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Medicine II > sleep disorders > Flashcards

sleep disorders Flashcards

1
Q

sleep occupies how much of a human’s life?

A

1/3

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2
Q

obstructive sleep apnea

A

if a patient’s breathing is interrupted or if they stop breathing completely during sleep

  • respiratory obstruction
  • decrease in oxygen, heart rate and pulse will increase; if no proper treatment, can lead to CV disease of higher dosage of medications
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3
Q

central sleep apnea

A

no obstruction of the airway, brain does not send signal to respiratory muscles

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4
Q

obstructive sleep apnea diagnoses

A
  • hospital based test

- poly somno graphy (PSG)

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5
Q

normal

A

0-5 respiratory events /hr of sleep

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6
Q

mild

A

5-15 respiratory events/ hr of sleep

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7
Q

moderate

A

15-30 respiratory events/ hr of sleep

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8
Q

severe

A

> 30 respiratory events/ hr of sleep

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9
Q

what causes snoring

A 
obesity
pregnancy
allergies
smoking
alcohol- muscle relaxant
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10
Q

hallmark symptom of sleep apnea

A

snoring, narrowing of upper airway

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11
Q

where does the snoring sound come from?

A

vibration of the uvula

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12
Q

percentage of snorers

A

25% men and 15% women are habitual snorers

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13
Q

percentage of snorers between 41 - 65 yrs

A

60% men and 40% of women between 41-65 yrs

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14
Q

what percent of sleep apnea patients snore?

A

95%

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15
Q

snoring is related to

A

cardiovascular disease
heavy smoking
myocardial infarction
atherosclerosis

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16
Q

nocturnal symptoms of obstructive sleep apnea

A

chocking or gasping
insomnia
diaphoresis (sweating)
impotence (weakness)

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17
Q

diurnal symptoms of obstructive sleep apnea

A

excessive daytime sleepiness

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18
Q

what percentage of people report daytime sleepiness

A

30% to 50% of general population

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19
Q

epworth sleeping scale

A

rating how much you doze during sitting, reading, watching TV, sitting inactive, passenger in a car for an hr, lying down to rest, sitting and talking to someone, sitting quietly after lunch with no alcohol, in a car while stopped in traffic

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20
Q

most common physical characteristic of obstructive sleep apnea

A

craniofacial anatomy-narrowing of the oropharyngeal airway

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21
Q

physical characteristics of obstructive sleep apnea

A 
craniofacial anatomy
retrognathia
narrow maxillomandibular arches
tonsillar hypertrophy
macroglossia
inferior displacement of hyoid bone
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22
Q

retrognathia

A

malocclusion, abnormal posterior positioning of maxillar or mandible

23
Q

narrow maxillomandibular arches

A

patient will have difficulty breathing through nose an become a mouth breather

24
Q

macroglossia

A

narrow maxilla + large tongue

25
Q

inferior displacement of hyoid bone

A

retrusive position of hyoid bone indicates restriction of airway

26
Q

look for shape and size of maxillar, position of mandible, amount of missing teeth; amount of missing teeth will decrease

A

vertical dimension

27
Q

clinical predictors of obstructive sleep apnea

A

scalloped tongue, size of tongue, position of tongue relative to occlusal plane

28
Q

bruxism and sleep apnea?

A

retrusive movement during bruxism may obstruct the airway

29
Q

friedman classification for tongue

A 
A Tongue is normal
B tongue covers half of space in throat
C tongue covers 2/3 of space in throat
D tongue covers space in throat 
E tongue covers space in throat and more
30
Q

sleep apnea patients Friedman classification

A

usually between C +D

31
Q

Friedman test for obstructive sleep apnea

A

patient opens mouth

32
Q

mallampati score to test for Obstructive sleep apnea

A

patient protrudes tongue

33
Q

mallampati score

A

I= normal
II= tongue covers half of throat
III= tongue covers more than half of throat
IV tongue covers throat

34
Q

Is Friedman or mallampati score more accurate for testing for obstructive sleep apnea?

A

friedman

35
Q

clinical predictor of obstrutive sleep apnea

A

wear facets

36
Q

OSA prevalence

A

male, 40-70 yrs, overweight, obese, central body fat distribution, large neck girth, craniofacial and upper airway abnormalities

37
Q

suspected risk factors for OSA

A 
genetics
smoking
meopause
alcohol before sleep
nighttime nasal congestion
38
Q

OSA symptoms

A

habitual, loud snoring
nocturnal breathing pauses, choking, gasping
excessive daytime sleepiness

39
Q

problems with daytime functioning

A 
daytime sleepiness
motor vehicle crashes
psychosocial problems
decreased cognitive function
reduced quality of life
40
Q

CV and cerebrovascular disease

A 
hypertension
coronary artery disease
myocardial infarction
CHF
stroke
diabetes and metabolic syndrome
41
Q

oral appliance therapy

A 
selection
fabrication
fitting
adjustment
long term follow up care
-muscle relaxation during sleep allows open airway to widen
42
Q

oral appliance therapy aims to

A
  • modify position of upper airway structures
  • increase the airway size
  • prevent the collapse of the tongue and soft tissues
43
Q

what the oral appliance does

A
  • hyoid bone will move forawrd and up, providing more clearance
  • prevents uvula from producing snoring sound; snoring sounds are at the level of the uvula
44
Q

oral appliance is

A

adjustable

45
Q

pre-fabricated oral appliances

A

not recommneded, potential side effects, dentist should evaluate

46
Q

monoblock non-adjustable oral appliance

A

first appliance used

-mech: increase vertical dimension and maintain jaw in forward position, which is similar to previous appliance

47
Q

clinical protocol for oral appliance

A 
examination
bite reg/ impressions
oral appliance selection
fitting/adjustments
follow ups (6 mos, yearly)
48
Q

why are symptoms worse while patient is sleeping on his back?

A

gravity causing lower jaw to move back, muscles to relax, and decrease in size of the airway

49
Q

during REM

A

increase in muscle relaxation; severity increases, oxygen decreases by 78%

50
Q

how do these devices work?

A

when the lower jaw is protruded, there is more airflow and the snoring sound is not as intense

51
Q

Home sleep monitor measures

A

oxygen levels and obstruction during sleep

52
Q

5 screening questions for obstructive sleep apnea

A

1 what prevents you from getting a good night sleep?
2are you excessively sleepy during the day?
3 how many hours do you normally sleep
4 have you been told that you snore or stop breathing
5 what medications and other substances do you take (muscle relaxants? )

53
Q

if you have a patient that falls asleep on the chair

A

send him for a consult on the 6th floor and follow up

Medicine II (8 decks)

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