vs severe OSA

Answer 2

• mild 5-14.9
• moderate 15- 29.9
• severe 30+

Question 3

what drives the CV consequences we see with OSA

Answer 3

hypoxia

Question 4

two complications of OSA that can also be seen

Answer 4

pulmonary HTN
arrhythmia

Question 5

what is the strongest risk factor for OSA? what are the other two?

Answer 5

• strongest is obesity (BMI over 40)
• age
• males

Question 6

most common sx of OSA in the male population is….

Answer 6

erectile dysfunction

Question 7

sx of OSA

Answer 7

• snoring
• unrestful sleep or insomnia
• nocturnal choking
• morning headaches

not conclusive

Question 8

neck circumference over ____ inches is often seen with OSA (diff number for male vs female)

Answer 8

17 males, 16 females

Question 9

____ is the most common predictor of OSA in kids

Answer 9

retrognathia

Question 10

4 apnea effects

Answer 10

• chronic intermittent hypoxia (CIH)
• arousals/sleep fragmentation (SF)
• increased work of breathing (WOB)
• stress on left ventricle–> decreased coronary blood flow

Question 11

tool used to screen for OSA by quantifying patients perception of fatigue and sleep

Answer 11

Epworth sleepiness scale (ESS)

Question 12

score needed to be abnormal on the ESS scale

Answer 12

11+

Question 13

gold standard diagnostic tool for OSA

Answer 13

in-lab polysomnography

Question 14

what result on PSG is indicative of obstructive apnea (ie. a ____ % decrease in airflow for 10+ secs)

Answer 14

• a 90% decrease in airflow for 10+ secs

Question 15

what result on PSG is indicative of obstructive hypopnea (2)

Answer 15

• a 30% decrease in nasal pressure for 10+ secs
• 4% desaturation

Question 16

name the two diagnostic tools used with OSA? (NOT the screening tool)

Answer 16

• PSG
• home sleep testing type 3

Question 17

when do we tx OSA??

Answer 17

• moderate or severe OSA
• mild OSA if any of these 6: HTN, stroke, insomnia, mood d/o, ischemic heart dz, excessive daytime sleepiness

Question 18

4 treatment options for OSA

Answer 18

• CPAP
• oral appliances
• hypoglossal nerve simulation
• surgery (PPP)

Question 19

when are hypoglossal nerve stimulators used? (4)

Answer 19

• in mod-severe OSA OR
• nonadherent to CPAP OR
• BMI under 32 OR
• otherwise healthy

Question 20

when are oral appliances typically used

Answer 20

• alternative for CPAP in mild OSA and snoring

Question 21

how does CPAP work?

Answer 21

acts as airway stent by splinting the upper airway open

Question 22

two benefits of CPAP

Answer 22

• reduces wakefulness SNA
• improves endothelium dependent vasodilation