Sleep Apnea Flashcards
Causes daytime sleepiness and impaired daily function.
OSA
Diagnosis requires the patient to have (1) either symptoms of nocturnal breathing disturbances (snoring, snorting, gasping, or breathing pauses during sleep) or daytime sleepiness or fatigue that occurs despite sufficient opportunity to sleep and is unexplained by other medical problems; and (2) five or more episodes of obstructive apnea or hypopnea per hour of sleep (the apnea-hypopnea index [AHI], calculated as the number of episodes divided by the number of hours of sleep) documented during a sleep study.
OSA also may be diagnosed in the absence of symptoms if the AHI is ____ episodes/h.
≥15
OSA may be most severe during ____, when neuromuscular output to the skeletal muscles is particularly low, and in the supine position due to gravitational forces.
rapid eye movement (REM) sleep
Which of the following factors is MOST responsible for the occurrence of obstructive sleep apnea (OSA)?
A. Collapse of the pharyngeal airway due to reduced neuromuscular output during sleep
B. Increased activation of the pharyngeal dilator muscles during sleep
C. Presence of fixed bone or cartilage in the pharyngeal airway
D. Increased sensitivity to oxygen levels during sleep
A
Which site is the MOST COMMON location of airway collapse in obstructive sleep apnea?
A. Tongue base
B. Epiglottis
C. Lateral pharyngeal walls
D. Soft palate
D
Which site is the MOST COMMON location of airway collapse in obstructive sleep apnea?
A. Tongue base
B. Epiglottis
C. Lateral pharyngeal walls
D. Soft palate
D
Which of the following statements regarding pharyngeal muscle activity during sleep is CORRECT?
A. Pharyngeal muscle activity increases during non-REM sleep.
B. Pharyngeal muscle activity is consistently high during all stages of sleep.
C. Pharyngeal muscle activity decreases significantly during REM sleep.
D. Pharyngeal muscle activity is controlled by oxygen levels rather than CO₂ levels.
C
The major risk factors for OSA are ___
obesity, male sex, and older age
Approximately 40–60% of cases of OSA are attributable to ____
excess weight.
_____ are at a fourfold or greater risk for OSA than their normal-weight counterparts.
Obese individuals
Factors that predispose men to OSA include ___pattern of obesity (resulting in upper-airway and abdominal fat deposition) and relatively ___ pharyngeal length, which increases collapsibility.
android
greater
Which of the following changes in body weight is MOST likely to worsen obstructive sleep apnea (OSA)?
A. A 5% weight loss
B. A 10% weight gain
C. Stable weight
D. Fluctuations within 2% of body weight
B
Which anatomical feature MOST commonly contributes to increased OSA risk in non-obese patients?
A. Retrognathia
B. Increased lung volume
C. Wide pharyngeal airway
D. Increased nasal resistance
A
What is the MOST likely reason men have a higher prevalence of OSA compared to premenopausal women?
A. Longer pharyngeal length and android fat distribution
B. Higher lung volumes and chest wall compliance
C. Higher estrogen and progesterone levels
D. Greater lower-body fat distribution
A
Which of the following BEST describes the influence of family history on OSA risk?
A. No association with familial history
B. First-degree relatives have a twofold higher risk of developing OSA
C. Genetic factors increase the risk only in obese individuals
D. Risk is limited to middle-aged adults with a family history of OSA
B
What is the primary reason for the decline in OSA prevalence in children after age 8?
A. Decreased craniofacial abnormalities
B. Regression of lymphoid tissue
C. Increased physical activity
D. Reduced sensitivity to CO₂ levels
B
The most common daytime symptom is ______, identified by a history of difficulty maintaining alertness or involuntary periods of dozing.
excessive daytime sleepiness
The gold standard for diagnosis of OSA is an ____
overnight polysomnogram (PSG).
The key physiologic information collected during a sleep study for OSA assessment includes measurement of ____
breathing (changes in airflow, respiratory excursion)
oxygenation (hemoglobin oxygen saturation)
body position
cardiac rhythm.
____ is the standard medical therapy with the highest level of evidence for efficacy.
CPAP
____ is often caused by an increased sensitivity to Pco 2 , which leads to an unstable breathing pattern that manifests as hyperventilation alternating with apnea.
CSA
Crescendo-decrescendo breathing with alternating hyperventilation and apnea.
Cheyne-Stokes Breathing (CSB):
CSA is an independent risk factor for the development of both ___and ____
heart failure
atrial fibrillation,
CSA may be an early marker of ____
subclinical myocardial dysfunction
Which of the following treatments is CONTRAINDICATED in a patient with central sleep apnea (CSA) and heart failure with reduced ejection fraction?
A. Adaptive servoventilation (ASV)
B. Supplemental oxygen
C. Optimization of heart failure therapy
D. Discontinuation of opioid medications
A
Other risk factors for CSA include _____ medications (which appear to have a dose-dependent effect on CSA
opioid
In which of the following scenarios is supplemental oxygen MOST likely to reduce central apneas?
A. In patients with treatment-emergent central sleep apnea (complex sleep apnea)
B. In patients with chronic obstructive pulmonary disease (COPD)
C. In patients with opioid-induced respiratory depression
D. In patients with high-altitude CSA and hypoxemia
D
