sleep disordered breathing

Question 1

List sleep stages

Answer 1

Stage 1,2,3,4 and REM

Question 2

Describe sleep stage 1 and 2

Answer 2

Positive muscle tone, Person is unresponsive but easily aroused

Question 3

Describe sleep stage 3 and 4

Answer 3

Positive muscle tone, High arousal threshold, More prominent during the first half of sleep.

Question 4

Describe REM sleep stage

Answer 4

Absent muscle tone, High arousal threshold, More prominent during the second half of sleep.

Question 5

Compare respiration control when awake and sleeping

Answer 5

When awake, the cortex and external sources provide input to the medulla to influence respiration. When sleeping, there is no input from the cortex or external sources

Question 6

Describe respirationpattern, rate, tidal volume, FRC, and minute ventilation during stages 3 and 4

Answer 6

Stable and regular pattern of respiration, Decrease or no change in respiratory rate, Decrease in tidal volume and functional residual capacity, Reduction in minute ventilation

Question 7

Describe respiration muscle usage, airway resistance, flow rate, PaCO2 and PaO2 during stages 3 and 4

Answer 7

Diminished activity of accessory respiratory muscles and pharyngeal dilator muscles, Increase in upper airway resistance and decrease in inspiratory flow rate., Increase in PaCO2, Decrease in PaO2

Question 8

Describe respiration pattern, nerves, airway resistance, flow rate, PaCO2 and PaO2 during REM sleep

Answer 8

Variable pattern of respiration, Intact activity of phrenic nerve innervating diaphragm, Absent activity of motor neurons to intercostal muscles (Atonia), Diminished activity of motor neurons to pharyngeal dilator muscles, Increase in upper airway resistance and decrease in inspiratory flow rate., Increase in PaCO2, Decrease in PaO2

Question 9

Muscles of upper airway involved in breathing

Answer 9

(1) muscles influencing hyoid bone position (geniohyoid, sternohyoid), (2) the muscle of the tongue (genioglossus), and (3) the muscles of the palate (tensor palatini, levator palatini).

Question 10

Describe genioglossal activity during wake and sleep

Answer 10

When awake, activity increases with inspiration and decreases with expiration. This pattern is the same during sleep but overall level of activity is much lower during sleep

Question 11

explain the pressure of upstream segment, collapsable segment and downstream segment in non-flow limited, flow limited and occluded airways

Answer 11

Non flow limited: Pus > Pds >Pcoll. Flow limited: Pus >Pcoll> Pds. Occluded: Pcoll > Pus=Pds

Question 12

Define apnea

Answer 12

Cessation of nasal and oral airflow for at least 10 seconds. Can be central, obstructive or mixed apnea

Question 13

Compare obstructive vs central vs mixed apnea

Answer 13

obstructive: Reducation of airflow despite persistence of ventilatory efforts. Central: reduction of airflow in association with absence of ventilatory efforts. Mixed: reduction of airflow with initial central component and terminal obstructive component

Question 14

Define hypopnea

Answer 14

Reduction of airflow or thoraco-abdominal movement by at least 30% from baseline, for at least 10 seconds and oxyhemoglobin desaturation of 4% or more

Question 15

epidemiology of snoring, upper airway resistance syndrome, sleep apnea syndrome, cheyne-stokes respiration

Answer 15

snoring: 44% of men and 28% of women. UARS: 9% of population. Sleep apnea: 4% of men and 2% of women. Most are obstructive, followed by mixed, then central. Cheyne-stokes respiration: 40-50% heart failure patients, 10% stroke patients.

Question 16

Sleep disordered breathing increases risk of ?

Answer 16

obesity, cardiovascular disease, motor vehicle crash

Question 17

Clinical features of sleep apnea

Answer 17

snoring, gasping at night, excessive sleepiness, nonrefreshing sleep, total sleep amount, nocturia, morning headaches, decreased concentration, memory loss, decreased libido, irritability

Question 18

Which patients should be assessed for sleep apnea

Answer 18

BMI>35, CHF, atrial fibrillation, type 2 diabetes, nocturnal dysrhythmias, CVA, pulm HTN

Question 19

Diagnostic test for sleep apnea

Answer 19

polysomnography- full night for diagnostic only, split night for diagnostic and therapeutics, portable study for diagnostics only

Question 20

What is CPAP

Answer 20

Continuous positive airway pressure- provides a constant pressure throughout the respiratory cycle

Question 21

oral appliances for sleep apnea

Answer 21

tongue retainer holds tongue forward. Mandibular repositioner advances the mandible and tongue forward but is contraindicated if compromised teeth or TMJ dysfunction

Question 22

surgical options for sleep apnea

Answer 22

Tracheostomy, maxillomandibular advancement, uvulopalatopharyngoplasty, tonsillectomy and adenoidectomy,

Question 23

Tracheostomy and indications

Answer 23

Tracheostomy- Used in patients with life threatening obstrictive sleep apnea and are intolerant to other therapies. Involves Percutaneous tracheal opening distal to the pharynx that bypasses the area of upper airway obstruction.

Question 24

Maxillomandibular advancement

Answer 24

–Advancement of both the maxilla and mandible by Le Fort I maxillary and sagittal-split mandibular osteotomies. Enlarges the retrolingual and retropalatal airway, but complications include chin and cheek numbness

Question 25

UvuloPalatoPharyngoPlasty (UPPP)

Answer 25

Excision of uvula, posterior portion of the soft palate, redundant pharyngeal tissue, and tonsils (if present), and trimming of the tonsillar pillars. Less effective than CPAP

Question 26

•Tonsillectomy and adenoidectomy

Answer 26

Removal of the tonsils and enlarged adenoids May be particularly effective in children with OSA due to adenotonsillar enlargement