Sleep Medicine Flashcards
What is VOTE in DISE? How are the subsites classified?
Velum, oropharynx, tongue base, epiglottis. They are classified as No Obstruction (<50% and no vibration), partial obstruction (50-75%/vibration), or complete obstruction (>75%/collapse), or not visualized.
Which of the following items from a level I sleep study is included in a level III sleep study?
EEG EOG ECG/Heart rate Chin/Limb EMG Respiratory effort at thorax and abdomen Nasal airflow Pulse Oximetry Body Position Snoring Sound
ECG, SaO2, nasal airflow (CMS guidelines)
ECG, body motion, snoring, and chest movement (KJ Lee)
What is an optimal Friedman stage (tonsil and palate) for UPPP?
Stage 1. Tonsils 2-4 with tongue 1-2 and a non-morbidly-obese BMI
What is the definition of CPAP adherence?
> 4 hours/night for 70% of nights in a 30-day period (or ~20h/week).
Definitions - hypopnea; parasomnias (hypnopompic vs hypnogogic); UARS
Hypopnea- decrease in airflow by 30% for 10 sec w 4% SpO2 decrease
Parasomnias – EEG changes/arousals w/o airflow changes
Hypnopompic – hallucinations as you are waking up; hypnoGOgic – as you are GOing to sleep
UARS – high RERAs/RDI, normal AHI (common in skinny men)
What waves are associated with which sleep stages?
Stage 1 – Theta; 2 – spindle and K; 3 – delta (shitty mnemonic- TSK’d)
What are the cut-off values on these risk factors for OSA: BMI, neck collar size (inches per gender)
BMI >35; neck 17” men, 16” women
In which stage do most apneas and hypopneas occur?
REM
Which stage do we spend the largest % of sleep in?
Stage 2 (3 is next most %)
What happens if CPAP titration is too low? Too high?
Too low - ineffective. Too high = central apneas.
What is the definition of surgical success for OSA?
50% reduction and into the normal range (<20 AHI)
What is the most important muscle targeted with the Inspire?
Genioglossus
Define: snoring, UARS, OSA, obesity-hypoventilation syndrome.
Snoring = upper airway resistance/sounds without increase in resp effort. UARS = resistance + incr resp effort without meeting the definition of OSA. OSA = sufficient objective apneas+hypopneas nightly to meet diagnostic criteria. obesity-hypoventilation syndrome = BMI >30, sleep-disordered breathing, daytime hypercapnia > 45mmHg
What are the 4 stages of sleep and what EEG waves are associated with each?
Stage 1- theta (NREM). Stage 2 - K complexes + sleep spindles (NREM). Stage 3 - delta (NREM). REM = beta waves.
BATS Drink Blood Beta- awake Alpha - falling asleep Theta- Stage 1 Sleep spindles - Stage 2 Delta -Stage 3 Beta - REM
In which stage do we spend most of our time asleep? In which stage are respiratory events least common?
~50% is Stage 2. Respiratory events least common in stage 3.
Approximately how many cycles of NREM-REM occur in one night?
We have 3 to 5 cycles nightly.
What is different about respiratory events occurring in REM (eg duration and severity)?
Longer duration and increased severity
How well do daytime sleepiness/QOL correlate with frequency and severity of respiratory events?
Poorly
Most common cardiac arrhythmia seen with OSA?
Brachycardia-tachycardia. Brady at cessation of breathing. Tachy upon resumption
Difference between Mallampati and Friedman scoring?
Mallampati with tongue stuck out, Friedman with tongue resting. Otherwise the same
What is the Mueller maneuver?
Pinch your nose and close your mouth, breathe in against a closed airway. Do it while being scoped sitting and supine
Cutoffs for neck circumference as OSA risk factors in men and women?
17cm in men, 15cm in women
What are level I through 4 polysomnography?
level I - all the works + attended. level II - all the works unattended. level III - unattended + 3 metrics (air flow, SpO2, HR). level IV - unattended + 1-2 metrics (like O2Sat)
Name 3 behavioral modifications for management of OSA.
weight loss, positional therapy, sleep hygiene, alcohol/sedative cessation
