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OSA Flashcards

1
Q

What are the two major types of sleep states?

A

Rapid eye movement (REM) and Nonrapid eye movement (NREM) sleep

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2
Q

How is NREM sleep characterized?

A

High-voltage, low-frequency synchronized wave activity with preserved skeletal muscle tonic activity and bursts of 12- to 14-Hz sleep spindles

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3
Q

What initiates NREM sleep?

A

Areas within the basal forebrain, including the preoptic region

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4
Q

What is the role of adenosine in NREM sleep?

A

Regulates metabolic and recovery aspects of NREM sleep within the basal forebrain and thalamocortical regions

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5
Q

What characterizes REM sleep?

A

Wakelike high-frequency, low-amplitude desynchronized activity in the EEG and attenuation of skeletal muscle tonic activity

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6
Q

What happens to neural activity in most brain regions during REM sleep?

A

Most brain regions show substantial increases in neural cell activity and glucose consumption

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7
Q

What are the developmental aspects of sleep in infants?

A

Neonates spend a disproportionate amount of time in REM sleep, and NREM sleep is poorly developed in newborns

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8
Q

What is periodic breathing in preterm neonates?

A

Defined as 3 episodes of apnea lasting longer than 3 seconds, separated by continued respiration over a period of 20 seconds or less

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9
Q

What is the function of the Pre-Botzinger complex?

A

It is a neural center responsible for generating respiratory rhythmic activity

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10
Q

What is a common respiratory pattern seen in neonates during REM sleep?

A

Short apneic episodes lasting less than 5 seconds

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11
Q

What is the significance of hypercapnia in infants?

A

It elicits a sustained ventilatory increase due to an increase in tidal volume

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12
Q

True or False: Neonates predominantly breathe through their mouths.

A

False

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13
Q

What happens to the depth of slow-wave sleep during the first decade of life?

A

It acquires its maximal expression in duration and depth

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14
Q

Fill in the blank: The _______ is responsible for the generation of respiratory rhythmic activity.

A

Pre-Botzinger complex

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15
Q

What is the impact of sleep deprivation on growth hormone secretion?

A

It may interfere with the secretion and regulation of growth hormone

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16
Q

What are peripheral chemoreceptors and where are they located?

A

They are located in the carotid bodies and respond to changes in blood O2 tension and hypercapnia

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17
Q

What phenomenon is associated with sustained hypoxia in neonates?

A

Hypoxic ventilatory roll-off or hypoxic ventilatory decline

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18
Q

What happens to arterial blood O2 levels during the first week of life?

A

They are lowest and increase over the next 1–3 months

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19
Q

What is the role of serotonin in central chemoreception?

A

Serotoninergic pathways are involved in the intrinsic sensory pathways associated with central chemoreception

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20
Q

What is a characteristic of congenital central hypoventilation syndrome (CCHS)?

A

A relative absence of variation of respiratory modulation of heart rate

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21
Q

What happens to the respiratory rate during infancy and early childhood?

A

It decreases exponentially with increasing body weight

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22
Q

What is the typical duration of sleep for a 1-year-old?

A

12–13 hours of sleep primarily during the night with 1 or 2 naps

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23
Q

What is hypoxic ventilatory roll-off?

A

The emergence of a relative ventilatory decline after 5–6 minutes of hypoxic exposure

Also referred to as hypoxic ventilatory decline, particularly prominent during infancy.

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24
Q

What occurs with sustained hypoxia in neonates?

A

An increase in breathing followed by a reduction in ventilation that usually reaches levels below normoxic breathing.

