Sleep Apnea Flashcards
T/F: OSA is a cause of HTN and is strongly associated with obesity in adults and cardiovascular disease in children
F
It is strongly associated with CVD IN ADULTS and behavioral problems in children
T/F CSA Can occur as a response to high altitude
T
Patients with CSA often report frequent awakenings and daytime fatigue, and at high risk for ____________ and ___________
Heart failure and atrial fibrillation
Apnea is cessation of airflow for more than ____________
10 seconds
OSA: (persistent/absent) respiratory effort
CSA: (persistent/absent) respiratory effort
OSA: persistent
CSA: absent
Hypopnea refers to ___% reduction in airflow for at least __ seconds during sleep that is accompanied by either more than __% desaturation or arousal
30% reduction
10 seconds
3% desaturation
This is a partial obstruction that does not meet the criteria for hypopnea but provides evidence of increasing respiratory effort punctuated by an arousal
Respiratory effort-related arousal (RERA)
This partially obstructed breath is identified by a flattened or scooped out inspiratory flow shape
Flow limited breath
Number of apneas+ hypopneas per hour of sleep
Apnea-hypopnea index
Apnea + hypopnea + RERA per hour of sleep
Respiratory disturbance Index
T/F: Mild OSAHS include AHI of 1-4 events per hour
F
5-14 events per hour
T/F: Moderate OSAHS include AHI of 15-29 events per hour
T
T/F: Severe OSAHS include AHI of more than 50 events per hour
F
equal to or more than 30 events per ho
What are the requirements for diagnosing OSA?
- Symptoms of nocturnal breathing disturbance and AHI of >/5
OR - 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
Explain the pathophysiology of OSA
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
most common site of pharyngeal airway collapse
Soft palate
T/F: OSA is most severe in REM due to low neuromuscular output and in supine position due to gravity
T
How does pharyngeal muscle activation linked to OSA?
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
Major risk factors of OSA
obesity, male, older age
T/F Genetics play a role in OSA development
T
T/F The greater pharyngeal length of females increase risk of collapsibility -> OSA
F - men
Women have lower arousal threshold (gets woken up easily) and less neuromuscular collapsibility
T/F Female sex hormones influence ventilatory drive, increases OSA incidence after menopause
T
T/F Dyspnea is common in sleep apnea
F
it is unusual
What is the STOPBANG score for OSA?
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
T/F: OSA diagnosis and severity is determined through, history, PE, and diagnostic testing
F
It is only determined through diagnostic testing
Gold standard diagnostic test for OSA
Overnight Polysomnogram
How does OSA relate to HTN?
OSA-related events stimulate sympathetic overactivity -> acute blood pressure increases -> daytime HTN
How does OSA induce prothrombotic and proinflammatory states?
Hypoxemia due to OSA causes release of acute phase proteins and reactants -> affects insulin resistance and lipolysis -> prothrombotic and proinflammatory state
Most commonly performed surgery for OSA
Uvulopalatopharyngoplasty
T/F: CSA is caused by decreased sensitivity to PCO2 -> unstable breathing pattern
F
It is caused by INCREASED sensitivity to PCO2 -> unstable breathing pattern that manifests as hyperventilation alternating with apnea
T/F CSA can be caused by delay between pulmonary arteries and carotid chemoreceptors seen in CHF
T
Congestive heart failure can result to what type of breathing?
Cheyne Stokes Breathing
