Sleep Apnea Flashcards
stages of sleep
non-REM - stages 1, 2, and slow wave
REM stage
4-5 cycles per night
stages of sleep and ventilation
stage 1 - periodic
slow wave - regular
tonic stage REM - mostly regular
phastic stage REM - irregular
obstructive apnea
cessation of respiration that lasts at least 10 seconds, due to obstruction in the upper airway
may be associated with arousal and/or desaturation
hypopnea - shallow breathing in which the air flow in and out of the airway is less than half of normal - usually associated with oxygen desaturation
central apnea
pause in respiratory activity due to failure to initiate the breath (no obstruction present)
obstructive sleep apnea
characterized by repeated episodes of apnea and hypopnea rsulting from inspiratory occlusion o fhte upper airway during sleep
syndrome is defined by OSA with daytime sleepiness (hypersolmnolence)
possible causes of obstructive sleep apnea
anatomy
physics
genetics
neural control
hormonal control
muscle control
venturi effect
describes the acceleration of airflow that occurs as a current of air enters a narrow passageway
OSA and the obesity hypoventilation syndrome
obesity drives the development of both sleep apnea and daytime hypercapnia
apnea hypopnea index
the number of apneas plus hypopneas per hour of sleep
greater than 5 defines OSA, but clinically significant and potentially serious complications generally do not occur unless AHI is >15
affect of testosterone on control of breathing
reduces sensitivity of response and depresses breathing
complaints related to OSA
day time sleepiness/fatigue
AM headaches
vivid dreams
insomnia
hyperactivity
memory and learning impairments
snoring
unrefreshing sleep
types of questionnaires for OSA
Berlin questionnaire and STOP BANG
STOP BANG
snoring
Tired
Observed
Pressure (blood)
BMI
Age
Neck size
Gender
mallampati classification
○ Class I - can see clear through to posterior phalanx and bottom of uvula
○ Class II - can’t see bottom of the uvula
○ Class III - can barely see the phalanx
○ Class IV - can barely see the palate
long term outcomes for OSA
cardiovascular
cognitive
inflammatory
metabolic
cancer
quality of life
risk factors for OSA
excess body weight
shirt collar size of 17 inches or larger
crowded pharynx
alcohol consumption
supine position during sleep
smoking
nasal congestion
hormonal changes during menopause
hypothyroidism
cardiac issues associated with OSA
hypertension
inability for the left ventricle to pump blood due to negative intrathoracic pressures - PH long term
What aspects of neuro-cognition is affected the most by OSA?
executive functioning
vigilance
What is the gold standard for diagnosing OSA?
overnight polsomnography
treatment for OSA
depends on the severity of the condition
in all cases, try to correct exacerbating conditions such as excess weight, alcohol or sedative use at bedtime, and nasal congestion
only weight loss has been shown to reliably improve OSA
treatment for mild cases of OSA
avoidance of supine positions
weight reduction
treatment for severe cases of OSA
continuous positive airway pressure (CPAP) via nasal or full-face mask
drying of mucosal membranes is a problem
severe OSA not adequately treated with CPAP is an indication for tracheostomy
surgical therapy for OSA
uvulopalatopharyngoplasty
laser assisted uvuolplasty
radio frequency volumetric tissue reduction
maxillary mandibular osteotomy
hyoid suspension
gastric reduction or bypass
tracheostomy
types of hoome nocturnal positive airway pressure devices
continuous pressure - unchanged throughout the night
bilevel pressure - separate inspiratory and expiratory pressure
autopressure - deliver pressure changes breath to breath
