Sleep Disorders Flashcards
most common form of sleep apnea?
obstructive!
M>W
complications of OSA?
hypoxemia and hypercapneia
central sleep apnea?
rare, due to decreased central respiratory drive
-can be idopathic, but also results from a brainsteme lesion or injury
pathophysiology of sleep apnea
- cyclic episodes of airway occulsion
- sympthetic tone increaases during ariway occlucsion- leads to htn and vasoconstriction
- intrathoracic pressure increases more (-) w/ inspiration
what can airway occlusion be due to?
- loss of pharyngeal tone (pharynx passively collapses during inspiration)
- narrow upper airway (micrognathia, macroglossia, obestisy, tonsillar hypertrophy)
micrognathia
undersized jaw
RF of obstructive sleep apnea
Male, middle ages, obese, abnormal upper airway anatomy,
alcohol/ sedative can increase/contribue to loss of pharyngeal tone
tobacco use, hypthyroidism
Clinical presentation of OSA
daytime sleepiness
- recurrent awakenings
- AM HA
- fatigue
- recent weight gain
- congnitive impariment
- impotence
Clinical exam or OSA
normal
+/-:
-elevated BP
-pulmonary HTN, peripheral edema, sx of right-sided heart failure
-prolonged episodes of hypoxemia and pulmonary vasoconstriction
lab findings in OSA
- erythrocytosis
- CO elevated (Pickwickian sx)
- ABG
dx of OSA
overnight polysomnography is required for formal dx
-EKG and EEG
-limb movements and O2 staturation
- r/o other issues like insomina, nacolepsy,
restless leg syndrome
**dx when airflow cessation occurs despite repeat muscular efforts to breath
tx of OSA Behaviorl
- weight loss
- avoid sedative use
- tobacco cessation
- avoid alcohol use
medical tx of OSA
CPAP BiPAP surgical intervention mouth gaurds (but poor compliance) **supplemental ox is not adequate
CPAP
positive airway pressure splints the upper airway
-proper fit is key
how does the CPAP work?
continuous airway pressure, increases functional residual capacity which allows alveoli to be recruited during ventilation
**increases intrathoracic pressure= decreased cardiac workload
complications of the CPA
- nasal congestion (steroids or antihistamines can help)
- mouth breating
- claustrophobia
BiPAP
non-invasive. allows pt to exhale against a lower pressure (two different pressure settings)
-used in pts w. comorbid pulmonary dz or Pickwickian syndrome
pickwickian syndrome
aka obestity hypoventilation syndrome
-severely obeses pt unable to breath rapidly or deeply enough
surgical intervention of OSA
uvulopalatopharyngoplasty (UPPP)
- Nasal septoplasty
- tracheostomy
what is the definitve tx for OSA?
tracheostomy
*but, reserved for those w/ life threatening arrhythmias or severe dz
consequences of tracheostomy?
scaring, stoma and airway infx, difficulty w/ speech
-difficult to care and maintain
OSA complications
HTN, nocturnal arrhythmias, pulm HTN, increased risk for CAD
Afib and OSA
A. Fib recurrence after cardioversion occurs at much higher incidence in those patients with untreated (or inadequately) OSA patients
what is the distinguishing feature of OHS that separates it from simple obestiy and OSA?
daytime hypercapnia
what is the mechanism behind hypoventiation syndrome?
obesity leads to leptin resistance and increased mechanical load that causes a blunted ventilatory reponse
what are the main clinical features that differentiate patients with OHS?
- more severe upper airway obstruction, impaired respiratory
- central nervous system: decreased central resipratory drive
