Sleep-Disordered Breathing and Obstructive vs. Central Sleep Apnea Flashcards
Sleep disordered breathing is an umbrella term for what types of patients?
Answer: snoring, mouth breathing, pauses in breathing
How must obstructive sleep apnea be diagnosed?
Answer: polysomnogram (PSG)
In order to properly diagnose and manage uncomplicated childhood obstructive sleep apnea syndrome, what must the FNP do?
Answer: screen all children for snoring
What diagnostic results from the PSG would signal to the FNP there is clinically significant OSA?
Answer: children with apnea-hypopnea index >5 events per hour
What diagnostic results from the PSG would be abnormal and warrant further investigation?
Answer: more than 1 apneic or hypopnea event per hour with duration of at least 2 respiratory cycles
What common co-morbid conditions warrant a PSG when suspecting sleep apnea? SELECT ALL THAT APPLY! A: Obesity B: Sickle cell C: Autism D: Myasthenia Gravis
A: Obesity
B: Sickle cell
D: Myasthenia Gravis
Answer: A, B, D (Also, down syndrome, craniofacial abnormalities, any neuromuscular disease)
In a healthy child, an adenotonsillectomy without PSG is recommended if what criteria are present? SELECT ALL THAT APPLY!
A: labored breathing with daytime fatigue
B: ADHD and weight gain
C: habitual snoring and sleepwalking
D: enlarged tonsils and increased frequency of urination
A: labored breathing with daytime fatigue
C: habitual snoring and sleepwalking
D: enlarged tonsils and increased frequency of urination
Answer: A, C, D (nighttime symptoms: habitual snoring + gasping, pauses, labored breathing, night terrors, sleepwalking, secondary enuresis; daytime symptoms: unrefreshed sleep, ADHD, emotionally labile, temperamental behavior, poor weight gain, daytime fatigue; Enlarged tonsils)
T or F: A child has markedly enlarged tonsils with dysphagia and recurrent tonsillitis. This patient requires a STAT PSG to confirm
sleep disordered breathing followed by adenotonsillectomy.
Answer: False (this patient meets criteria for surgery WITHOUT PSG)
T of F: OSA is a result of lack of effort to breathe
Answer: False (lack of effort to breathe is central sleep apnea; OSA is cessation of breathing due to attempt to breathe through an obstructed airway)
What are some common risk factors for OSA?
Answer: craniofacial abnormalities, neuromuscular dx, drugs (hypnotics, sedatives, anticonvulsants)
What symptoms should signal to the provider that OSA is present in a child? A: infrequent nighttime arousals B: habitual snoring C: shallow breathing D: rapid weight gain
B: habitual snoring
Answer: B (loud habitual snoring, witnessed apnea, labored breathing, frequent nighttime arousals)
What is a common cause of airway obstruction in ages 2-7 yr old?
Answer: tonsillar hypertrophy
What age group is affected by central sleep apnea at increased elevations?
Answer: infants/children
A 7yr old patient presents to your clinic with poor school performance over the last 6 months. His mother states she is concerned that he may have ADHD. What also must be part of your differential diagnosis / work-up for this patient?
Answer: obstructive sleep apnea
What must be performed in all cases suspected of OSA to diagnosis this condition?
Answer: PSG
