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PCM > Sleep Apnea > Flashcards

Sleep Apnea Flashcards

1
Q

What brain wave patters accompany different stages of sleep and wakefulness

A 
BATS Drink Blood
Beta waves= awake
alpha waves= falling asleep
Theta waves= stage 1
Sleep spindles= stage 2
Delta waves 20% of the time, slow waves= stage 3
Delta waves >50% of the time= stave 4
REM sleep
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2
Q

How much time normally passes before the first REM cycle

A

45-60 min

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3
Q

By the time you wake up after a full night of sleep what percentage of sleep is REM

A

20-25%

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4
Q

How does the the time between NREM and REM sleep change over the course of a night

A

REM inc in length while NREM shortens

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5
Q

What is the normal combined time to cycle through NREM and REM sleep

A

90-110 min

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6
Q

Physiologic changes to breathing during sleep and their effects

A

Decreased cortical input= no higher brain stim to drive sleep
Decreased chemoreceptor sensitivity= CO2 inc and O2 dec
Decreased activation of respiratory motor neurons= breathing is less deep
Reduced alveolar ventilation with V/Q mismatches b/c of body postiion, CO, inc airway resistance, and dec breathing volumes

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7
Q

What happens to PaCO2 while sleeping?

Does it change during REM vs NREM

A

Inc by 2-8 mmHg

Higher end during REM

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8
Q

What happens to PaO2 during sleep

A

Decreases by 3-10 mmHg

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9
Q

What happens to Oxygen demand during sleep

A

decreases by 15-25%

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10
Q

What happens to SaO2 during sleep

A

dec by 2%

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11
Q

Where are the chemo receptors

A

Central- Medulla

Peripheral- Carotid body, Aortic arch

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12
Q

What does the central chemorecptor sense

A

PaCO2 (via pH)

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13
Q

what do the peripheral chemoreceptors sense and what are they innervated by

A

PaO2 is the main stim but also respond to PaO2
Carotid body is innervated by CN IX
Aortic Arch is innervated by CN X

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14
Q

Pulmonary sleep changes in Asthma

A

increased airway restriction= nocturnal bronchoconstriction

nocturnal cough

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15
Q

Pulmonary and blood chemistry sleep changes in COPD

A

Hypercapnia and Hypoxemia are already problems in these patients
during sleep SaO2 may drop between 10 and 35%

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16
Q

Pulmonary and blood chemistry sleep changes Diffusion problems ie ILD, CF

A

CO2 can diffuse fine by hypoxemia may be severe

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17
Q

What are indications for non invasive positive pulmonary pressure ventilation in COPD

A

Severe COPD with hypercapnia (PaCO2 < 55) during the day OR
>2 hospitalizations for hypercapnic respiratory failure with PaCO2 of 50-55 OR
SaO2<88% for more than 5 min while on nasal oxygen

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18
Q

What are indications for non invasive positive pulmonary pressure ventilation in restrictive lung dz or worsening neuromuscular dz

A

either with worsening symptoms
FEV < 50%
max inspiratory force < 60 cm H2O

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19
Q

Pickwickian syndrome

A

Obesity Hypoventilation syndrome

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20
Q

What is the pathology of Pickwikian syndrome

A

daytime hypoventilation b/c of obesity- chest mass limits chest wall excursion –> alveolar hypoventilation

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21
Q

Symptoms of hypoventilation

A

Hypersomnelence
Dyspnea
Hypoxemia with cyanosis, polycythemia, and plethora

22
Q

Complications of pickwickian syndrome

A

Cor pulmonlae- hypoxemia mediated

peripheral edema

23
Q

Will CPAP help in Pickwikian syndrome

A

NO

24
Q

Definition of Apnea

A

Cessation of breathing for at least 10 seconds

25
Q

Definition of hypopnea

A

30% dec in airflow for at least 10 seconds with 4% desaturation

26
Q

what does RERA stand for

A

Respiratory associated Respiratory arousal

27
Q

what is RERA

A

series of increased breathing with increased effort resulting in awakening

28
Q

what is the respiratory disturbance index

A

Apnea’s+ hypponeas’s + RERA’s/ night

29
Q

AHI- what does it stand for

what is it, and what is it used for

A

Apnea - Hypopnea index
Apnea’s + Hypopnea’s / night
used to determine severity of sleep apnea

