Sleep Apnea Lecture Powerpoint COPY Flashcards
Gold standard for diagnosing sleep apnea
Polysomnogram (PSG)
What mallampati class puts a patient at greatest risk of sleep apnea
Class 4
__% of the population suffers with sleep apnea, __% is undiagnosed/untreated, what race is at greatest risk independent of body weight?
5, 90, African Americans
Sleep apnea
Collapsing of upper airways during sleep that causes cessation of breathing (apnea) or inadequate breathing (hypopnea) and sleep fragmentation
Apnea
Cessation of breathing that lasts more than 10 seconds
Hypopnea
Respiration that declines more than 10 seconds but does not necessarily stop, determined by measurements of nasal pressure which leads to consequences such as o2 desaturation
Arousal
Brief sudden change in sleep state that can be detected on the EEG caused by a drop in O2 and increased CO2 following an apnea or hypopnea episode that then moves to a sympathetic response to compensate which stirs the patient awake slightly resulting in a lack of deep sleep
apnea-hypopnea index (AHI) and what are the range of values
- Average number of apneas + hypopneas per hour of sleep of a patient, most common used
- Normal is <5 events per hour, mild is 5-14, moderate is 15-29, severe is 30 events per hour or more
Respiratory disturbance index (RDI)
Average number of apneas + hypopneas + RERAs (preferred to be measured by uncomfortable esophageal manometry so often not used) per hour of sleep of a patient
3 types of sleep apnea
- Obstructive (most common, airway is blocked by nocturnal muscle done decrease or anatomic obstructions)
- Central (brain fails to signal muscles in order to breath, rib and abdominal motion ceases)
- Mixed/complicated (central and obstructive, hard to diagnose)
Common anatomic obstructions in obstructive sleep apnea (4) and which is most common in children
- muscle relaxation
- obesity
- nasal obstruction
- enlarged tonsils/adenoids (most common in children)
Example of nocturnal muscle tone decrease in obstructive sleep apnea
Posterior pharyngeal muscles decrease tone and tongue drops back causing airway to narrow
Mallampati scoring for obstructive sleep apnea
Used in anasthesia to predict ease of intubation, can be used to predict whether a patient might have obstructive sleep apnea based on whether soft palate or uvula can be visualized (class 1-4 going from able to see soft palate and uvula, only partial of soft palate, only uvula, or nothing)
2 nasal anatomic obstructions that can contribute to obstructive sleep apnea
- enlarged turbinates
- deviated septum
Pierre Robin Sequence
Congenital condition present at birth that results in a smaller than normal lower jaw, tongue being placed back further than normal, and opening in roof of mouth (cleft palate) predisposing to obstructive sleep apnea
Treacher Collins syndrome
Varies in severity of presentation but due to underdeveloped facial bones with downward slanting eyes and a cleft palate as well as malformed ears
Most common risk factor for obstructive sleep apnea
Obesity
Hypertension resistant to treatment can indicate….
….obstructive sleep apnea
New onset of A-fib if acute MI is ruled out is likely to be from…
….Obstructive sleep apnea
Obstructive sleep apnea cycle
- Sleep
- Decreased compensation overtime to retain patent airway
- Airway collapse
- Decreased O2 and increased CO2, increased effort to breath
- arousal from sleep
- Hyperventilation to decrease CO2 and increase O2
- sleep
Untreated obstructive sleep apnea can result in these 3 conditions
- insulin resistance (type II diabetes)
- hypertension
- CV disease
Risk factors for central sleep apnea (4)
- Rapid ascent to high altitude
- obesity hypoventilation syndrome (not breathing quickly or deeply enough, also called pickwickian syndrome)
- increasing age
- Cheyne-Stokes breathing
Common presentation of sleep apnea (5)
- Sleepiness (inability to remain awake and alert but not fatigue (lack of physical or mental energy))
- Snoring
- Choking sounds
- awaken feeling unrested
- morning headaches
DOT physicals and sleep apnea
Need to check for it, can’t let these people on the road
Potential presentations of sleep apnea in children (3)
- bedwetting
- sweating at night
- poor school performance
Epworth sleepiness scale
Useful screening tool for sleep apnea
Polysomnogram (PSG)
Gold standard diagnosis of sleep apnea, sleep study done in a lab or at home, often require nocturnal oximetry test for insurance first, monitors blood oxygen levels, brain wave activity, body position and leg movements, respiratory rate, oro-nasal airflow and snoring monitoring, and ultimately produces number of apnea and hypopneas per hour which is then calculated to apnea-hypopnea index (AHI)
Apnea-hypopnea index (AHI) values and interpretation (4)
Normal: <5 events per hour
Mild: 5-15 events per hour
Moderate: 15-30 events per hour
Severe: >30 events per hour
Sleep apnea treatment options (3)
- CPAP or Bipap
- oral appliance therapy
- surgery
CPAP vs BiPAP
CPAP is one constant level of pressure to passively open the upper airway, while BiPAP has 2 pressure settings, one prescribed for inhalation and a lower one for exhalation (can be easier to exhale)
Oral appliance therapy
2nd line treatment for sleep apnea including mandibular advancement devices to adjust position of mandible during sleep or tongue retaining devices that prevent tongue from obstructing
Surgical treatment for sleep apnea
Less effective than PAP therapy, in children often OSA is well treated with tonsillectomy, in adults can perform uvulopalatopharyngoplasty or UPPP
Respiratory effort related arousal (RERA)
Event characterized by increased respiratory effort for 10 sec or more leading to arousal from sleep but not due to apnea or hypopnea, rather tied to negative esophageal pressure being terminated upon arousal
Retropositioned mandibles
A predisposing genetic trait that can result in increased risk of obstructive sleep apnea