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25
How does the ventilatory response differ between mature children/adults and neonates?
In mature children and adults, the reduction in ventilation usually reaches levels below peak but still higher than baseline room-air breathing.
26
What is the developmental status of premature neonates regarding biphasic response to hypoxia?
Premature neonates show that this biphasic response will persist into the second month of postnatal life.
27
What is the effect of hypoxia on very small preterm neonates?
They may show only a decrease in ventilation with hypoxia.
28
What anatomical parts comprise the upper airway?
Nose, pharynx, larynx, and extrathoracic trachea.
29
What is the role of the upper airway?
Designed for vocalization, ingestion, airway protection, and respiration.
30
What predisposes the upper airway to impaired respiration?
The inherent collapsibility of the pharynx when the regulation of pharyngeal muscles is impaired.
31
What model describes airflow in the upper airway?
Starling resistor model.
32
What is critical closing pressure (Pcrit)?
Pressures at which collapse of the airway occurs.
33
True or False: In normal subjects with low upstream resistance, airflow is limited by Pcrit.
False.
34
How does upper airway collapsibility in children compare to adults?
Upper airway collapsibility in children is reduced compared to adults.
35
What occurs to the upper airway tone during sleep?
Upper airway tone is diminished.
36
What are accessory muscles of respiration?
Upper airway muscles activated by stimuli such as hypoxemia, hypercapnia, and upper airway subatmospheric pressure.
37
What happens to children with OSA during sleep?
They may experience reduced or lacking pharyngeal airway neuromotor responses.
38
What is the typical region of upper airway obstruction in children with OSA?
Retropalatal region – 80% of the time.
39
What is apnea?
Cessation of breathing for 20 seconds or any duration with bradycardia <100 or cyanosis.
40
What is the classic presentation of Congenital Central Hypoventilation Syndrome (CCHS)?
Life-threatening disorder manifesting as sleep-associated respiratory insufficiency and impaired ventilatory responses to hypercapnia and hypoxemia.
41
What is the putative gene underlying CCHS?
Pairedlike homeobox 2B (PHOX2B).
42
What are the main risk factors for OSA in infants?
* Craniofacial abnormalities * Soft tissue infiltration * Neurologic disorders inducing pharyngeal hypotonia.
43
What is the prevalence of OSA in infants?
10% of infants, more frequent in preterm infants.
44
What is the effect of stimuli leading to enhanced proliferation of lymphadenoid tissues?
They are probably implicated in the pathophysiology of OSA.
45
What characterizes the breathing control abnormalities in SIDS cases?
Developmental breathing control abnormalities may be shared with CCHS.
46
What are the two main types of Central Hypoventilation Syndromes?
* Primary (congenital CHS and late-onset CHS) * Secondary.
47
What is the relationship between CCHS and Hirschsprung disease?
Both disorders may relate to abnormal development or migration of neural crest cells.
48
What is the significance of the PHOX2B gene mutation in CCHS?
It manifests an autosomal-dominant mode of inheritance and is critical for embryologic development of the autonomic nervous system.
49
What alterations are seen in autonomic nervous system function in patients with CCHS?
Diffuse alterations including frequent neuro-ocular findings and reduced chemoreceptors.
50
What is the expected outcome for infants with CCHS over time?
Some may mature to adequate breathing during wakefulness, but apnea or hypoventilation persists during sleep.
51
What is predominantly observed in patients with vagal dysfunction?
Signs of vagal withdrawal and baroreflex failure ## Footnote Additionally, there is relative preservation of cardiac and vascular sympathetic function.
52
What is the clinical presentation of infants with CCHS?
Varies greatly depending on severity ## Footnote Some may not breathe at birth and require assisted ventilation.
53
What are common symptoms in infants with CCHS during sleep?
Apnea or hypoventilation ## Footnote These symptoms persist despite apparent improvement over the first few months of life.
54
What are the criteria for diagnosing CCHS?
Include: * Persistent evidence of sleep hypoventilation (PaCO2 >60 mm Hg) * Presentation of symptoms during the first year of life * Absence of other dysfunctions explaining hypoventilation ## Footnote Diagnosis is best achieved through overnight polysomnography.
55
What is a lifelong condition that may require ventilatory support?
