OSA

Question 1

What are the 4 history clues for OSA?

Answer 1

Impaired daytime attention for no reason
Snoring
Witnessed Apnea
Mood alterations

Question 2

What patient population should always be screened for OSA?

Answer 2

Obese patients with depression

Question 3

What are 6 characteristics of the typical OSA patient?

Answer 3

Obese
Large neck
Nasal obstruction
Enlarged tonsils
Narrow oropharynx
Small jaw

Question 4

2 main goals we have for managing OSA patients?

Answer 4

Improve daytime sleepiness and prevent long term complications

Question 5

What are the 3 long term complications resulting from OSA?

Answer 5

More likely to die
More likely to develop cancer
More likely to have a CVA

Question 6

What are 4 lifestyle modifications for OSA?

Answer 6

Lose weight
Avoid alcohol and sedatives a few hours before sleep
Lateral decubitus sleeping position
Intranasal decongestants can help

Question 7

What are the two effects CPAP has on the patient?

Answer 7

Increased intraluminal airway pressure and FRC

Question 8

What are two other tools we can use for the patient besides CPAP?

Answer 8

Mandibular assist device and UPPP

Question 9

How does the mandibular assist device work?

Answer 9

It protrudes the jaw and pulls the tongue forward, opening the airway up

Question 10

What is going on during a UPPP procedure?

Answer 10

They respect part of the oropharynx so the airway is larger

Question 11

What are the 3 main systems being affected by Obesity Hypoventilation Syndrome?

Answer 11

Respiratory, which includes the airway, CNS, and CV

Question 12

What is the problem with the CNS?

Answer 12

Decreased central respiratory drive

Question 13

What is going on with the airway?

Answer 13

OSA

Question 14

What two things are going on with the heart?

Answer 14

CAD and CHF

Question 15

What is going on with the lungs? 4 things

Answer 15

Restrictive chest physiology
PHTN
Hypoxemia and Hypercapnia
Chronic respiratory acidosis with attempted compensation

Question 16

What condition can OHS mimic, but what does the PFT look like?

Answer 16

Mimic COPD, but PFT is restrictive

Question 17

90% of OHS patients have what condition?

Answer 17

OSA

Question 18

OSA with marked hypoxemia can lead to secondary what?

Answer 18

Erythrocytosis

Question 19

What is the most common manifestation of OSA?

Answer 19

Excessive daytime sleepiness

Question 20

What are two tools we can use to screen for OSA?

Answer 20

Epworth sleepiness scale and stop bang questionnaire

Question 21

What is the most important risk factor for OSA?

Answer 21

Obesity

Question 22

What kind of women are at risk for OSA?

Answer 22

Postmenopausal

Question 23

What study is needed to diagnose OSA and what is the confirming test result?

Answer 23

PSG.

Apnea-hypo apnea index greater than 5 confirms OSA.

Question 24

What are the two big time sequelae of untreated OSA?

Answer 24

Heart failure and stroke

Question 25

What are the two cornerstones of therapy for OSA?

Answer 25

Lifestyle changes and CPAP

Question 26

What can we put patients on if CPAP is not comfortable for them?

Answer 26

BIPAP