Sleep Apnea

Question 1

Sleep Apnea

Answer 1

A temporary pause in breathing during sleep that last at least 10 seconds. Should occur a minimum of 5 times within an hour

Question 2

Central Apnea

Answer 2

Occurs when both airflow and respiratory efforts are absent. Result from an a neural output from the brainstems respiratory control center

More common in those who live at high altitudes

Seen neurological disease

Question 3

Obstructive Sleep Apnea

Answer 3

Respiratory efforts persist although airflow is absent at the nose and mouth. Tongue and soft palate fall backwards and obstruct the pharynx partially or completely

Question 4

Mixed apnea

Answer 4

Both central and obstructive sleep apnea

Question 5

Apnea-hypopnea index

Answer 5

Dividing the total number of events (apnea episodes plus hypopnea episodes) through out the entire night by the number of total hours slept

Question 6

Respiratory disturbance index

Answer 6

The AHI plus the average number of snoring related arousals per hour

Question 7

Diagnosis of OSA

Answer 7

• AHI or RDI greater than or equal to 5 less than 14 of comorbid factors such as excessive daytime sleepiness, hypertension, stroke, or heart failure are present
• AHI or RDI greater than or equal to 15 in the absence of comorbid factors

Question 8

Consequences of OSA

Answer 8

Long term Neuro behavioral and cardiovascular morbidity
Risk for hypertension
Increased cardiac risk ( especially CAD patients)
Cardiac dysthymias
P. 363

Question 9

Epidemiology

Answer 9

• OSA 30 % in adult male, 15% female population
• 38,000 deaths are directly attributed to OSA
• most prevalent in men older than 50 and in post menopausal women
• OSA more common than central

Question 10

Causes

Answer 10

• upper airway tract malformation, oropharyngeal muscle dysfunction and abnormal respiratory drive
• family history
• obesity and alcohol consumption (aggravating factors)
• neck size ( men larger than 17 inches, and women greater than 16

Question 11

REM

Answer 11

Rapid Eye Movement
Characterized by desynchronized low voltage, fast activity
Occurs every 90 minutes after 1-2 hours of NREM
REM episodes get longer each time

Question 12

NREM

Answer 12

Stage 1: slow eye movements preceding sleep
Stage 2: slowing, sleep spindles and slow eye movement
Stage 3: low frequency, high amplitude delta waves with occasional sleep spindles but no slow eye movements

Question 13

Sleep in OSA

Answer 13

Characterized by loss of physiological REM/NREM alteration, as well as by a defector of REM and slow wave sleep

Question 14

Subjective Data

Answer 14

Daytime sleepiness
Hypersomnolence
Morning headache
Decreased concentration
Personality changes
Sexual dysfunction 
Loud snoring
Automobile accidents
Right sided heart failure (central apnea)

Question 15

Objective Data

Answer 15

Obesity
Increased neck size
Crowded oropharynx
Hypertensive
Enlarged soft plate

Question 16

Diagnostics

Answer 16

Subjective: questionnaires such as Stanford sleepiness or Epworth sleepiness scale

Objective: overnight polysomnogram (sleep study)
MSLT( if sleep study negative, evaluate for other sleep disorders)

Question 17

Management OSA

Answer 17

Avoidance of alcohol, sedatives, narcotics, pain medications,  hypnotics 
Weight loss
Positional therapy
Oral appliances
CPAP
BILevel BIpap
Autorotating pap
Surgery (adenotonsillectomy) upper airway

Question 18

Management Central Sleep Apnea

Answer 18

CPAP (not always responsive)
Diaphragm pacing device (tracheostomy often performed with diaphragm pacing)
BIpap

Question 19

Follow Up

Answer 19

COPD often with sleep apnea (overlap syndrome)

Increased risk of nocturnal mortality in patients with COPD

Question 20

Patient education

Answer 20

Education on use of CPAP and compliance
Teach family about CPAP
Emotional support
Weight loss (nutritional counseling)
Follow up programs
Educate on avoiding alcohol and sedatives