Perioperative Obstructive Sleep Apnea (OSA) Flashcards
What are the primary physical causes of OSA in adults? And in children?
Adults: obesity
Children: tonsils hypertrophy or enlargement
Approximately how many muscles are in the pharynx?
More than 20.
During sleep, neuronal stimulation to which muscles are decreased?
pharyngeal dilator muscles
During which cycle of sleep do we see the most decrease in neuronal stimulation to the pharyngeal dilator muscles?
REM sleep
What are some functions of the pharynx?
- funnel food to esophagus
- speech resonator for phonation
- channel for respiratory airflow
T/F. The pharynx is not supported by bony musculature.
True
What are the two animal species that could have OSA?
- flat-faced dogs (eg. bugs, bull dogs)
- humans
Name 3 areas of airway collapse. Which one is the most common?
- retropalatal: most common
- retroglossal
- hypopharyngeal
What are the biomechanical forces supporting airway patency?
- neuronal stimulation to the pharyngeal dilators
- low extra-luminal pressure
- higher lung volumens
- posture
What are the biomechanic forces opposing airway patency?
- 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
T/F. OSA is the most common sleep disorder in adults.
True
____% of males and ____% of females have OSA.
11.4% males, 4.7% females
Define apnea and hypopnea.
Apnea: cessation or total obstruction of breathing
Hypopnea: reduction in breathing death or frequency
What are some cardic co-morbid conditions with sleep apnea?
- hypertension
- bi-ventricular heart failure
- ischemic heart diseases
- atrial fibrillation
- cardiac dysrhythmias
What are some pulmonary co-morbid conditions with sleep apnea?
- asthma
- pulmonary hypertension
What are some neurological co-morbid conditions with sleep apnea?
- transient ischemic attack
- cerebral vascular accident
What are some neurocognitive co-morbid conditions with sleep apnea?
- daytime hyper-somnolence: chronically tired or fatigue bc of not getting good sleep
- memory impairment
- concentration difficulties
What are some hormonal(endocrine) and metablic co-morbid conditions with sleep apnea?
- DM II
- Metabolic syndrome
- hypothroidism
- cortisol, stress hormone dysregulation
- obesity
- Pickwickian syndrome: “Fat Boy”; obese, chronically tired, snored loudly, HTN, DM, CHF
Name the risk factors for OSA.
- male gender
- smokers
- obesity
- older patients
What is the Apnea-Hypopnea Index (AHI)?
Total number of obstructions per hour of sleep
Name the 3 OSA classifications and their respective AHI critera.
- Mild: 5-15 AHI
- Moderate: 15-30 AHI
- Severe: >30 AHI
OSA Screening
S_____
T_____
O_____
P_____
High risk for OSA with ___ or more criteria.
Snoring
Tired
Observed apnea
Pressure elevation
2 or more- high risk for OSA
OSA Screening
B____
A____
N____
G____
BMI > 35
Age > 50
Neck circumference > 40cm
Gender= male
High risk for OSA with 3 or more (STOP-BANG)
What does it mean when the STOP-BANG Screening has a specificity of 43%?
It means a fair number of ppl tested postive on STOP-BANG, but yet have a negative in-house sleep study.
“False Positive”
