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
