Sleep and Breathing Assessment

Question 1

What are the two phases of sleep

Answer 1

Non rapid eye movement (NREM)
Rapid eye movement (REM)

Question 2

What are the three stages of NREM

Answer 2

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.

Question 3

What is REM

Answer 3

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

Question 4

What is a hypersomnolence disorders

Answer 4

Relates to patients who excessive sleepiness and includes narcolepsy

Question 5

How long does the cessation of airflow have to be to qualify for OSA

Answer 5

10 seconds, < 6 breaths per min

Question 6

What is an example of a circadian rhythm disorder?

Answer 6

Jet lag and shift work disorder (night shift)

Question 7

What is a parasomnias

Answer 7

Undesirable physical events or experiences that occur during sleep such as REM behavior disorder, night terrors, and sleep walking

Most common in kids

Question 8

What is a sleep related movement disorder

Answer 8

Involve movements that disturb sleep

Restless leg syndrome and periodic limb movement disorder

Question 9

What is restless leg syndrome

Answer 9

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

Question 10

What is periodic limb movement disorder

Answer 10

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

Question 11

When should you see a sleep specialist according to the Epworth Sleepiness Scale

Answer 11

> 9

Question 12

What does the Berlin Questionaire identify

Answer 12

Sleep apnea risk factors

Question 13

What does the STOP BANG assessment identify

Answer 13

Quick and effective identification of OSA

Question 14

During a physical exam what should you look for sleep disorders

Answer 14

Obesity and increased neck circumference

Will have oral airway crowding

Mallampati score

Question 15

What Mallampati scores are associated with OSA

Answer 15

3 and 4

Question 16

What is the diagnostic sleep study that provides tracings of various physiologic parameters

Answer 16

Polysomnography

Question 17

What physiologic parameters are monitored during a polysomnography

Answer 17

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

Question 18

What Apnea-Hypopnea Index (AHI)

Answer 18

Defines number of hypopneas and apneas per hour of sleep time

Question 19

What is the classifications for the Apnea Hypopnea Index

Answer 19

Normal: AHI <5
Mild: AHI 5-15
Moderate: AHI 15-30
Severe: AHI >30

Question 20

Risk factors for OSA

Answer 20

Excessive BMI >25
Alcohol consumption before bedtime
Smoking
Nasal congestion at night
Increased neck size
Large tonsils
Males >40 y/o

Question 21

What classifies as hypopnea

Answer 21

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

Question 22

What is an EEG arousal

Answer 22

Occurs when a patient sleep is momentarily disrupted and is documented by a change in the EEG tracings during a sleep study

Question 23

What is EEG arousal in response too?

Answer 23

Changes in the oxygenation and acid base imbalance

Question 24

Any reduction of airflow ______ of baseline is defined as what?

Answer 24

> 90%

Apnea episode