Test #2 OSA PPt- Josh Flashcards
OSA: definition
OSA is the cessation of airflow for more than ____ seconds dispite continuing ventilation effort, ____ or more times per ____ of sleep, and is usually associated w/ a decrease in arterial O2 saturation SAO2 or more than ___%
- 10 sec
- 5 or more
- per hour
- 4%
OSA:
what % of general sx pts have OSA:
25%
(just thought that is alot)
OSA:
what are conditions that cause OSA
- Obesity
- Race/genetics
- Age
- Male
- Alcohol/sedatives/analgesics/anesthestics
- Smoking
- Nasal/pharyngeal/laryngeal obstruction
- Cranio-facial abnormality
- endocrine/metabolic d/o
- Connective tissue d/o
- Storage diseases
- Chronic renal failure
OSA:
what are the 3 main muscles of the upper airway that are considered dilator muscles? (they are the ones that keep the airway open)
from top to bottom airway
tensor palatine
Genio glossus
Hyoid Muscles
OSA:
what is the circular cycle of OSA
10 steps
- Sleep
- decreased airway tone
- Obstruction
- Apnea
- decreased PO2 increased PCO2
- Sympathetic Surge
- Arousal
- Increased airway tone
- Breathing resumes
- back to sleep and cycle restarts
OSA: Patho
with OSA the obstructed breathing can cause decreased O2 and Increased CO2 wchich can leax to what complications
- Arrhythmias- MI
- Pulmonary HTN- RVH
- Systemic HTN- LVH
- Daytime sleepiness-personality/behavior changes- accident prone
OSA: classification
what are the 3 classifications?
- Mild
- moderate
- Severe
OSA: classification
what is the AHI (apnea/hypopnea index) for mild OSA
- 5-15 episodes/ hr
OSA: classification
what are clinical findings with mild OSA
- Mild sleepiness/insomnia
- Mild O2 desat
- Benign cadiac arrhythmia
*
OSA: classification
what is the AHI for moderate OSA
- 15-30 episodes/hr
OSA: classification
S/S of moderate OSA
- Moderate daytime sleepiness, fatigue that interferes w/ ADLs
- Moderte O2 desat
- Mild arrhythmias
- At risk for injuries/accidents
- At risk for HTN/MI/Stroke/Cor pulmonale
OSA: classification
what is severe OSA AHI
- > 30 episodes/hr
- and/or
- Hypoxia < 90% for >20% of total sleep time
OSA: classification
S/S of severe OSA
- daytime sleepiness interferes w/ normal activities
- Severe O2 desat
- Moderate to severe cardiac arrhythmia
- At increased risk for injuries/accidents
- At risk for HTN, MI, Stroke, and cor pulmonale
Screening for OSA:
what is the gold standard for screening?
- Polysomnography
Screening for OSA:
what is the con of the polysomnography
- Not practical for each surgical pt
Screening for OSA:
what screening tool is good for primary care?
- Berlin Questionnaire
- (usefullness w/ surgical pt’s has not been established)
Screening for OSA:
what is overall the most practical screening tool?
STOP-BANG questionaire
Screening for OSA:
what all does the Polysomnography test, test for?
- Brain activity for sleep
- eye movement
- Air movement
- Muscle tone (pharynx neck)
- heart action
- Chest movement
- Abd movement
- O2 saturation
- Leg movement
Screening for OSA:
the berlin questionaire is 3 categories and 10 questions,
1 positive score for OSA is what?
- 2 points or more in cat 1
- 2 or > points in cat 2
- if #10 is yes and BMI > 30 in cat 3
Screening for OSA:
w/ the berlin you have a high risk for OSA if what?
And a low risk for OSA if what?
- 2 or more cat pos (high risk)
- only 1 cat or no cat pos
Screening for OSA: STOP-BANG
tell me all the questions
- S- Do you SNORE loudly (louder than talking or can be heard through a closed dorr)
- T- do you often feel TIRED, fatigued, or sleepy during the daytime?
- O- has anyone OBSERVED you stop breathing during your sleep?
- P- do you have or are you being treated for high blood PRESSURE?
- B- BMI > 35kg/m2
- A- AGE > 50
- N- NECK circumference > 40 cm?
- G- GENDER male
stop is subjective-do you/ have you/ has anyone?
Bang- is objective- things we see!
Screening for OSA:
w/ STOP-BANG
what scores show a high risk?
what scores show a low risk?
- high risk- yes to > 3 items
- Low risk- yes to < 3 items
like rudy said tough b/cas men we are starting w/ 2 points we are always tired and male, and DWAYNE is over 50 so he basically has OSA automatically (sorry to bare the bad news)
OSA: treatment
what is teh treatment?
- CPAP
- Oral appliances
- Behavioral modification
- Surgical intervention
OSA:
what is central Sleep Apnea (CSA)
- cessation of airflow w/o respiratory effort
OSA: CSA
when does CSA occur?
- when PCO2 falls below apneic threshold
OSA:
CSA makes up what % of all sleep anpea cases
- 20%
CSA:
what are the 3 types
- Cheyne-stokes breathing
- Idiopathic central apnea
- Narcotic induced central apnea
CSA:
what is the etiology of CSA?
- NM d/o
- Excessive resp load (obesity)
- D/O of central ventilatory control (CVA)
- Endocrine/metabolic
CSA:
treatment
- Optimize medical therapy
- CPAP
- Oxygen
- Inhaled Co2
- Acetazolamide
- Theophylline
OSA: Anesthestic implications:
pwhat should you do preop?
- STOP-BANG
- talk to family members
- If they use CPAP bring machine for post-op
- Regional vs GETA
- Airway assessment
OSA: Anesthestic implications:
intraop
- Anticipate difficult airway
- GETA vs deep sedation
- Spinal or Epidural for LE procedures
- Concientious Anesthestic choices
- Adjuncts for pain control
- NMBD fully reversed
OSA: Anesthestic implications:
Extubation
Fully awake
Semi-upright position
Airway exchanger catheter
OSA: Anesthestic implications:
Postop what to consider
- Consider status of OSA (treated vs Untreated)
- Anotommical abnormalities
- Levels of co-morbidities
- type of sx
- Anesthesia modality
- Postop opioid use
Thats it
Thanks RTFF
