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clin med pulmonology > OSA > Flashcards

OSA Flashcards

1
Q

What is OSA

A

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

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2
Q

What is the most common cause of OSA in children

A

enlarged tonsils / adenoids

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3
Q

What is the most common association of OSA in adults

A

obesity
Males (17+ inch neck)
advancing age

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4
Q

What is the pathophys of OSA

A

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

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5
Q

What is a typical presentation of OSA

A

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

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6
Q

What may be see on physical exam with OSA

A

Large neck
large tongue
crowded oropharynx
retrognathism

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7
Q

What is class 1 mallampati score

A

complete visualization of soft palate

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8
Q

What is class 2 mallampati score

A

complete visualization of uvula

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9
Q

What is class 3 mallampati score

A

visualization of only the base of the uvula

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10
Q

What is class 4 mallampati score

A

soft palate is not visible at all

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11
Q

What is the presentation of OSA in children

A

hyperactive rather than sleepy
loud nightly snoring
academic difficulties

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12
Q

What may be seen in PE of kids of OSA

A

Adenoid facies
tonsils hypertrophy
hypo-nasal speech
high arched palate

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13
Q

Which patients should be screened for OSA regardless of symptoms

A

any patients with hypotonia (downs syndrome)

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14
Q

What is the Hepworth sleepiness scale

A

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

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15
Q

What is the use of the Berlin questionnaire

A

predicts high or low likelihood OSA

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16
Q

What is the STOP-BANG score

A

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

17
Q

How can you workup sleep apnea

A

Nighttime in lab polysomnography (PSG) - gold standard

18
Q

What is the criteria for hypopnea

A

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

19
Q

What is the home sleep test

A

Higher accessibility and lower cost than PSG

20
Q

What is the downfall of home sleep tests

A

can miss mild OSA

21
Q

What is Apnea-hypopnea index (AHI)

A

average number of obstructive events per hour

22
Q

What AHI gives you the dx of OSA

A

> 15 events/hour

23
Q

What is moderate OSA AHI score

A

15-30 events/houe

24
Q

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

A

severe

25
Q

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

A

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

26
Q

What is the AHI criteria for children with OSA

A

Mild = 1-4.9 events/hour & clinical sequela

Moderate = 5-10

Severe = 10+

27
Q

What is the most effective tx for sleep apnea

A

CPAP

28
Q

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

A

near resolution of symptoms

29
Q

who is BiPAP used for

A

severe OSA

30
Q

When is surgery used with OSA

A

Severe

Unable to tolerate treatment modalities

31
Q

Is weight loss curative with OSA

A

no but it is recommended when obese

32
Q

What is the primary treatment of OSA in children

A

tonsillectomy and adenoidectomy

33
Q

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

A

trial of montelukast and nasal steroids may reduce AHI goal

34
Q

What are the surgical options for OSA

A

Uvulopalatopharyngoplasty (UPPP)

Drug-induced sleep endoscopy (DISE)

maxillomandibular advancement (MMA)

Implantable hypoglossal nerve stimulator (inspire)

35
Q

Who is inspire useful for

A

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

36
Q

What is the STAR clinical trial

A

stimulation therapy for apnea reduction

37
Q

What is treatment for extreme cases of OSA

A

tracheostomy

clin med pulmonology (12 decks)

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