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Pulmonology > SM 185 Sleep > Flashcards

SM 185 Sleep Flashcards

1
Q

What is sleep?

A

A rapidly reversible state of reduced responsiveness and motor activity

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2
Q

What is sleep good for?

A

Memory consolidation, energy conservation, brain restoration, and immune function

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3
Q

What are the stages of sleep?

A

Awake, Non REM 1, Non REM 2, Nom REM 3, REM

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4
Q

Which stage of sleep is most prominent early in the sleep cycle?

A

Stage 3 Non REM is most prominent early in the night

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5
Q

Which stage of sleep is most prominent late in the sleep cycle?

A

REM sleep is most prominent late in the night

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6
Q

What are the two types of sleep apnea?

A

Obstructive sleep apnea and central sleep apnea

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7
Q

How do the Bernoulli Principle and the Venturi Effect tie into Obstructive Sleep Apnea?

A

The Bernoulli Principle states that fluid flow is higher with smaller areas, while the Venturi Effect states that fast fluid flow is associated with lower pressure

Therefore, narrow parts of the airway experience faster flow and lower pressure, predisposing obstruction

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8
Q

How does lower pressure in the airway lead to obstruction?

A

Lower airway pressure exacerbates compressive forces from the surrounding tissue, and can result in a flap of tissue obstructing the airway

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9
Q

Describe the prevalence of Obstructive Sleep Apnea?

A

Obstructive Sleep Apnea can occur at any stage of life and is more common in men

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10
Q

Anatomically, what predisposes Obstructive Sleep Apnea?

A

Oropharyngeal crowding can impede airflow, which is due to excessive tissue in the mouth, micrognathia, macroglossia, and impaired Oropharynx muscular tone

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11
Q

How does excessive tissue predispose Obstructive Sleep Apnea?

A

Extra tissue makes it more likely the airway will be obstructed

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12
Q

How does Micrognathia predispose Obstructive Sleep Apnea?

A

Micrognathia = small chin, makes it easier for the airway to be blocked

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13
Q

How does Macroglossia predispose Obstructive Sleep Apnea?

A

Macroglossia = large tongue, which is more likely to block the airway

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14
Q

How does impaired Oropharynx muscular tone predispose Obstructive Sleep Apnea?

A

Lower muscle tone makes it more likely for the airway to collapse

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15
Q

What is a Mallampati score and what is it used for?

A

Mallampati scores are assessments of the airway and how open it is; Class 1 = normal and Class 4 = most obstructed

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16
Q

What factors may predispose Obstructive Sleep Apnea?

A

Obesity, familial inheritance, and certain minority groups

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17
Q

How do obesity rates correspond with Obstructive Sleep Apnea rates?

A

Higher obesity rate = higher Obstructive Sleep Apnea rate

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18
Q

How do sex hormones mediate Obstructive Sleep Apnea?

A

Testosterone exerts central effects that make Obstructive Sleep Apnea more likely, while Estrogen protects against Obstructive Sleep Apnea

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19
Q

When are women more at risk for Obstructive Sleep Apnea and why?

A

Post menopausal women are more at risk for Obstructive Sleep Apnea because they lose the protective effects of Estrogen

20
Q

What are symptoms of Obstructive Sleep Apnea?

A

Unrefreshing sleep, daytime sleepiness, AM headache, vivid dreams, snoring

21
Q

Why does Obstructive Sleep Apnea cause snoring?

A

Airflow is impeded by tissue in Obstructive Sleep Apnea, so snoring is caused by the airflow forcing the tissue flap open

22
Q

How is OSA screened for?

A

Screening tools for OSA include questionnaires

23
Q

How is OSA diagnosed?

A

Polysomnography is the gold standard for Obstructive Sleep Apnea diagnosis

24
Q

What does Polysomnography involve?

A

Polysomnography involves an EEG, EOG, EKG, abdominal belt and pulse ox to determine when airflow stops and whether or not efforts to breath stop as well

25
Q

How can an apnea be distinguished as Obstructive on a Polysomnograph?

