Sleep Apnea B&B + lecture

Question 1

How long do sleep apnea episodes usually last?

Answer 1

> 10 seconds, multiple episodes per night typical

Question 2

What causes central sleep apnea?

Answer 2

no effort to breathe - patients with marginal ventilation (hypoventilation) when awake

ex: encephalitis, severe kyphoscoliosis, narcotics

—> Cheyne-Stokes breathing

Question 3

What pattern of breathing is seen in patients with central sleep apnea?

Answer 3

Cheyne-Stokes breathing: cyclic breathing caused by delayed detection/response to changes in PaCO2

Common in heart failure and stroke patients

Question 4

What causes obstructive sleep apnea and what is the strongest risk factor?

Answer 4

recurrent soft tissue collapse in the pharynx

Strongest risk factor is obesity

Question 5

What kinds of complications can develop from sleep apnea?

Answer 5

HTN, pulm HTN, arrhythmias, sudden death

Erythropoiesis in response to chronic hypoxia (EPO release)

Question 6

Polysomnography

Answer 6

A.k.a. sleep study - measure EEG, eye movements, O2 level, HR, respiratory rate, number of apnea episodes

gold standard of diagnosing obstructive sleep apnea

Question 7

what are some risk factors for obstructive sleep apnea?

Answer 7

obesity
age
male gender
neck size
anatomic factors (ex, craniofacial abnormalities)
medications, alcohol

Question 8

what will patients with obstructive sleep apnea (or their partners !) complain of?

Answer 8

loud snoring, nocturnal gasping for air, dry mouth in the morning, morning headache, excessive daytime somnolence, poor sleep quality, nocturia

*however note sensitivity/specificity for each symptom is poor

Question 9

if PE reveals any of the following exam findings in a patient, what should you be concerned for?

macroglossia, narrowing of lateral airway, high/arched palate, retrognathia, tonsillar hypertrophy (pediatrics)

Answer 9

risk for obstructive sleep apnea

Question 10

How can opiate use cause or contribute to central sleep apnea?

Answer 10

opiates bind to u opioid receptors in the brainstem and depress respiration

Question 11

If a patient with sleep apnea tells you they snore at night, what kind of sleep apnea do they have?

Answer 11

obstructive sleep apnea

No snoring in central sleep apnea because it occurs due to respiratory control dysfunction, not upper airway collapse

Question 12

Why does it make sense to use hypoglossal nerve stimulator therapy in obstructive sleep apnea but phrenic nerve stimulator therapy in central sleep apnea?

Answer 12

obstructive sleep apnea causes increase in SNS activity – stimulate hypoglossal nerve to increase PSNS activity

Central sleep apnea occurs from respiratory control dysfunction/no breathing effort – stimulate phrenic nerve to stimulate diaphragm to breathe