Sleep Apnea Flashcards
What is the definition of hypopnea?
Hypopnea is a 50% decrease in airflow for more than 10
seconds that occurs more than 15 seconds per hour of sleep
that is sufficient to result in a 4% decrease in oxygen saturation.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1053.
What is the definition of apnea?
10 seconds or more of complete cessation of breathing.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1053.
What are the characteristics that define obstructive sleep apnea (OSA)?
Periodic complete or partial obstruction of the airway during
sleep with frequent episodes of apnea or hypopnea, and
snoring.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 921-922.
What are factors that are commonly associated with
an increased risk of sleep apnea?
Body mass index greater than 35, neck circumference > 15.9
in., hyperinsulinemia, elevated glycosylated hemoglobin, and
anatomic abnormalities of the upper airway.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1278.
What physical abnormalities result from OSA?
Hypoxemia, hypercapnia, pulmonary hypertension, systemic
hypertension, polycythemia, right ventricular failure, and an
increased risk for ischemic cardiac and cerebrovascular disease.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1278.
A patient with sleep apnea is presenting for surgery
at an ambulatory surgery center. What is the ASA
recommendation for determining whether or not the
surgery should be performed in an outpatient setting?
Patients with OSA can be safely managed at outpatient surgical
centers, but they have an increased risk of postoperative
complications. This requirement for additional monitoring,
radiology and laboratory services, and ventilatory support would
make office-based procedures potentially unwise.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 923.
How does the distribution between males and
females compare with obstructive sleep apnea and
obesity hypoventilation syndrome?
Males have a greater incidence of OSA, but the incidence of
OHS is equal for males and females.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 595.
What is obesity hypoventilation syndrome?
This is a syndrome that results from chronic OSA and occurs in
about 5-10% of patients with OSA. It is characterized by
obesity, awake arterial hypercapnia, and insufficient alveolar
impairment independent of any other pulmonary disease. It
progresses to right ventricular failure.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1278.
According to the ASA guidelines, what patients with
sleep apnea must be admitted to the hospital for
monitoring of their respiratory status?
Children under the age of 3 who have had a tonsillectomy and
patients who have undergone uvulopalatoplasty. It is also
recommended for patients with sleep apnea who have
significant co-morbidities.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 595.
Studies indicate that the use of CPAP prior to
anesthesia reduces the risk of postoperative sleep
apnea episodes. What explains this?
The use of CPAP preoperatively has been explained to
decrease the incidence of postoperative sleep apnea by
providing better sleep prior to anesthesia and reducing the
hypersomnolence due to sleep deprivation.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 595.
What anesthetic drugs may need dosage adjustment
in patients with obstructive sleep apnea?
Any drug with a risk of respiratory depression such as
sedatives, narcotics, and inhaled anesthetics may need to be
used cautiously in patients with sleep apnea.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 595.
