Sleep Apnea Lecture Powerpoint COPY

Question 1

Gold standard for diagnosing sleep apnea

Answer 1

Polysomnogram (PSG)

Question 2

What mallampati class puts a patient at greatest risk of sleep apnea

Answer 2

Class 4

Question 3

__% of the population suffers with sleep apnea, __% is undiagnosed/untreated, what race is at greatest risk independent of body weight?

Answer 3

5, 90, African Americans

Question 4

Sleep apnea

Answer 4

Collapsing of upper airways during sleep that causes cessation of breathing (apnea) or inadequate breathing (hypopnea) and sleep fragmentation

Question 5

Apnea

Answer 5

Cessation of breathing that lasts more than 10 seconds

Question 6

Hypopnea

Answer 6

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

Question 7

Arousal

Answer 7

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

Question 8

apnea-hypopnea index (AHI) and what are the range of values

Answer 8

• 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

Question 9

Respiratory disturbance index (RDI)

Answer 9

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

Question 10

3 types of sleep apnea

Answer 10

• 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)

Question 11

Common anatomic obstructions in obstructive sleep apnea (4) and which is most common in children

Answer 11

• muscle relaxation
• obesity
• nasal obstruction
• enlarged tonsils/adenoids (most common in children)

Question 12

Example of nocturnal muscle tone decrease in obstructive sleep apnea

Answer 12

Posterior pharyngeal muscles decrease tone and tongue drops back causing airway to narrow

Question 13

Mallampati scoring for obstructive sleep apnea

Answer 13

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)

Question 14

2 nasal anatomic obstructions that can contribute to obstructive sleep apnea

Answer 14

• enlarged turbinates

- deviated septum

Question 15

Pierre Robin Sequence

Answer 15

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

Question 16

Treacher Collins syndrome

Answer 16

Varies in severity of presentation but due to underdeveloped facial bones with downward slanting eyes and a cleft palate as well as malformed ears

Question 17

Most common risk factor for obstructive sleep apnea

Answer 17

Obesity

Question 18

Hypertension resistant to treatment can indicate….

Answer 18

….obstructive sleep apnea

Question 19

New onset of A-fib if acute MI is ruled out is likely to be from…

Answer 19

….Obstructive sleep apnea

Question 20

Obstructive sleep apnea cycle

Answer 20

• 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

Question 21

Untreated obstructive sleep apnea can result in these 3 conditions

Answer 21

• insulin resistance (type II diabetes)
• hypertension
• CV disease

Question 22

Risk factors for central sleep apnea (4)

Answer 22

• Rapid ascent to high altitude
• obesity hypoventilation syndrome (not breathing quickly or deeply enough, also called pickwickian syndrome)
• increasing age
• Cheyne-Stokes breathing

Question 23

Common presentation of sleep apnea (5)

Answer 23

• Sleepiness (inability to remain awake and alert but not fatigue (lack of physical or mental energy))
• Snoring
• Choking sounds
• awaken feeling unrested
• morning headaches

Question 24

DOT physicals and sleep apnea

Answer 24

Need to check for it, can’t let these people on the road

Question 25

Potential presentations of sleep apnea in children (3)

Answer 25

• bedwetting
• sweating at night
• poor school performance

Question 26

Epworth sleepiness scale

Answer 26

Useful screening tool for sleep apnea

Question 27

Polysomnogram (PSG)

Answer 27

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)

Question 28

Apnea-hypopnea index (AHI) values and interpretation (4)

Answer 28

Normal: <5 events per hour
Mild: 5-15 events per hour
Moderate: 15-30 events per hour
Severe: >30 events per hour

Question 29

Sleep apnea treatment options (3)

Answer 29

• CPAP or Bipap
• oral appliance therapy
• surgery

Question 30

CPAP vs BiPAP

Answer 30

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)

Question 31

Oral appliance therapy

Answer 31

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

Question 32

Surgical treatment for sleep apnea

Answer 32

Less effective than PAP therapy, in children often OSA is well treated with tonsillectomy, in adults can perform uvulopalatopharyngoplasty or UPPP

Question 33

Respiratory effort related arousal (RERA)

Answer 33

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

Question 34

Retropositioned mandibles

Answer 34

A predisposing genetic trait that can result in increased risk of obstructive sleep apnea