Sleep Disordered Breathing Flashcards

Question

% of Canadian diagnosed with sleep apnea

Answer 1

3% of Canadian adults 18 years and older will be diagnosed with sleep apnea Out of those diagnosed with sleep apnea 4% reported symptoms and risk factors that are associated with a high risk of having or developing obstructive sleep apnea

Answer 2

Many Canadians were diagnosed with sleep apnea without the benefit of sleep laboratory testing. In order to be diagnosed with sleep apnea the Canadian Thoracic Society recommends that an individual undergo a polysomnography, but portable home monitoring devices are also sometimes used to test for sleep apnea

Answer 3

Snoring loud enough to be heard through closed doors Often feeling tired during the day Having been observed stopping breathing in their sleep Diagnosed with high blood pressure Having a BMI \>35 Being over 50 Being male

Answer 4

Patients with CSA will display a periodic breathing pattern where they periodically not breath or breathe so shallowly that oxygen intake is ineffectual Waxing and waning or respiratory pattern May show Cheyne Stokes breathing pattern Occurs when respiratory centers of the medulla fail to send signals to the respiratory muscles Characterized by cessation of airflow at the nose and mouth with absence of diaphragmatic excursions

Answer 5

Cheyne-Stokes is a severe type of periodic breathing that is often associated with CHF Cheyne-Stokes breathing is shallow/under breathing that will alternate with a deep over breathing

Answer 6

* Congestive heart failure * Cheyne-Stokes respiration * Metabolic alkalosis * Idiopathic hypoventilation syndrome * Brain stem neoplasm or infarction * Bulbar poliomyelitis * Spinal surgery * Encephaslitis * Cervical cordotomy * Hypothyroidism * Will result in abnormalities in ventilatory control

Answer 7

Infectious disease caused the poliovirus A severe infection can extend into the brainstem and even into higher brain structures, resulting in polioencephalitis. This can affect breathing, swallowing, and other vital functions. Bulbar polio leads to weakness of muscles innervated by cranial nerves.

Answer 8

Encephalitis is an acute inflammation (swelling) of the brain usually resulting from either a viral infection or due to the body's own immune system mistakenly attacking brain tissue

Answer 9

Cordotomy is a surgical procedure that disables selected pain-conducting tracts in the spinal cord, in order to achieve loss of pain and temperature perception.

Answer 10

Combination of obstructive and central sleep apnea Usually begins as central sleep apnea, followed by: Ventilatory efforts without airflow—OSA Clinically, mixed sleep apnea is usually classified and treated as OSA

Answer 11

When OSA and COPD co-exist Worse prognosis Worse ABG abnormalities than “simple” OSA

Answer 12

**High Risk**: Answering yes to three for more items **Low Risk:** Answering yes to less than three items * S = Snoring * T = Tiredness * O= Observed apneas/gasping * P = Pressure (as in high BP) * B = BMI * A = Age * N = Neck circumference * G = Gender

Answer 13

Do you snore loud enough to be heard through closed doors or louder than talking

Answer 14

BMI more than 35 kg/m2 ?

Answer 15

Neck circumference greater than 40 cm?

Answer 16

Are you male

Answer 17

* Used to measure excessive daytime sleepiness * Has patient rate how likely they are to fall asleep in different situations * Validated for OSA * Scores are added up * 0-9 is normal * 10-24 indicates need for expert medical advice * ≥ 16 indicates possibility of severe sleep apnea or nacolepsy * Can be repeated after beginning treatment with CPAP to see if symptoms have improved

Answer 18

Both studies read and interpreted by a specialist physician (usually a respirologist).

Answer 19

* Polysomnogram (PSG) * Done in a hospital or sleep lab * Diagnoses all sleep disorders * Able to stage sleep * Uses 16 channels to gather information: * SpO2, snoring, airflow, EMG, respiratory effort, limb movement, EOG, ECG, EEG

Answer 20

* There will be a lack of airflow, but the presence of respirtory drive * There will be a paradoxical efforts of the rib cage and abdomen * Efforts will continue to increase until arousal and airflow returns * The arousal is shown on the EEG and results in the airway opening and resumption of airflow

Answer 21

There is a decrease (not total stop) of airflow at the same time as paradoxical efforts There will be an increase in efforts until arousal occurs and airflow resumes The arousal will result in complete airway opening and resumption of airflow There will be a desaturation but to a **lesser degree than OSA**

