Sleep Apnea

Question 1

T/F: OSA is a cause of HTN and is strongly associated with obesity in adults and cardiovascular disease in children

Answer 1

F
It is strongly associated with CVD IN ADULTS and behavioral problems in children

Question 2

T/F CSA Can occur as a response to high altitude

Answer 2

T

Question 3

Patients with CSA often report frequent awakenings and daytime fatigue, and at high risk for ____________ and ___________

Answer 3

Heart failure and atrial fibrillation

Question 4

Apnea is cessation of airflow for more than ____________

Answer 4

10 seconds

Question 5

OSA: (persistent/absent) respiratory effort
CSA: (persistent/absent) respiratory effort

Answer 5

OSA: persistent
CSA: absent

Question 6

Hypopnea refers to ___% reduction in airflow for at least __ seconds during sleep that is accompanied by either more than __% desaturation or arousal

Answer 6

30% reduction
10 seconds
3% desaturation

Question 7

This is a partial obstruction that does not meet the criteria for hypopnea but provides evidence of increasing respiratory effort punctuated by an arousal

Answer 7

Respiratory effort-related arousal (RERA)

Question 8

This partially obstructed breath is identified by a flattened or scooped out inspiratory flow shape

Answer 8

Flow limited breath

Question 9

Number of apneas+ hypopneas per hour of sleep

Answer 9

Apnea-hypopnea index

Question 10

Apnea + hypopnea + RERA per hour of sleep

Answer 10

Respiratory disturbance Index

Question 11

T/F: Mild OSAHS include AHI of 1-4 events per hour

Answer 11

F
5-14 events per hour

Question 12

T/F: Moderate OSAHS include AHI of 15-29 events per hour

Answer 12

T

Question 13

T/F: Severe OSAHS include AHI of more than 50 events per hour

Answer 13

F
equal to or more than 30 events per ho

Question 14

What are the requirements for diagnosing OSA?

Answer 14

1. Symptoms of nocturnal breathing disturbance and AHI of >/5
   OR
2. AHI >/15 in the absence of symptoms

nocturnal breathing disturbances include snoring, gasping, breathing pauses during sleep, daytime sleepiness or fatigue unexplained by other medical problems

Question 15

Explain the pathophysiology of OSA

Answer 15

During inspiration, there is more negative pharyngeal pressure that causes suction of air -> the pharynx remains open due to the pharyngeal dilator muscle, which the airway is dependent on (since it has no fixed bone/cartilage)

When asleep, the neuromuscular output declines and cannot keep the patency of the airway -> may collapse at diff sites, most commonly at the soft palate

Question 16

most common site of pharyngeal airway collapse

Answer 16

Soft palate

Question 17

T/F: OSA is most severe in REM due to low neuromuscular output and in supine position due to gravity

Answer 17

T

Question 18

How does pharyngeal muscle activation linked to OSA?

Answer 18

Pharyngeal muscle gets activated even during sleep if there are minor changes in CO2 -> prevents collapse once activated

If one is not sensitive to CO2 -> pharyngeal muscles wont get activated -> chance of collapsing

Question 19

Major risk factors of OSA

Answer 19

obesity, male, older age

Question 20

T/F Genetics play a role in OSA development

Answer 20

T

Question 21

T/F The greater pharyngeal length of females increase risk of collapsibility -> OSA

Answer 21

F - men

Women have lower arousal threshold (gets woken up easily) and less neuromuscular collapsibility

Question 22

T/F Female sex hormones influence ventilatory drive, increases OSA incidence after menopause

Answer 22

T

Question 23

T/F Dyspnea is common in sleep apnea

Answer 23

F
it is unusual

Question 24

What is the STOPBANG score for OSA?

Answer 24

snoring
tiredness (daytime sleepiness)
observed apnea
pressure (high bP)
bmi >35
Age over 50 yo
Neck circumference >40cm
Gender male

> /3 positive response = high risk for OSA

Question 25

T/F: OSA diagnosis and severity is determined through, history, PE, and diagnostic testing

Answer 25

F
It is only determined through diagnostic testing

Question 26

Gold standard diagnostic test for OSA

Answer 26

Overnight Polysomnogram

Question 27

How does OSA relate to HTN?

Answer 27

OSA-related events stimulate sympathetic overactivity -> acute blood pressure increases -> daytime HTN

Question 28

How does OSA induce prothrombotic and proinflammatory states?

Answer 28

Hypoxemia due to OSA causes release of acute phase proteins and reactants -> affects insulin resistance and lipolysis -> prothrombotic and proinflammatory state

Question 29

Most commonly performed surgery for OSA

Answer 29

Uvulopalatopharyngoplasty

Question 30

T/F: CSA is caused by decreased sensitivity to PCO2 -> unstable breathing pattern

Answer 30

F
It is caused by INCREASED sensitivity to PCO2 -> unstable breathing pattern that manifests as hyperventilation alternating with apnea

Question 31

T/F CSA can be caused by delay between pulmonary arteries and carotid chemoreceptors seen in CHF

Answer 31

T

Question 32

Congestive heart failure can result to what type of breathing?

Answer 32

Cheyne Stokes Breathing