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Week 7 Physiology > Perioperative Obstructive Sleep Apnea (OSA) > Flashcards

Perioperative Obstructive Sleep Apnea (OSA) Flashcards

1
Q

What are the primary physical causes of OSA in adults? And in children?

A

Adults: obesity

Children: tonsils hypertrophy or enlargement

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2
Q

Approximately how many muscles are in the pharynx?

A

More than 20.

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3
Q

During sleep, neuronal stimulation to which muscles are decreased?

A

pharyngeal dilator muscles

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4
Q

During which cycle of sleep do we see the most decrease in neuronal stimulation to the pharyngeal dilator muscles?

A

REM sleep

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5
Q

What are some functions of the pharynx?

A
  • funnel food to esophagus
  • speech resonator for phonation
  • channel for respiratory airflow
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6
Q

T/F. The pharynx is not supported by bony musculature.

A

True

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7
Q

What are the two animal species that could have OSA?

A
  • flat-faced dogs (eg. bugs, bull dogs)
  • humans
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8
Q

Name 3 areas of airway collapse. Which one is the most common?

A
  • retropalatal: most common
  • retroglossal
  • hypopharyngeal
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9
Q

What are the biomechanical forces supporting airway patency?

A
  • neuronal stimulation to the pharyngeal dilators
  • low extra-luminal pressure
  • higher lung volumens
  • posture
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10
Q

What are the biomechanic forces opposing airway patency?

A
  • low lung volumes: eg. morbidly obese pt with low FRC
  • increased extra-luminal pressure: eg. with redundant tissue
  • supine position
  • residual neuromuscular blockade
  • sedatives and narcotics
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11
Q

T/F. OSA is the most common sleep disorder in adults.

A

True

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12
Q

____% of males and ____% of females have OSA.

A

11.4% males, 4.7% females

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13
Q

Define apnea and hypopnea.

A

Apnea: cessation or total obstruction of breathing

Hypopnea: reduction in breathing death or frequency

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14
Q

What are some cardic co-morbid conditions with sleep apnea?

A
  • hypertension
  • bi-ventricular heart failure
  • ischemic heart diseases
  • atrial fibrillation
  • cardiac dysrhythmias
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15
Q

What are some pulmonary co-morbid conditions with sleep apnea?

A
  • asthma
  • pulmonary hypertension
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16
Q

What are some neurological co-morbid conditions with sleep apnea?

A
  • transient ischemic attack
  • cerebral vascular accident
17
Q

What are some neurocognitive co-morbid conditions with sleep apnea?

A
  • daytime hyper-somnolence: chronically tired or fatigue bc of not getting good sleep
  • memory impairment
  • concentration difficulties
18
Q

What are some hormonal(endocrine) and metablic co-morbid conditions with sleep apnea?

A
  • DM II
  • Metabolic syndrome
  • hypothroidism
  • cortisol, stress hormone dysregulation
  • obesity
  • Pickwickian syndrome: “Fat Boy”; obese, chronically tired, snored loudly, HTN, DM, CHF
19
Q

Name the risk factors for OSA.

A
  • male gender
  • smokers
  • obesity
  • older patients
20
Q

What is the Apnea-Hypopnea Index (AHI)?

A

Total number of obstructions per hour of sleep

21
Q

Name the 3 OSA classifications and their respective AHI critera.

A
  • Mild: 5-15 AHI
  • Moderate: 15-30 AHI
  • Severe: >30 AHI
22
Q

OSA Screening

S_____

T_____

O_____

P_____

High risk for OSA with ___ or more criteria.

A

Snoring

Tired

Observed apnea

Pressure elevation

2 or more- high risk for OSA

23
Q

OSA Screening

B____

A____

N____

G____

A

BMI > 35

Age > 50

Neck circumference > 40cm

Gender= male

High risk for OSA with 3 or more (STOP-BANG)

24
Q

What does it mean when the STOP-BANG Screening has a specificity of 43%?

A

It means a fair number of ppl tested postive on STOP-BANG, but yet have a negative in-house sleep study.

“False Positive”

25
Q

What is the gold standard for OSA diagnosis? And why is it useful?

A

A polysomnography. For diagnosis and classification of severity, and titration of CPAP

26
Q

What is the prevalence of OSA in general population? What percent of patients presenting for surgery with OSA are undiagnosed?

A

2-25%. 70-80%

27
Q

What are some post-operative adverse outcomes of patients with sleep apnea?

A
  • hypoxia
  • respiratory arrest
  • ischemia
  • delirium
  • cardiac arrest
  • death
28
Q

Describe the OSA Arrest Loop

A

Snoring or snorking(profound snoring, almost completely obstructed) -> self-correcting apnea -> non-self correcting apnea -> decreased level of consciousness

29
Q

Ways for OSA Risk Reduction

A

Patient screening, classification, and treatment

Pre and Post-Op CPAP compliance

Prolonged PACU Observation

In-patient oximetry, capnography, ECG monitoring

30
Q

Patient with OSA are more sensitive to which type of drugs?

A

Benzodiazepines. They depress CNS activity and increase in supraglottic airway resistance.

31
Q

Which anesthetic agent has shown to increase obstruction when used with propofol?

A

Isoflurane

32
Q

Propofol, when added with which anesthetic gas, increase incidence in postoperative desaturation?

A

Isoflurane

33
Q

What is unique about the drug clonidine? Name one other analog.

A
  • decreased perioperative anesthetics and analgesic requirements
  • sedation
  • analgesia
  • maintain respiratory drive
  • dexmedetomidine
34
Q

What are some recommendations for OSA patients presenting for surgery?

A
  • Pts who screen at risk should undergo polysomnography to access severity
  • CPAP or BiPAP in the perioperative period
  • perioperative weight loss
  • preoperative medication
  • preoperative use of mandbular advancement or oral supplies

Week 7 Physiology (2 decks)

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