Sleep Flashcards
Apnea
Episode of breathing cessation for atleast 10 sec
Hypopnea
Decrease in airflow more than 30% lasting for 10 sec
Or 3% fall from pre event baseline or an arousal
Osa criteria
Ahi 5 /hr and persistent complaints of excessive data and sleepiness and un-refreshing sleep or fatigue
Presence of episodes of upper Airway obstruction during sleep
What are the other criteria for OSA
10 to 14 per hour or if between 5 to 14 documented hypertension CAD stroke complaining of excessive day time sleepiness and impaired cognition ,mood disorder or insomnia
Patho
Multiple potential sites of collapse, small caliber
Lateral diameter decreased
Nexk circumference- large tongue soft palette pharyngeal wall total upper Airways of tissues causes narrowing neck
Patho continued
Increase of tissue mass around the neck increases the pressure causes collapse
cranio facial morphology
Expiration- more collapse.
Sleep- supine position
Risk factors
Bmi more than 30 Neck 17 male 16 female Male Anatomy Macroglossia Tonsil/dns/retro, Micrognathia Mallampatti 3-4 Endocrine- hypo/pcod/acromegaly Alcohol,sedatucev, hypnotic
Nocturnal symptoms
Snoring Witnessed apnoea Choking Insomnia Nocturia
Waht are the tests
Subjective- ess
Objective- mslt
Epworth sleepiness scale
Other tests
Map index- multivariable apnea prediction Berlin questionnaire Stopbang Snore. Tiredness Obsevved apnoea Pressure Bmi Age Neck size Gender
How do u diagnose
Symptoms- nocturnal +day time
Physical 4 points- neck bmi mms , upperairway
Assessment of eds- mslt. Epworth
Clinical prediction score- stop bang
Berlin and modified
Asa check list- physical , Symptoms,somnolosence.
Sleep studies
Epworth sleepiness scale
0- would neve doze 1-slight chance of dozing 3- high xhances 0-24 More than10 abnormal
Psg levels
4 levels At institute- attended Eeg. Eog, ecg, emg , flow , movt, spo2 2- same at home 3 - only physiological parameters 4- one or two spo2, hr, airflow
What is AHI
Avg no of episodes of apnoea/hypopnea /hr Normal<5 Osa>5 Mild up to 15 Mod 15-30 Severe >30
Rera
Evwnt that cause decrease in o2 saturation nkt qualifying as apnea/hypopnea
Resp disturbance index
Avg no resp disturbance (apnea, hypopnea, rera) prr hour 5- consider osa 5-20- mild 20-40 mod 40- severe
Consequences
Lipid peroxidation- nerve damage
Ne dysfunction- lower no levels
Dysregulated endotheliwm- hc and atherosclerosis
Sleep fragmentation- dec cognitive function, attention
Cve- sympathetic surges
Htn,cad, chf, arrythmia, cva,
Metabolic- obesity. Glucose. Lipid.insulin resistance
Tests other than psg
Dynamic nasopharyngolaryngoscopy
Ct/mri
Sleep nasoendoscopy
Treatment pap
Cpap- indicated in mod to severe sleep apnoea
Mask/humdifier/position
Bipap - with lung disease.
Auto cpap- for titration and determination
General rx
Alcohol Sedatives Opioids Good sleep hygiene Wt loss- 1%wt decrease -3%change in ahi
Other rx options
Tounge retainer
Palatal kifting device
Mandibular advancing device
Saluvation/pain/discomfort
Position therapy- raised head, lat decubitus
Nasal epap - one way mech valve , provides exp resistance
Pharynegal muscle activation
Surgery- site of obstruction
Septoplasty/ tonsil/uvulopalatopharyngoplasty/sliding genioplasty/trach/mandibular advancement
How do u quantify sleep
Subjective- stanford sleepiness scale
Ess
Objevtive- mslt