Answer 22

There will be no detectable decrease in airflow Subtle paradoxical efforts are not unusual, but efforts will increase until arousal occurs No desturataion is associated with the arousal

Answer 23

There is a lack of airflow **and** a lack of respirtory efforts There will be and arousal which is followed by a maximal respiratory effort Desaturations are common

Answer 24

There is a lack of airflow and respirtory efforts=Central Componenets Respiratory Efforts resume without airflow= Obstructive Componenet Arousal with increased respirtory efforts occur Desaturations are common

Answer 25

Uses 6 channels to gather information: SpO2, snoring, airflow, respiratory effort (optional), body position and heart rate

Answer 26

* The apnea-hypopnea index is defined as the average number of apneas and hypopneas the patient has per hour of sleep. * The AHI score provides the following severity categories of sleep apnea: * Normal— \< 5 * Mild—5 to 15 * Moderate—15 to 30 * Severe—\> 30

Answer 27

RDI= (#of desats and resats events)/ Total monitoring time (hours) This is calculated by the SnoreSat

Answer 28

Like the AHI, an RDI \> 15 is considered clinically significant and will be treated! AHI ≠ RDI. AHI is calculated from the “gold standard” PSG. RDI is calculated from the Snore Sat.

Answer 29

* Level III device * Ares * Apnea risk evaluation system * Gives RDI and AHI. * PSG * Gives an “AHI” score * The gold standard * Will detect OSA that the ARES misses

Answer 30

Weight loss/maintain healthy BMI Good sleep hygiene Avoidance of alcohol Work with physician to change/alter schedule of sedatives Avoid excessive fatigue Smoking cessation

Answer 31

CPAP APAP AVAS/VPAP BiPAP

Answer 32

Continuous positive airway pressure Level determined by repeating sleep study while on CPAP Pressurized air delivered through mask and tubing; designed to act as a pneumatic airway splint CPAP usage of 4 hours/night on at least 70% of nights is generally considered the minimum required to see improvement in symptoms and quality of life Established Outcomes * Decreased BP and MVA When to use * Severe OSA * Mild-moderate PSA * Pt preference

Answer 33

Auto-adjusting CPAP, within a set range Thought to result in a lower failure rate Special modes (“C-Flex”) may decrease the CPAP level during expiration to ease exhalation; “A-flex” does both inspiration and expiration

Answer 34

Allows volume-targeting and minimal minute volumes Often used in when severe OSA or a central component

Answer 35

Usually when there is a component of hypoventilation

Answer 36

* Tongue retaining device (TRD) * Holds tongue forward to prevent it from falling back and obstructing the airway * Mandibular advancement device (MAD) * Holds the lower jaw forward to maintain an open airway * Over-the-counter and custom made * May be used in conjunction with CPAP therapy (and allows reduced CPAP pressures to be used) * These typically used in treating snoring, UARS, intolerant of CPAP, and mild OSA

Answer 37

Nasal surgery (septoplasty, turbinate reduction…) Tonsillectomy uvulopalatopharyngoplasty Genioglossal advancement Mandibular advancement Surgical interventions typically use a “phased” approach

Answer 38

* Devices used to “encourage” sleeping on the side (as snoring is typically worse when on their back) * Effective for those with positional SDB (i.e. only when supine) * Methods: * Specially designed shirt * “Tennis ball” technique * Backpack

Answer 39

* Pharmaceutical * Area of current research * Neurostimulation * New surgery * For pt that cannot tolerate CPAP * Implant with a sensor that measures breath which sends a signal to the implant which will move the tongue

Answer 40

The symptoms of central sleep apnea are for the most part the same as those of obstructive sleep apnea. They include chronic fatigue, daytime sleepiness, morning headaches and restless sleep. But if the cause is a neurological disease The CSA sufferer may also experience difficulty swallowing, voice changes, and an overall sense of weakness and numbness.

Answer 41

Patients with suspected nocturnal hypoventilation should not be started on therapy (including oxygen) outside of a monitored setting. Such patients are at increased risk of worsening respiratory failure and should be referred for polysomographic titration of PAP therapy.

Answer 42

* Patients with AHI or RDI ≥ 5 with daytime sleepiness or equivalent symptoms (fatigue, poor concentration) * CPAP or oral appliance therapy * Patients with severe OSA as defined by AHI or RDI * CPAP as first line therapy; oral appliance for patients who do not tolerate or refuse CPAP * Allpatients who are started on therapy should be clinically reassessed within 2-4 weeks to ensure that symptoms have improved and that OSA is adequately treated