Sleep Apnea

Question 1

Define sleep apnea

Answer 1

1. Disorder where normal breathing is periodically interrupted during sleep
2. Pauses in breathing can be length of 2-3 breaths
3. Results in significant decrease in gas transport during episodes

Question 2

Where is the breathing problem in central sleep apnea? What is the result?

Answer 2

Brain centers are dysregulated

Results in lack of effort to breathe

Question 3

Where is the breathing problem in obstructive sleep apnea? What is the result?

Answer 3

Obstruction prevents airflow

Respiratory effort is normal

Question 4

Where is the breathing problem in complex sleep apnea? What is the result?

Answer 4

Combination of central & obstructive

Question 5

What is the clinical significance of sleep apnea?

Answer 5

↑ incidence of heart disease and stroke

Question 6

What comorbidity is usually present with OSA?

Answer 6

HTN

Question 7

What demogrpahic is OSA most prevalent in?

Answer 7

obese middle aged men

Question 8

What are the risk factors for OSA?

Answer 8

1. Patients with anatomically narrowed airways:
A. Macroglossia
B. Obesity
C. Tonsillar hypertrophy
2. Ingestion of alcohol or sedatives before sleep
3. Nasal obstruction
4. Hypothyroidism
5. Tobacco Use

Question 9

What is the pathophys of OSA?

Answer 9

Loss of normal pharyngeal muscle tone allows pharynx to collapse during inspiration

Question 10

What are the important symptoms in OSA?

Answer 10

1. Daytime somnolence/fatigue
2. Disrupted sleep
3. Snoring

Question 11

What are the other symptoms in OSA?

Answer 11

Morning sluggishness  
Morning headaches
Cognitive impairment
Weight gain
Irritability, mood changes
Nocturia
Heartburn

Question 12

What are the witnessed symptoms in OSA?

Answer 12

1. Loud snoring
2. Witnessed apnea
3. Gasping
4. Restlessness
5. Thrashing movements of extremities

Question 13

What signs may be present on physical exam that indicate OSA?

Answer 13

1. Physical exam may be normal or patients may have systemic HTN or pulmonary HTN
2. Narrowed oropharynx
   A. Excessive neck soft tissue folds
   B. Large tonsils
   C. Prominent uvula or tongue
3. Nasal obstruction may be present
4. Overweight

Question 14

What are the Hgb/Hct dx studies results in OSA?

Answer 14

Increased

Question 15

Why should the TSH dx studies be checked OSA?

Answer 15

1. Should be checked due to presenting sx’s

2. Association between hypothyroidism & OSA

Question 16

What other studies should be performed in OSA?

Answer 16

1. Sleep study (polysomnography)

2. Overnight oximetry and apnea link screening

Question 17

Define sleep study

Answer 17

Observation of sleeping patient reveals loud snoring interrupted by episodes of increasing ventilatory effort that fail to produce airflow

Question 18

How long do apneic episodes last? What do they follow?

Answer 18

Loud snort often accompanies first breath, followed by apneic episodes lasting up to 60 seconds

Question 19

What happens to the heart rhythms in OSA?

Answer 19

Bradydysrhythmias occur followed by tachydysrhythmias when airflow is re-established

Question 20

What are the lifestyle change treatments for OSA?

Answer 20

1. Weight loss
2. Avoidance of alcohol & hypnotic meds
   A. Suppress respirations

Question 21

What is the surgical treatment of OSA?

Answer 21

1. Uvulopalatopharyngoplasty (UPPP)
   A. Resection of pharygeal soft tissue
   B. Helpful in 50% of select patients

Question 22

What is the curative treatment for most OSA pts?

Answer 22

Nasal Continuous Positive Airway Pressure (Nasal CPAP)