30
Q

What is a normal AHI

what are the different stages of sleep apnea

A

normal: AHI30

31
Q

what is polysomnography

A

sleep study

32
Q

Why do you use do a sleep study

A

determine if sleep issues are behavioral or pathological

Allows for documentation of latency, efficiency, arousals/ awakenings, timing and quantification of stages based on EEG

33
Q

What monitors are used

A

EEG
EOG- REM vs NREM
EMG’s- muscle activity
respiratory monitors- SaO2, EKG, airflow

34
Q

What are the two main categories of sleep apnea

A

Obstructive sleep apnea vs central sleep apnea

35
Q

What is the key difference between obstructive sleep apnea and central sleep apnea

A

EFFORT
obstructive sleep apnea- want to breath but cant
central sleep apnea- lose drive to breath

36
Q

Definition of obstructive sleep apnea

A

intermittent obstruction of airflow resulting in apnea or hypopnea

37
Q

where does the obstruction in obstructive sleep apnea normally occur

A

oropharynx

38
Q

Risk factors for obstructive sleep apnea

A 
obese
enlarged neck
African American
Smoking
Craniofacial abnormalities- large: tonsils, adenoids, uvula, soft palate, nasal polyps, tongue
Retrognathia
Diabetes
Alcoholic
Fam Hx
Hypothyroidism
39
Q

Signs and symptoms of obstructive sleep apnea

A

Snoring
Excessive daytime sleepiness
morning HA (arteries in brain expand to bring more blood in)
personality changes
respiratory acidosis from chronic hypercapnia

40
Q

Diagnosis of sleep apnea

A

must be done with polysomnography

AHI>5 with hypersomnelence

41
Q

Treatment of obstructive sleep apnea

A

behavioral changes- sleep hygiene- regulating bed time and duration, avoiding noise, drugs, and alcohol before bed. comfy bed
avoid sleeping in a supine position
weight loss
CAPA
uvulopalatopharyngoplasty, septoplasty, tubinoplasty- have varying success
tongue base ablation in kids

42
Q

Complications of obstructive sleep apnea

A

Cor pulmonale
Secondary polycythemia
systemic HTN
arrhythmias

43
Q

Central sleep apnea- definition

A

Repeated apneic efforts without respiratory muscle effort

44
Q

Symptoms- of central sleep apnea

A 
similar to OSA
excessive daytime sleepiness
morning HA
personality changes
respiratory acidosis
45
Q

Risk Factors for central sleep apnea

A

general seen in sicker people, but have a normal BMI
elderly men
CHF
Afib- smal emboli go to brain
prior stroke
endocrine abnomralities- acromegaly, hypothyroid
Renal failure

46
Q

Manifestations of central sleep apnea

A

Cheyne Stokes breathing

47
Q

Describe Cheyne strokes breathing

A

apnea –> CO2 inc –> increasingly faster and deeper breathing –> CO2 dec –> lose respiratory drive –> apnea

48
Q

pathophysiology of central sleep apnea

A

alveolar hypoventilation –> hypercapnia, hypoxemia, acidemia
controller gain can magnify the response
if it is from a neurologic abnormality the feedback system in the brain may not be working properly
if CHF- feedback is delayed

49
Q

what is controller gain central sleep apnea

A

compensatory release of catecholamines

50
Q

diagnosis of central sleep apnea

A

same as obstructive

51
Q

treatment of central sleep apnea

A

treat the underlying cuase
reduce overshoot which causes sudden hyperventilation with NIPPV
blunt control with benzos and narcotic
O2 and CPAP dont work great for this

PCM (12 decks)

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