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Sleep Related Breathing Disorders Flashcards

1
Q

What is the sleep requirements for neonates? Adults?

A

12-18 hours

7-9 hours

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2
Q

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

A

400 mg

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3
Q

How many sleep disturbances per hour can affect performance?

A

5 times/hour

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4
Q

What are the waves that are found in deep sleep?

A

Delta waves

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5
Q

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

A

90-110 minutes

3-6 cycles per night

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6
Q

What are the two general stages of sleep?

A

Non-REM

REM

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7
Q

What is a hypnogram?

A

A recording of the sleep cycle

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8
Q

What are the four major effects of sleep deprivation?

A
  • excessive daytime sleepiness
  • Irritability/anxiety
  • Decreased performance
  • HTN, insulin resistance
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9
Q

What percent of adults have complaints of sleep disruption?

A

30%

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10
Q

What is the most common sleep disorder?

A

insomnia

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11
Q

What happens to Vt with sleep?

A

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

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12
Q

What happens to airway resistance with sleep? Why?

A

Increases by 230% during NREM

Reduced tonic drive to the pharyngeal muscles

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13
Q

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

A

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

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14
Q

What are the three major sleep related breathing disorders?

A
  • Obstructive sleep apnea
  • Central sleep apnea
  • Sleep related hypoventilation syndrome
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15
Q

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

A

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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16
Q

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

A

Upper airway

Inspiration

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17
Q

What is the triad of OSA?

A
  • Loud snoring
  • Oxygen desaturation
  • Frequent arousals
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18
Q

What is the incidence of OSA in men and women?

A

4% and 2% respectively

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19
Q

Who should be screened for OSA?

A
  • Dissatisfied with sleep

- Do they have daytime sleepiness

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20
Q

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

A
  • HTN
  • CHF
  • DM II
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21
Q

What occupation in particular should be screened for OSA?

A

High risk driving occupations

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22
Q

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

A
  • Berlin questionnaire

- STOP-BANG test

23
Q

Over what BMI is OSA particularly common?

24
Q

What is the most common reason for OSA in children?

A

Adenotonsillar hypertrophy

25
Q

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

A

Epworth sleepiness scale

26
Q

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

A

Shift work

27
Q

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

A
  • Respiratory
  • Neck
  • Mallampati score
28
Q

A mallampati score of what is suspicious for OSA?

29
Q

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

A

16” for females

17” for males

30
Q

What is class I mallampati score?

A

Can see uvula, soft and hard palate and pillars

31
Q

What is class II mallampati score?

A

Uvula touches tongue, pillars not present

32
Q

What is class III mallampati score?

A

Can barely see uvula and hard palate

33
Q

What is class IV mallampati score?

A

Can only see soft palate

34
Q

How do you evaluate for OSA?

A

Polysomnography in the sleep lab

35
Q

What are the two types of sleep studies?

A

Full night sleep

Split night sleep (before and after CPAP)

36
Q

What is CPAP?

A

Continuous positive airway pressure

37
Q

Why are EKGs needed with sleep studies?

A

Apnea may cause arrhythmias

38
Q

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

A

10 seconds

39
Q

What is the classic breathing pattern with OSA?

A

Paradoxical breathing

40
Q

What is the definition of Hypopnea?

A

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

41
Q

What is apnea hypopnea index (AHI)?

A

Number of apnea and hypopneas per hour of sleep

42
Q

What is the role of in-home sleep studies?

A

Uncomplicated patients, but does not definitively exclude diagnosis

43
Q

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

44
Q

What are the therapies for OSA, besides CPAP?

A

Oral appliances

Maxillomandibular advancement

45
Q

What is the last resort for sleep apnea?

A

Tracheostomy

46
Q

What is “adequate” CPAP use?

A

more than 4 h/night on 70% of nights

47
Q

What are the sequelae of untreated sleep apnea?

A

HTN

Insulin resistance

48
Q

What is central sleep apnea (CSA)?

A

Recurrent cessation of respiration during sleep without associated ventilatory effort

49
Q

What is the pathophysiology of central sleep apnea?

A

High ventilatory chemo responsiveness to PaCO2 with exaggerated hyperapnea

50
Q

What is Cheyne-stokes respiration?

A

irregular crescendo-decrescendo pattern of breathing

51
Q

What are the diseases associated with Cheyne stokes respiration?

A

CHF
Cerebrovascular disease
Renal insufficiency

52
Q

What is the cause of Cheyne-stoke respiration?

A

Decreased perfusion of breathing centers of the brain (maybe)

53
Q

What is congenital central alveolar hypoventilation?

A

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

Respiratory (34 decks)

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