Sleep Disordered Breathing Flashcards
Generally, what is sleep apnea?
what are the two main categories
abnormal ventilation during sleep
- periods of apnea (breathing actaully stopping)
or
- periods of hypopena (significanlty reduced breathing) where Hgb sat. drops at least 4%
Central Sleep Apnea: ventilatory effort is absent for duration of the apneic episode central brain signlaing isnt triggering ventliation
Obstructive Sleep Apnea: ventilory effort is happening (from central brain) but there is obstruction in the upper airway (chest wall still moving – but something in the upper airway is blocking teh airflow)
why is diagnosis of sleep apnea essential?
- underdiagnosed
- daytime sleepiness –> car crashes, etc.
- fatal arrythmias can occur due to hypoxia –> death as a result
- heart and blood pressure issues can arise
what is a polysomnogram? when is it used
- the gold standard for diagnosis of sleep apneas
- in lab study which watches…
- EEG
- EKG
- eye movement
- muscle movement
- respiratory effort
- air flow
- snoring
home tests avalible and done but gold standard is PSM
what is central sleep apena
how common is it?
what is is assocaited with?
repetitive cessation or decreased of ventilory effory and flow during sleep
- much less common (10%)
- associated with other medical conditions
- ** heart failure, stroke, opioid use**
RARELY is it a primary issue or idiopathic
within central sleep apnea – what are the two categories??
hyperventaion associated CSA (most common)
- the body triggers an increase in ventiliation after periods of apnea due to hypoxia
- conditions that may trigger this include…
- heart failure
- stroke
- CNS disease
- a fib
- ticagrelor may help pts. here
hypoventiliation associated CSA
- CNS disease
- CNS depressing substances or durgs
- neuromuscular disorders
- severe abnormal chest wall deformities
risk factors for someone to develop sleep apnea
- men > females
- over age 65
- **heart failure
- post stroke**
- renal failure
- a fib
- mitocondrial disease
- medications including…
- opioids, bbenzos, TCAs, baclofen (high dose muscle relaxer)
how will someones present with Central Sleep Apena symptoms ?
- excessive daytime sleepiness
- claims poor sleep quality
- insomnia
- poor concentration
- fatigue
- paroxysmal noctural dyspnea
- bed partner awareness THEY WILL NOT SNORE!!! just hear them wake and gasp
Central Sleep Apnea
signs on exam
- nothing pathopneumonic
- look for signs causing another condition –> which the condition puts them at risk (HF, stroke, CNS disease, a fib)
how is Central sleep apena diagnosed?
- can be noted during hospital stay and other conditions
- gold standard is polysom. !!
- home test not sufficient
what patterns of polysomnography will you see for a pt. with central sleep apnea
- cheynne-stokes breathing
- high altitue
- medication or substance
- priamry CSA
what is our treatment of central sleep apnea?
goals of therapy
actual treatments
1 medication possible
what do you have to do in patients with severe heart failure (less than 45% ejection fracture)
what about those with hypoventilation CSA
goals
- normalize their sleeping beathing
- address underlying issue (if known)
treatment
- CPAP
- can use O2 in addition to a CPAP for those ** with hypoxia**
- acetazolomide – a diertic which may cause acidosis and trigger breathing drive
- pts with HF EF < 45% – CPAP wont work –> consider BiPAP and supp. O2
- direct stiumlation of the phrenic nerve for diaphragm implation
- hypoventliation – BiPAP +/- acetozolomide
what is obstructive sleep apnea?
who gets it?
- decreased ventiliation due to an obstruction in the upper airway (not becuase the signals arent firing) leading to periods of apnea or hypopnea
- upper airway collapse
- most commong sleep disorder of breathing (90%)
- men most common
- women post menopasue
what are some risk factors for OSA?
- OBESTIY !! #1 predictor – alwasy screen your obese or overweight pts.
- older age, male
- craniofacial or airway abnormalites
- ## smoking, alcohol, benzoz, nasal congestion
what are some common co-morbidities of those with OSA?
who should we be thinknig about
- obesity/overweight pts.
- CHF
- A fib
- pulmonary HTN
- CVD (any kinds)
- COPD, asthma
- ESRD
- stroke
- pregnancy!!
- PCOS
- parkinsons
what are some key signs and symtpoms you will find in pts. with OSA
- daytime sleepiness
- SNORING
- **CHOKING
- GASPING**
- bed partner reports of above events
- headaches in the morning
- insomina due to snoring or gasping wakes
- increased anxiety/depression
- problesm with anesthesia
- nocturia
