Sleep Apnea Flashcards
Who are more likely to have sleep apnea?
Women
AA
Hispanics
What is the sleep wake cycle?
During sleep, the brain displays several different stages of electrical activity
How do we measure the sleep wake cycle?
EEG
What are the stages of NREM?
Stage 1 have the lowest amplitude and highest frequency
Stage 3 has the highest amplitude and lowest frequency
When does HR and BP decrease during sleep?
Stage 3 of NREM
When does HR and BP increase during sleep?
REM
When does GI motility increase during sleep?
Stage 3 NREM
What happens during REM?
Skeletal muscle (except those that control the eyes) are completely inhibited from moving
When does visual dreaming occur?
REM
What is a normal breath rate?
12-16 BMP
What are dyssomnias?
Primary disorder of initiating or maintaining sleep or of excessive sleepiness
How is dyssomnia characterized?
Disturbance in the amount, quality, or timing of sleep
What is parasomnias?
Unusual or undesirable behavior or physiologic events that occurs during sleep or at the threshold between waking and sleeping
What is apnea?
Cessation of airflow for 10 or more seconds
What is hypopnea?
30% reduction in airflow for 10 or more seconds associated with a 4% decrease in oxygen saturation
What is the AHI?
Apnea-hypopnea Index
Number of apnea and hypopnea episodes per hour
What is OSA in the AHI?
15+ events/hr w/ or w/o sx
or
5+ events w/sx
What is OSA?
Cessation of airflow despite continued respiratory effort
What is central sleep apnea?
Cessation of airflow with no respiratory effort
What are the characteristics of OSA?
Continued respiratory effort
Collapse in tissue near the throat
Snoring
Fragmented sleep and daytime somnolence
What are the characteristics of CSA?
Less common, more serious No respiratory effort Common in patients w/HF and CVD No snoring Fragmented sleep and daytime somnolence
What happens to the muscles in OSA?
Skeletal muscle of the tongue, larynx and pharynx relax as well as smooth muscle in the upper airways
What are long term effects of OSA?
HTN
CVD
Stroke
Higher mortality
What are the etiologies of OSA?
HTN Pulmonary do (pulmonary HTN) Cardiac do Diabetes Mortality and accidents
What are the clinical findings of OSA?
Obesity Large neck circumference Dental overbite; malocclusion Edema, erythema, of the uvula Elongated and low-hanging soft palate Narrow mandible; narrow maxilla Tonsillar hypertrophy Adenoid hypertrophy Nasal septal deviation
What are RFs for OSA?
Obesity Neck circumference (17+ men, 15+ women) Male FH AA, Pacific islander, mexican american) Downs syndrome 40+ yo Postmenopausal status EtOH before bed Respiratory allergies and nasal congestion HTN
What are daytime sx of OSA?
Daytime sleepiness and fatigue Morning or nocturnal HA Impaired memory and concentration Decreased dexterity Personality changes
What are nocturnal sx of OSA?
Snoring Nocturnal choking Nocturnal snorting and gasping Restlessness Dyspnea Diaphoresis Nocturia Dry mouth Drooling Gastroesophageal reflux
What is the gold standard for OSA?
Overnight polysomnogram
AHI 5+ events per hour
What questionnaire can be used for OSA?
STOP BANG
Berlin
Epworth sleepiness scale
What is mild OSA?
5-14 events/hr
What is moderate OSA?
15-29 events/hr
What is severe OSA?
30 or more events/hr
What is the treatment of OSA?
Wt loss Avoid sleep deprivation Refrain from tobacco, alcohol, and sedative use Sleep position (avoid back) Good sleep hygiene CPAP
When is CPAP used in OSA?
Possibly mild OSA
Moderate - severe OSA definitely (possible surgical interventions)
What are the characteristics of CSA?
Periodic episodes of apnea caused by loss of ventilatory motor output
What are causes of CSA?
Idiopathic ANS lesions Neurologic dz CH Opioid abuse High altitudes
What are tx for snoring?
Wt loss Nasal decongestants Drugs to reduce upper airway inflammation Avoid etoh Smoking cessation Positional therapy CPAP
