Sleep apnea Flashcards
What are the two main characteristics of sleep apnea?
Loud snoring and excessive daytime sleepiness
What can untreated sleep apnea lead to?
HTN
heart disease
stroke
DM
depression
What are the type of sleep apnea?
Central sleep apnea - disruption of brain signals to respiratory muscles
Obstructive sleep apnea - upper airway obstruction (more common)
What is the incidence of sleep apnea in males and females?
3-7% of males and 2-5% of females
Males - body habitus of bull neck and central obesity
Females - rises after menopause
What are the high risk/high incidence groups?
High risk:
obesity
CAD
DM
Higher incidence in young black males vs young white males
What is the pathophysiology of sleep apnea (central)?
Not fully understood
Multifactorial including anatomic and neuromuscular causes:
Upper airway anatomy
Ability of upper airway dilator muscles to respond to respiratory challenge during sleep
Arousal threshold
Stability of respiratory control system
What is the pathophysiology of obstructive sleep apnea?
Caused by either intermittent partial or complete obstruction of the pharynx during sleep
-lack of bony structures lead to airway collapse during negative pressure
-tongue, enlarged tonsils, crowd upper airway
-depression of respiratory drive due to disease, metabolic derangements, or drugs
What regulates the respiratory drive?
chemoreceptors
-centrally respond to changes in CO2
-Peripherally respond to changes in PaCO2 and PaO2
What are central factors that affect respiratory drive?
Insults to brainstem:
-tumor
-infarct
-congenital malformation
-trauma
Congenital central hypoventilation syndrome
Drugs (opioids)
Obesity hypoventilation syndrome
What are peripheral factors impacting the physical work of breathing?
Neuromuscular disorder
-Myasthenia gravis
-ALS
-post-polio syndrome
-GBS
What is the typical OSA patient?
Male
Obese
Middle aged and older
Complain of daytime somnolence and nonrestorative sleep despite adequate hours
Frequent naps while sitting
Bed partner complains of loud snoring and frequent apnea with partial arousals
What are OSA risk factors?
Obesity
Hypothyroidism
Cigarette smoking
Post-menopausal women
What can exacerbate OSA?
Alcohol
Sleep meds
Conditions causing nasal obstruction
OSA is commonly associated with?
HTN
T2DM
stroke
CAD
CHF
What symptoms are common due to nonrestorative sleep?
Decreased mental sharpness and memory loss
Poor judgement
Inability to concentrate
Personality changes
Headache
What are some secondary symptoms to sleep apnea?
Decreased libido
Erectile dysfunction
Morning dry or sore throat
Dyspepsia
What may be found on physical exam?
Often normal
Obesity
Increased neck circumference (>17M.>15F)
Crowding on oropharynx
Nasal obstruction from deviated septum
What should be assessed additionally on physical exam?
Blood pressure
Pulmonary, cardiac, and peripheral vascular exam
What is the gold standard diagnostic choice?
Polysomnography
-in sleep lab or at home
-also monitors for periodic limb movement and restless leg syndrome
What are additional diagnostic studies for sleep apnea?
Apnea-hypopnea index
-measures # of episodes each hour
-AHI>15 or >5+symptoms or cardiovascular comorbidities
Evaluate airflow and respiratory muscle activity
-CSA: cessation of airflow for 10 sec with NO respiratory effort
What are additional evaluation options if sleep apnea is suspected?
Screen for undiagnosed hypothyroidism and depression
Questionnaire - Epworth sleepiness scale or STOP-BANG
Consult sleep specialist
Obtain PSG
What is measured in PSG?
EEG
Chin EMG
ECG
Snoring
Nasal pressure
Thermistor
Thorax
Abdomen
SpO2
What is the severity classification according to AHI?
AHI < 5 - normal
AHI 5-14 - mild
AHI 15-29 - moderate
AHI 30+ - severe
What are non-surgical options for treatment?
Weight loss: lifestyle, medical, or surgical
CPAP (most effective)
Oral appliances:
-reposition mandible
-move tongue and soft palate forward
What are surgical options for sleep apnea?
Uvulopalatopharyngoplasty
nasal septoplasty
tracheostomy
What patient education points should be made with sleep apnea?
Serious in nature
Risk of comorbidities if untreated
Benefit of weight loss
Avoid alcohol, sedating drugs
Good sleep hygiene
Avoid sleeping on back
What are some cases that sleep apnea may occur in children?
Increase incidence due to obesity increase in children
Enlarged tonsils and adenoids
Down syndrome/other craniofacial syndromes are at a higher risk
