Sleep

Question 1

Apnea

Answer 1

Episode of breathing cessation for atleast 10 sec

Question 2

Hypopnea

Answer 2

Decrease in airflow more than 30% lasting for 10 sec

Or 3% fall from pre event baseline or an arousal

Question 3

Osa criteria

Answer 3

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

Question 4

What are the other criteria for OSA

Answer 4

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

Question 5

Patho

Answer 5

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

Question 6

Patho continued

Answer 6

Increase of tissue mass around the neck increases the pressure causes collapse
cranio facial morphology
Expiration- more collapse.
Sleep- supine position

Question 7

Risk factors

Answer 7

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

Question 8

Nocturnal symptoms

Answer 8

Snoring
Witnessed apnoea
Choking
Insomnia 
Nocturia

Question 9

Waht are the tests

Answer 9

Subjective- ess
Objective- mslt
Epworth sleepiness scale

Question 10

Other tests

Answer 10

Map index- multivariable apnea prediction
Berlin questionnaire 
Stopbang
Snore.
Tiredness 
Obsevved apnoea
Pressure
Bmi
Age
Neck size
Gender

Question 11

How do u diagnose

Answer 11

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

Question 12

Epworth sleepiness scale

Answer 12

0- would neve doze
1-slight chance of dozing
3- high xhances 
0-24
More than10 abnormal

Question 13

Psg levels

Answer 13

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

Question 14

What is AHI

Answer 14

Avg no of episodes of apnoea/hypopnea /hr
Normal<5
Osa>5
Mild up to 15
Mod 15-30
Severe >30

Question 15

Rera

Answer 15

Evwnt that cause decrease in o2 saturation nkt qualifying as apnea/hypopnea

Question 16

Resp disturbance index

Answer 16

Avg no resp disturbance (apnea, hypopnea, rera) prr hour
5- consider osa
5-20- mild
20-40 mod
40- severe

Question 17

Consequences

Answer 17

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

Question 18

Tests other than psg

Answer 18

Dynamic nasopharyngolaryngoscopy
Ct/mri
Sleep nasoendoscopy

Question 19

Treatment pap

Answer 19

Cpap- indicated in mod to severe sleep apnoea
Mask/humdifier/position

Bipap - with lung disease.
Auto cpap- for titration and determination

Question 20

General rx

Answer 20

Alcohol
Sedatives
Opioids
Good sleep hygiene 
Wt loss- 1%wt decrease -3%change in ahi

Question 21

Other rx options

Answer 21

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

Question 22

How do u quantify sleep

Answer 22

Subjective- stanford sleepiness scale
Ess
Objevtive- mslt