Sleep Apnea Flashcards
Most common form of sleep apnea
OSA
T/F: OSA has no effect on the cardiopulmonary system
F
It has a potential significant damage to the cardiopulmonary system due to the reduction in blood oxygen levels and an increase in the activity of the sympathetic nervous system
T/F: In the onset of sleep, the muscle tone decreases -> negative pressure decreases -> airway resistance decreases
F
Muscle tone decreases
negative pressure INCREASES
airway resistance INCREASES
T/F: low po2, pco2, and pH due to sleep apnea cause bradycardia
T
This is absence of ventilation without an effort to breathe
Central sleep apnea
Classic pattern of breathing with central apnea, showing crescendo-decrescendo pattern
Cheyne-Strokes Breathing
What is mixed sleep apnea?
It occurs when there is ABSENT respiratory effort in the initial portion of event, but there is RESUMPTION of respiratory effort afterwards
T/F: Septal deviation can increase risk for OSA
T
How does alcohol increase risk for OSA?
Alcohol can decrease the muscle tone -> can prevent the airways to stay dilated while asleep
This may also apply to nicotine, drugs, shiftwork, hypothyroidism
T/F: prone position increases the risk for OSA
T/F: OSA has a male predominance
F - supine
T
What is the pathophysiology of nocturnal dyspnea?
There is upper airway obstruction > the body increases its respiratory effort to overcome it > there is increased negative intrathoracic pressure > the venous return to the heart increases > pulmonary capillary wedge pressure increases > pulmonary hypertension > right ventricular dysfunction
What is the pathophysiology of nocturia in sleep apnea?
There is an increase in ANP secretion
The intraabdominal pressure increases especially during snoring
Excessive daytime sleepiness is caused by
sleep fragmentation
What is the pathophysiology of morning/nocturnal headaches?
Since there is oxygen desaturation during apneic episodes, hypercapnia occurs -> triggers the cerebral blood vessels to dilate > increase in ICP
T/F: Hyperthyroidism increase the risk of OSA
T/F: Cushing’s syndrome, down syndrome, allergic rhinitis, and acromegaly increase risk for SOA
F - hypothyroidism; although HTN is also associated with sleep-disordered breathing
T
A neck circumference of >___ cm increase chances of OSA
40cm
43cm in males
41cm in females
This is used to assess the oral cavity of patients with sleep apnea, wherein stage (I-IV) is determined by what can be visualized
Friedman Tongue Position
T/F: Overjet dental occlusion refers to upper incisors behind the lower incisors
F- upper incisors ahead of the lower incisors
Negative overjet = upper incisors are behind the lower incisors
T/F: Overbite refers to vertical distance or upper incisors overlapping the lower incisors
T
In inadequate retropalatal space presented in patients with OSA, the _____ and _________ are close to each other
palate and posterior pharyngeal wall
What are other physical findings in patients with OSA?
macroglossia, high arch palate with crowding of teeth, redundant pharyngeal soft tissue, inadequate retropalatal space, elongated uvula
Most common cause of OSA in children is
hypertrophy of tonsils and adenoids
T/F: Children with OSA usually have hyperactivity, aggression, and behavioral disturbances
T/F: Children with OSA could also have chest deformities
T
T
This is the objective test and the gold standard used to confirm the presence OSA, differentiating it from other sleep disorders
Basic Polysomnography; or Level I Attended Overnight PSG (Gold standard)
This is the “dream stage” where OSA occurs
Stage REM
First line of management for moderate to severe OSA
Positive airway pressure - serves as a pneumatic splint
Why is CPAP effective?
Because it provides positive air pressure serving as a pneumatic splint. It also works on all levels of airway problems of OSA
T/F: OSA is a multi-level airway problem involving the nose, throat, and neck
T
Surgical indications for OSA include AHI of equal to more than ____ events/hr of sleep or AHI <____ with excess daytime fatigue; O2 desaturation nadir <___%, esophageal pressure of < ____ H20
Surgical indications for OSA include AHI of equal to more than 20 events/hr of sleep or AHI <20 with excess daytime fatigue; O2 desaturation nadir <90%, esophageal pressure of < -10cm H20
T/F: Alcohol or drug abuse is a contraindication to surgery as tx to OSA
T/F: Severe pulmonary disease is a contraindication to surgery as tx to OSA
T
T
T/F: Palatal stiffening is done in severe OSA to lessen tendency of it moving
Palatal stiffening involves (soft/hard) palate
F - mild OSa
Soft palate