Congenital Central Hypoventilation Syndrome (CCHS) ## Footnote Patients may need support while asleep or 24 hours a day.
56
What types of chronic ventilatory support are commonly used for CCHS?
Includes: * Positive pressure ventilation (PPV) * Bilevel positive airway pressure * Negative pressure ventilation ## Footnote Majority use PPV through a permanent tracheotomy.
57
What complications may arise in early preschool-aged children with CCHS?
Neurocognitive deficits ## Footnote Initially attributed to unrecognized hypoxic events during infancy.
58
What are secondary central hypoventilation syndromes associated with?
Conditions like: * Myelomeningocele * Arnold-Chiari malformations ## Footnote These can cause sleep-disordered breathing and are suspected in sudden unexpected deaths.
59
What is a hallmark indicator of obstructive sleep apnea (OSA) in children?
Habitual snoring during sleep ## Footnote Affects as many as 27% of children.
60
What are daytime symptoms of obstructive sleep apnea?
Includes: * Mouth breathing * Difficulty waking * Moodiness * Daytime sleepiness * Cognitive problems ## Footnote Severe cases may lead to developmental delays and death.
61
What are common risk factors for pediatric OSA?
Includes: * Adenotonsillar hypertrophy * Obesity * Craniofacial abnormalities * Neurologic disorders ## Footnote Occurs in all pediatric age groups.
62
What is the prevalence of obstructive sleep apnea in young children?
2 to 4% ## Footnote Peaks between 2–8 years.
63
What is the primary diagnostic tool for obstructive sleep apnea?
Overnight polysomnography ## Footnote It is the only definitive diagnostic approach for OSA.
64
What are potential long-term morbidities associated with untreated OSA in children?
Includes: * Failure to thrive * Frequent O2 desaturations * Pulmonary hypertension * Decreased intellectual function ## Footnote These can lead to serious cardiovascular consequences.
65
What is the first line of treatment for pediatric OSA?
Tonsillectomy and adenoidectomy ## Footnote It has a high immediate curative rate for OSA.
66
What are additional treatment options for obstructive sleep apnea?
Includes: * Nasal CPAP * Supplemental O2 * Uvulopharyngopalatoplasty * Craniofacial reconstructive procedures ## Footnote Nasal CPAP is effective but has low adherence rates.
67
What are the potential complications following tonsillectomy and adenoidectomy?
Upper airway edema, increased secretions, respiratory depression ## Footnote High risk in children <3 years and those with severe OSA.
68
What is the relationship between sleep-disordered breathing and cognitive function in children?
Inverse relationship ## Footnote Frequent snoring can predict poor academic performance later.
69
What mechanism is proposed for cognitive deficits in children with OSA?
Sleep fragmentation and episodic hypoxia affect neurochemical substrates ## Footnote Particularly in the prefrontal cortex, leading to executive dysfunction.
70
What is Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD)?
Consists of hypothalamic dysfunction and late onset of central hypoventilation ## Footnote Not associated with Phox2B mutations.
71
What is the impact of obesity on central chemosensitivity in children with OSA?
Progressively reduces central chemosensitivity ## Footnote Ameliorated by growth hormone therapy and increased muscle mass.
72
What reflex is stimulated by pulmonary stretch receptors?
Hering-Breuer reflex
73
What type of ventilation can remedy issues caused by the Hering-Breuer reflex?
Bilevel positive airway pressure ventilation with a backup rate
74
What is supplemental O2 reserved for?
Temporary palliative measure preceding T&A
75
True or False: Supplemental O2 can be used without monitoring changes in PCO2.
False
76
What condition can occur in patients with OSA when breathing supplemental O2?
Unpredictable and potentially life-threatening hypercapnia
77
What surgical procedure is useful in patients with upper airway hypotonia?
Uvulopharyngopalatoplasty
78
Craniofacial reconstructive procedures are reserved for which patients?
Some children with craniofacial anomalies
79
Name two procedures that may be indicated for airway issues.
* Tongue wedge resection * Epiglottoplasty * Mandibular advancement * Lingual tonsillectomy
80
The role of intraoral appliances and myofunctional therapy in treatment remains _______.
unclear
81
What is the impact of CPAP on the need for tracheostomy?
Now rarely required
82
Intranasal steroids and oral leukotriene receptor modifiers may have a role in symptomatic children with which syndrome?
Upper-airway-resistance syndrome
83
What is an alternative to CPAP in some cases?
High-flow oxygen via a nasal cannula

Kendigs Respiratory Diseases (38 decks)

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