Sleep and Breathing Assessment Flashcards
What are the two phases of sleep
Non rapid eye movement (NREM)
Rapid eye movement (REM)
What are the three stages of NREM
N1: slow rolling eye movement, 5-10% of the sleep period, easy to wake up
N2: EEG tracings showing K complexes and sleep spindles, 40-50% of total sleep, predominant stage of sleep.
N3: considered the deepest stage of sleep. Sleeper may be difficult to arouse. 25% of sleep period. High amplitude waves.
What is REM
Named for the presence of rapid fluttering or rolling of the eyes and is characterized by loss of muscle tone.
25% of total sleep
Dreaming occurs
Skeletal muscle semi paralysis
May result in upper airway obstruction
Reduces VE, may be associated with hypoxemia and hypercapnia
What is a hypersomnolence disorders
Relates to patients who excessive sleepiness and includes narcolepsy
How long does the cessation of airflow have to be to qualify for OSA
10 seconds, < 6 breaths per min
What is an example of a circadian rhythm disorder?
Jet lag and shift work disorder (night shift)
What is a parasomnias
Undesirable physical events or experiences that occur during sleep such as REM behavior disorder, night terrors, and sleep walking
Most common in kids
What is a sleep related movement disorder
Involve movements that disturb sleep
Restless leg syndrome and periodic limb movement disorder
What is restless leg syndrome
Feelings of intense crawling, prickling, tingling, burning, painful aching, etc..
Occurs most often in elderly pts
Iron deficiency is often present
Exacerbated during pregnancy or by caffeine, diabetes, or renal insufficiency
What is periodic limb movement disorder
Repetitive movements of the leg muscles during sleep in a rhythmic pattern
Occurring ~30 seconds apart
Occurs during NREM and stops when pt is awake
When should you see a sleep specialist according to the Epworth Sleepiness Scale
> 9
What does the Berlin Questionaire identify
Sleep apnea risk factors
What does the STOP BANG assessment identify
Quick and effective identification of OSA
During a physical exam what should you look for sleep disorders
Obesity and increased neck circumference
Will have oral airway crowding
Mallampati score
What Mallampati scores are associated with OSA
3 and 4
What is the diagnostic sleep study that provides tracings of various physiologic parameters
Polysomnography
What physiologic parameters are monitored during a polysomnography
EEG: Changes in brain, sleep stages
Electrooculogram (EOG): eye movements, sleep stages REM and NREM
Electromyogram (EMG): muscle activity, chin and legs
EKG: heart rate and arrhythmias
SpO2: oxygen saturation and desat
Snoring microphone: taped to larynx
Airflow thermistor or pressure: nose and mouth, measures airflow or lack of airflow during obstructive event
Ventilatory effort: thoracic belt and abdominal belts to detect rib cage and abdominal motion
Body position, low light video camera for recording
What Apnea-Hypopnea Index (AHI)
Defines number of hypopneas and apneas per hour of sleep time
What is the classifications for the Apnea Hypopnea Index
Normal: AHI <5
Mild: AHI 5-15
Moderate: AHI 15-30
Severe: AHI >30
Risk factors for OSA
Excessive BMI >25
Alcohol consumption before bedtime
Smoking
Nasal congestion at night
Increased neck size
Large tonsils
Males >40 y/o
What classifies as hypopnea
Reduction in airflow of >30% from baseline for at least 10 seconds with at least a 4% reduction in SpO2
OR
A decrease in airflow of at least 50% with either a 3% decrease in SpO2 and or and EEG arousal >3 seconds
What is an EEG arousal
Occurs when a patient sleep is momentarily disrupted and is documented by a change in the EEG tracings during a sleep study
What is EEG arousal in response too?
Changes in the oxygenation and acid base imbalance
Any reduction of airflow ______ of baseline is defined as what?
> 90%
Apnea episode
