Sleep Apnea

Question 1

Most common form of sleep apnea

Answer 1

OSA

Question 2

T/F: OSA has no effect on the cardiopulmonary system

Answer 2

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

Question 3

T/F: In the onset of sleep, the muscle tone decreases -> negative pressure decreases -> airway resistance decreases

Answer 3

F
Muscle tone decreases
negative pressure INCREASES
airway resistance INCREASES

Question 4

T/F: low po2, pco2, and pH due to sleep apnea cause bradycardia

Answer 4

T

Question 5

This is absence of ventilation without an effort to breathe

Answer 5

Central sleep apnea

Question 6

Classic pattern of breathing with central apnea, showing crescendo-decrescendo pattern

Answer 6

Cheyne-Strokes Breathing

Question 7

What is mixed sleep apnea?

Answer 7

It occurs when there is ABSENT respiratory effort in the initial portion of event, but there is RESUMPTION of respiratory effort afterwards

Question 8

T/F: Septal deviation can increase risk for OSA

Answer 8

T

Question 9

How does alcohol increase risk for OSA?

Answer 9

Alcohol can decrease the muscle tone -> can prevent the airways to stay dilated while asleep

This may also apply to nicotine, drugs, shiftwork, hypothyroidism

Question 10

T/F: prone position increases the risk for OSA

T/F: OSA has a male predominance

Answer 10

F - supine

T

Question 11

What is the pathophysiology of nocturnal dyspnea?

Answer 11

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

Question 12

What is the pathophysiology of nocturia in sleep apnea?

Answer 12

There is an increase in ANP secretion
The intraabdominal pressure increases especially during snoring

Question 13

Excessive daytime sleepiness is caused by

Answer 13

sleep fragmentation

Question 14

What is the pathophysiology of morning/nocturnal headaches?

Answer 14

Since there is oxygen desaturation during apneic episodes, hypercapnia occurs -> triggers the cerebral blood vessels to dilate > increase in ICP

Question 15

T/F: Hyperthyroidism increase the risk of OSA

T/F: Cushing’s syndrome, down syndrome, allergic rhinitis, and acromegaly increase risk for SOA

Answer 15

F - hypothyroidism; although HTN is also associated with sleep-disordered breathing

T

Question 16

A neck circumference of >___ cm increase chances of OSA

Answer 16

40cm

43cm in males
41cm in females

Question 17

This is used to assess the oral cavity of patients with sleep apnea, wherein stage (I-IV) is determined by what can be visualized

Answer 17

Friedman Tongue Position

Question 18

T/F: Overjet dental occlusion refers to upper incisors behind the lower incisors

Answer 18

F- upper incisors ahead of the lower incisors

Negative overjet = upper incisors are behind the lower incisors

Question 19

T/F: Overbite refers to vertical distance or upper incisors overlapping the lower incisors

Answer 19

T

Question 20

In inadequate retropalatal space presented in patients with OSA, the _____ and _________ are close to each other

Answer 20

palate and posterior pharyngeal wall

Question 21

What are other physical findings in patients with OSA?

Answer 21

macroglossia, high arch palate with crowding of teeth, redundant pharyngeal soft tissue, inadequate retropalatal space, elongated uvula

Question 22

Most common cause of OSA in children is

Answer 22

hypertrophy of tonsils and adenoids

Question 23

T/F: Children with OSA usually have hyperactivity, aggression, and behavioral disturbances

T/F: Children with OSA could also have chest deformities

Answer 23

T
T

Question 24

This is the objective test and the gold standard used to confirm the presence OSA, differentiating it from other sleep disorders

Answer 24

Basic Polysomnography; or Level I Attended Overnight PSG (Gold standard)

Question 25

This is the “dream stage” where OSA occurs

Answer 25

Stage REM

Question 26

First line of management for moderate to severe OSA

Answer 26

Positive airway pressure - serves as a pneumatic splint

Question 27

Why is CPAP effective?

Answer 27

Because it provides positive air pressure serving as a pneumatic splint. It also works on all levels of airway problems of OSA

Question 28

T/F: OSA is a multi-level airway problem involving the nose, throat, and neck

Answer 28

T

Question 29

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

Answer 29

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

Question 30

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

Answer 30

T
T

Question 31

T/F: Palatal stiffening is done in severe OSA to lessen tendency of it moving

Palatal stiffening involves (soft/hard) palate

Answer 31

F - mild OSa
Soft palate