Sleep Related Breathing Disorders Flashcards by tcarlso 3

What is the sleep requirements for neonates? Adults?

12-18 hours

7-9 hours

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What is the level of caffeine intake that is safe for adults?

400 mg

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How many sleep disturbances per hour can affect performance?

5 times/hour

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What are the waves that are found in deep sleep?

Delta waves

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What is the length of the sleep cycle? How many times are cycles repeated each night?

90-110 minutes

3-6 cycles per night

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What are the two general stages of sleep?

Non-REM

REM

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What is a hypnogram?

A recording of the sleep cycle

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What are the four major effects of sleep deprivation?

excessive daytime sleepiness
Irritability/anxiety
Decreased performance
HTN, insulin resistance

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What percent of adults have complaints of sleep disruption?

30%

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What is the most common sleep disorder?

insomnia

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What happens to Vt with sleep?

Reduced by 6-16% during NREM and 25% in REM

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What happens to airway resistance with sleep? Why?

Increases by 230% during NREM

Reduced tonic drive to the pharyngeal muscles

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What is the effect of the reduction of ventilation with sleep?

increases PaCO2 by 2-4 mmHg, and reduces PaO2 by 3-9 mmHg

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What are the three major sleep related breathing disorders?

Obstructive sleep apnea
Central sleep apnea
Sleep related hypoventilation syndrome

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What is OSA? What are the two major physiologic causes?

Dynamic upper airway narrowing or closure during sleep d/t a combination of:

Decreased muscular tone
Crowding of upper airway structures

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is snoring an upper or lower airway obstruction? When, then, does it occur in the respiratory cycle?

Upper airway

Inspiration

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What is the triad of OSA?

Loud snoring
Oxygen desaturation
Frequent arousals

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What is the incidence of OSA in men and women?

4% and 2% respectively

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Who should be screened for OSA?

Dissatisfied with sleep

- Do they have daytime sleepiness

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What are the non-obvious risk factors for OSA? (heart x2, metabolic conditions)

HTN
CHF
DM II

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What occupation in particular should be screened for OSA?

High risk driving occupations

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What are the two questionnaires that can be administered to screen for OSA?

Berlin questionnaire

- STOP-BANG test

Over what BMI is OSA particularly common?

Over 35

What is the most common reason for OSA in children?

Adenotonsillar hypertrophy

What is the scale used to determine the severity of sleepiness?

Epworth sleepiness scale

What type of work specifically can lead to excessive daytime sleepiness?

Shift work

What are the components of the PE that should be done if you suspect OSA?

- Respiratory - Neck - Mallampati score

A mallampati score of what is suspicious for OSA?

3 or 4

What neck circumference for men and women are concerning for OSA?

16" for females | 17" for males

What is class I mallampati score?

Can see uvula, soft and hard palate and pillars

What is class II mallampati score?

Uvula touches tongue, pillars not present

What is class III mallampati score?

Can barely see uvula and hard palate

What is class IV mallampati score?

Can only see soft palate

How do you evaluate for OSA?

Polysomnography in the sleep lab

What are the two types of sleep studies?

Full night sleep | Split night sleep (before and after CPAP)

What is CPAP?

Continuous positive airway pressure

Why are EKGs needed with sleep studies?

Apnea may cause arrhythmias

An event on a sleep study must last how long to be considered sleep apnea?

10 seconds

What is the classic breathing pattern with OSA?

Paradoxical breathing

What is the definition of Hypopnea?

Decrease in airflow by 30% AND drop in pulse ox by 4%

What is apnea hypopnea index (AHI)?

Number of apnea and hypopneas per hour of sleep

What is the role of in-home sleep studies?

Uncomplicated patients, but does not definitively exclude diagnosis

Sleeping in what position may lead to an increase in sleep apnea episodes?

Supine

What are the therapies for OSA, besides CPAP?

Oral appliances | Maxillomandibular advancement

What is the last resort for sleep apnea?

Tracheostomy

What is "adequate" CPAP use?

more than 4 h/night on 70% of nights

What are the sequelae of untreated sleep apnea?

HTN | Insulin resistance

What is central sleep apnea (CSA)?

Recurrent cessation of respiration during sleep without associated ventilatory effort

What is the pathophysiology of central sleep apnea?

High ventilatory chemo responsiveness to PaCO2 with exaggerated hyperapnea

What is Cheyne-stokes respiration?

irregular crescendo-decrescendo pattern of breathing

What are the diseases associated with Cheyne stokes respiration?

CHF Cerebrovascular disease Renal insufficiency

What is the cause of Cheyne-stoke respiration?

Decreased perfusion of breathing centers of the brain (maybe)

What is congenital central alveolar hypoventilation?

a life-threatening disorder manifesting as sleep-associated alveolar hypoventilation