Sleep apnea

Question 1

What is sleep apnea?

Answer 1

During sleep, gracity and muscle relaxation allows the tongue and surrounding tissues to fall back into the mouth and obstruct air flow

Question 2

For non-obese and young people, OSA might be caused by this?

Answer 2

Craniofacial morphology

Question 3

What are some of the causes of craniofacial morphology?

Answer 3

Short maxilla or mandible, retropostioned mandible, inferiorly positioned hyoid boin, long anterior face height, enlarged tongue/soft palate/ uvula, large parapharyngeal fat pads and lateral pharyngeal fat pads, small upper airway spaces

Question 4

Strongest risk factor for OSA?

Answer 4

Obesity

Question 5

During sleep muscle town is ________ and airways are ___________?

Answer 5

decreases, especially the genioglossus, and airway diameter is decreased

Question 6

Physiological effects of frequent hypoxia?

Answer 6

Increased sympathetic tone ( increase BP), peripheral vasoconstriction, increared HR and SBP, decreased cerebral blood flow, pulm and hear effects (decreased coronary and pulmonary artery flow

Question 7

Clinical manifestations for OSA?

Answer 7

snoring, daytime somnolence, apneas, morining dry mouth, morning headache, irritability, depression

Question 8

Physical exam findings for OSA?

Answer 8

Obesity, crowded upper airways, neck larger than 17” mean, 16” woman, HTN

Question 9

What is the GOLD standard test for diagnosis of OSA?

Answer 9

overnight sleep study (polysomnography)

Question 10

Information derived from sleep study?

Answer 10

Total sleep time, sleep efficiency (TST)/time in bed, sleep stage percentage, sleep latency (time from seel onset to particular stage of sleep)

Question 11

Information derived from sleep study, more important information?

Answer 11

arousals (# of times patients wakes), apneas (cessation of breathing), hypopneas (reduced breathing), RERAs (respiratory effort relate arousals) smaller arousals that do no meet criteria for apnea or hypopnea

Question 12

What would constitute as positive for sleep apnea?

Answer 12

5 or more obstructive events per hour with 1 or more risk factors or greater than 15 obstructive events per hour with no risk factors

Question 13

How is OSA staged?

Answer 13

Mild 5-15 events, moderate 16-30 events, severe >30

Question 14

Standard for treating sleep apnea?

Answer 14

CPAP feeds continuous positive airway pressure into the airway to prevent obstruction

Question 15

This treatment delivers different levels of pressure during inspiration and expiration

Answer 15

Bilevel positive airway pressure (BPAP)

Question 16

This treatment can be offered to individuals with mild-moderate OSA who don’t wanna use CPAP? May have craniofacial abnormalities

Answer 16

Oral device

Question 17

What is central sleep apnea?

Answer 17

Sleep apnea that results from absences of airflow during sleep that results from lack of respiratory effort

Question 18

Causes of central apnea?

Answer 18

Brain stem tumors, encephalitis, bulbar polio, muscular atrophy, myasthenia gravis, ALS