Sleep apnea, DVT Flashcards
What is sleep apnea?
period collapse of upper airway during sleep
When does sleep apnea occur?
loss of normal pharygneal muscle tone allows pharynx to collapse during inspiration
Patients with sleep apnea have an increased risk of whast?
diurnal and plumonary HTN noctural dysrhythmias right and left ventricular failure MI/atrial fibrillations stroke
Risk factors with sleep apnea:
narrowed upper airway
hypothyroidism
smoking
cardiovascular related disease
Factors that aggravate sleep apnea:
alcohol or sedatives
nasal obstruction
What is OSA an independent risk factor for developing?
stroke
CAD
congestive cardiac failure
hypertension (cardiovascular disease)
Hallmark findings of OSA:
obese, middle aged men
systemic HTN
Patient complaints with OSA:
daytime fatigue morning sluggishness and HA cognitive impairment recent weight gain impotence
What do bed partners report with OSA?
loud snoring breath cessation witnessed apneas restlessness thrashing during sleep
Non-MSK differential diagnosis:
asthma central sleep apnea syndrome COPD depression GERD hypothyrodism narcolepsy periodic limb movement disorer
MSK differential diagnosis:
arthritis
fibroyalgia
chronic back pain
STOP-Bang questionnaire:
snoring tiredness observed apnea high BP BMI age gender male
Gold standard for OSA:
polysomnography
Berline questionnaire:
self reported
BMI greater than 30
high risk 2 or more categories with positive score
American Academy of Sleep Medicine Diagnostic Criteria5
- Excessive daytime sleepiness that is not better explained by other factors.
- Two or more of the following that are not better explained by other factors:
a. Choking or gasping during sleep
b. Recurrent awakenings from sleep
c. Unrefreshing sleep
d. Daytime fatigue
e. Impaired concentration
- Overnight monitoring demonstrates five or more obstructed breathing
events per hour of sleep
PT interventions:
weight management jaw pain relief soft tissue mobs postural exercises patient ed
OSA causes acute physiological changes including:
alveolar hypoventilation
pulmonary artery vasoconstriction
Calf muscle pump:
When flexed, the muscles force blood up towards the heart, and when
relaxed, the veins refill from the superficial circulation comprising two
veins
Hallmark findings of DVT
Unilateral tenderness or leg/calf pain Unilateral swelling Warmth Discoloration Pain with placement of BP cuff around calf & inflated to 160 - 180 mmHg Pain intensified with standing or walking Pain relieved by rest and elevation Possible pallor Possible loss of dorsalis pedis pulse
Calf measurement:
10cm below tibial tuberosity
swelling 3cm of more
DVT differential diagnosis:
positive Homan Ruputered Baker's cyst cellulitis post-thrombotic syndrome venous insufficiency
Where do 70-80% of DVT occurs:
popliteal vein and superficial femoral vein
When are DVT symptoms present?
present 24-48 hours postoperatively
How long does the risk of developing a DVT last
3 months
DVT red flags:
Calf pain, edema, tenderness, warmth
Calf pain that is intensified with standing or walking and relieved by rest and elevation
Recent surgery, malignancy, pregnancy, trauma, leg immobilization
High probablity of DVT
3 or more
Moderate probability of DVT
1 or 2
Low probability of DVT
0
Wells criteria questions worth 1 point:
active cancer (6 months)
paralysis, paresis or recent immobilization
Bedridden for 3 or more days with past 12 weeks
localized tenderness along distribution of deep venous system
entire leg swelling
previous DVT
pitting edema
Swelling larger than 3 cm
collateral superficial veins
Wells criteria -2 points:
alternative diagnosis at least as likely as DVT