A

Look for a flat airflow (no airflow) in the presence of diaphragmatic excursions (diaphragm activity), which indicates the patient is trying to breath but unable to due to the obstruction = Obstructive Sleep Apnea

26
Q

How long must an apnic episode last to be considered apnea?

A

Obstructed airflow for at least 10s due to obstruction of the upper airway

27
Q

How does Obstructive Sleep Apnea affect the heart?

A

Upper airway obstruction leads to a negative intrathoracic pressure on inspiration, raising the venous return and increasing transmural pressure, leading to greater LV afterload

28
Q

How does Obstructive Sleep Apnea effect the LV afterload?

A

Increased LV Afterload

29
Q

How does Obstructive Sleep Apnea respond to hypoxia?

A

Since Obstructive Sleep Apnea causes hypoxia by restricting airflow, pulmonary vasocontriction occurs, leading to RV dilation and impingement on the LV, decreasing LV filling and lowering LV output

30
Q

How does Obstructive Sleep Apnea effect the RV?

A

Obstructive Sleep Apnea causes hypoxia, which results in vasoconstriction of the pulmonary bed; in turn, this leads to increased RV afterload, causing RV dilation and impingement on the LV, lowering CO

31
Q

How does Obstructive Sleep Apnea affect the cardiovascular system as a whole?

A

Hypoxemia, sustained catecholamine release from increased sympathetic tone, increased endothelin secretion, and overall a pro-inflammatory state ensues

32
Q

How does Obstructive Sleep Apnea effect nocturnal blood pressure?

A

Normally, BP drops in sleep; Obstructive Sleep Apnea results in the normal blood pressure drop disappearing

33
Q

How does Obstructive Sleep Apnea effect Cardiovascular Risk?

A

Increased risk of CV events, independent of obesity and other shared risk factors, with higher levels of Troponin and worse outcomes for patients with CAD

34
Q

What arrhythmia can Obstructive Sleep Apnea precipitate?

A

Obstructive Sleep Apnea can cause a greater risk for Atrial Fibrillation and Tachy-Brady syndrome

35
Q

If someone has AFib, what can be modified about them related to sleep?

A

AFib correlates with Obstructive Sleep Apnea, so send the patient in for a sleep evaluation to try and improve the sleep disorder and improve the AFib

36
Q

What receptor mediates Cheyne-Stokes respirations?

A

C-fibers mediate Cheyne-Stokes respirations

37
Q

What are Cheyne-Stokes respirations?

A

Irregular breathing that act as a sign of PCO2 response dysregulation

38
Q

What pulmonary symptom is frequently present in Obstructive Sleep Apnea?

A

Pulmonary Hypertension is common in people with Obstructive Sleep Apnea, and worsens existing lung disease

39
Q

What is the single best way to improve sleep apnea?

A

Weight loss has the biggest impact, but is the least often achieved measure

40
Q

What sleeping position worsens sleep apnea?

A

Sleeping while supine worsens sleep apnea; some therapies alter sleeping position in patients with mild/moderate Obstructive Sleep Apnea to improve the disease

41
Q

How do dental appliances alter sleep apnea?

A

Dental appliances can improve airflow by reducing obstruction in the oropharynx

42
Q

What is CPAP?

A

Continuous Positive Airway Pressure, which uses a machine to act like a stent and keep the airways patent, preventing obstruction

43
Q

What is APAP?

A

Auto-titrating CPAP; normal CPAP does not sense nasal airflow and is unable to adjust pressure to maintain flow, while APAP is ale to adjust airflow

44
Q

When is Central Sleep Apnea?

A

Sleep Apnea due to an issue with the brain or sensation

45
Q

How can Central Sleep Apnea be diagnosed from a Polysomnograph?

A

If airflow decreases without an increase in diaphragmatic excursion, this suggests that no attempt is being made to maintain airflow and that a brain or sensation issue is at play = Central Sleep Apnea

46
Q

How can Obstructive Sleep Apnea and Central Sleep Apnea be distinguished on a Polysomnograph?

A

Central Sleep Apnea = no airflow + no diaphragm movement, Obstructive Sleep Apnea = no airflow + increased diaphragm movement

47
Q

What underlies Central Sleep Apnea?

A

Abnormal ventilatory control

Pulmonology (22 decks)

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