OSA

Question 1

What is OSA

Answer 1

Characterized by episodes of complete airway collapse of partial collapse associated with decrease in O2 or arousal from sleep

Question 2

What is the most common cause of OSA in children

Answer 2

enlarged tonsils / adenoids

Question 3

What is the most common association of OSA in adults

Answer 3

obesity
Males (17+ inch neck)
advancing age

Question 4

What is the pathophys of OSA

Answer 4

Episode of apnea is caused by at least 90% anterior to posterior collapse of the airway >10sec

Question 5

What is a typical presentation of OSA

Answer 5

Excessive daytime sleepiness
loud nightly snoring
overweight
night sweating
night time reflux

Question 6

What may be see on physical exam with OSA

Answer 6

Large neck
large tongue
crowded oropharynx
retrognathism

Question 7

What is class 1 mallampati score

Answer 7

complete visualization of soft palate

Question 8

What is class 2 mallampati score

Answer 8

complete visualization of uvula

Question 9

What is class 3 mallampati score

Answer 9

visualization of only the base of the uvula

Question 10

What is class 4 mallampati score

Answer 10

soft palate is not visible at all

Question 11

What is the presentation of OSA in children

Answer 11

hyperactive rather than sleepy
loud nightly snoring
academic difficulties

Question 12

What may be seen in PE of kids of OSA

Answer 12

Adenoid facies
tonsils hypertrophy
hypo-nasal speech
high arched palate

Question 13

Which patients should be screened for OSA regardless of symptoms

Answer 13

any patients with hypotonia (downs syndrome)

Question 14

What is the Hepworth sleepiness scale

Answer 14

indicator of inadequate restorative nighttime sleep
*score >10 suggest sleep disorder rather than general fatigue

Question 15

What is the use of the Berlin questionnaire

Answer 15

predicts high or low likelihood OSA

Question 16

What is the STOP-BANG score

Answer 16

most specific criteria for OSA
*3+ positive answers is considered high risk of OSA and should be referred for further eval

Question 17

How can you workup sleep apnea

Answer 17

Nighttime in lab polysomnography (PSG) - gold standard

Question 18

What is the criteria for hypopnea

Answer 18

Reduction in airflow >30% for more than 10sec with >4% O2 desaturation

Reduction in airflow >30% for more than 10sec with >3% O2 desaturation or an arousal from sleep on EEG

Question 19

What is the home sleep test

Answer 19

Higher accessibility and lower cost than PSG

Question 20

What is the downfall of home sleep tests

Answer 20

can miss mild OSA

Question 21

What is Apnea-hypopnea index (AHI)

Answer 21

average number of obstructive events per hour

Question 22

What AHI gives you the dx of OSA

Answer 22

> 15 events/hour

Question 23

What is moderate OSA AHI score

Answer 23

15-30 events/houe

Question 24

If someone has 30+ obstructive events per hour, what is their OSA dx

Answer 24

severe

Question 25

If a patient has <5 obstructive events at night... what is their DX

Answer 25

mild OSA IF there is excessive daytime drowsiness, sleep maintenance insomnia, or cognitive dysfunction is reported

Question 26

What is the AHI criteria for children with OSA

Answer 26

Mild = 1-4.9 events/hour & clinical sequela Moderate = 5-10 Severe = 10+

Question 27

What is the most effective tx for sleep apnea

Answer 27

CPAP

Question 28

If someone is adherent to CPAP, what will the outcome be

Answer 28

near resolution of symptoms

Question 29

who is BiPAP used for

Answer 29

severe OSA

Question 30

When is surgery used with OSA

Answer 30

Severe Unable to tolerate treatment modalities

Question 31

Is weight loss curative with OSA

Answer 31

no but it is recommended when obese

Question 32

What is the primary treatment of OSA in children

Answer 32

tonsillectomy and adenoidectomy

Question 33

If a child has mild OSA, what may their treatment be

Answer 33

trial of montelukast and nasal steroids may reduce AHI goal

Question 34

What are the surgical options for OSA

Answer 34

Uvulopalatopharyngoplasty (UPPP) Drug-induced sleep endoscopy (DISE) maxillomandibular advancement (MMA) Implantable hypoglossal nerve stimulator (inspire)

Question 35

Who is inspire useful for

Answer 35

if CPAP cannot be used moderate to severe OSA At least 18 y/o not significantly overweight

Question 36

What is the STAR clinical trial

Answer 36

stimulation therapy for apnea reduction

Question 37

What is treatment for extreme cases of OSA

Answer 37

tracheostomy