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Cadiopulmonary Medicine > Test 3 Ch. 32 Sleep Apnea > Flashcards

Test 3 Ch. 32 Sleep Apnea Flashcards

1
Q

Sleep related breathing disorders are characterized by abnormal breathing patterns during sleep and include: (4)

A
  1. Obstructive Sleep Apnea (OSA) syndrome
  2. Central Sleep Apnea (CSA) syndrome
  3. Mixed Sleep Apnea
  4. Sleep- related hypoventilation and hypoxemia syndromes
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2
Q

According to the the American Academy of Sleep Medicine (AASM) sleep disorders can be classified into

A

eight major groups

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3
Q

Obstructive Sleep Apnea (OSA) is a common

A

sleep disorders that often requires lifelong care

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4
Q

OSA is when the ____________ muscles fails to oppose the forces that tend to collapse the airway passage during ____________, the tongue moves into the _________________ area and _________ the airway

A

genioglossus
inspiration
oropharyngeal
obstructs

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5
Q

Recurring collapse of the upper airway during sleep causes (3)

A
  • obstructive apneas
  • hypopneas
  • respiratory effort-related arousals (RERA’s)
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6
Q

A sorting sound called _________ breathing maybe heard at the end of apneic periods

A

fricative

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7
Q

“The fat boy” who snored and had excessive daytime sleepiness, included features of what is now recognized as sleep apnea syndrome w/ hypercapnia or the obesity hypoventilation syndrome is called

A

Pickwickian syndorme

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8
Q

A disorder characterized by the repetitive stopping or reduction of both air flow and ventilatory effort during sleep.

A

Central sleep apnea (CSA)

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9
Q

CSA can be classified as: (2)

A
  • primary central sleep apnea (idiopathic or unknown cause)
  • secondary central sleep apnea
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10
Q

Examples of conditions associated w/ secondary CSA include (3)

A
  • Cheyne Stokes breathing (CHF)
  • medical conditions (spinal surgery, drug or substance abuse)
  • high altitude periodic breathing
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11
Q

CSA is further categorized as (2)

A
  • hyperventilation related CSA
  • hypoventilation- related CSA
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12
Q

Which is this most common CSA

A

Hyperventilation- related CSA

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13
Q

Hyperventilation- related CSA includes primary

A

CSA and CSA associated w/ Cheyne- Stokes breathing pattern

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14
Q

Is a combination of both OSA and CSA

A

Mixed apnea

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15
Q

Mixed apnea is mostly treated as

A

OSA

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16
Q

Mixed apnea usually begins as

A

central apnea followed by the onset ventilatory effort w/o airflow (obstructive apnea)

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17
Q

Sleep- related Hypoventilation and hypoxemia syndrome (SRHHs) include a broad range of sleep disorders, some are quiet common such as

A

obesity hypoventilation syndrome (pickwickian syndrome) or coexisting w/ COPD the overlap syndrome

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18
Q

A specialized sleep test that monitors and records a number of physiologic parameters that occur during

A

Polysomnography (PSG)

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19
Q

That test result is called a

A

polysomnogram

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20
Q

This considered the gold- standard diagnostic test for OSA

A

full- night, attended, in- laboratory PSG

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21
Q

The diagnosis of OSA is establish during portion of study followed by a form of positive airway pressure treatment called a………

A

split night, attended, in- laboratory PSG
and
CPAP titration polysomnogram

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22
Q

During a polysomnogram, OSA is confirmed when either of the following conditions exists

A
  • 15 or more apneas, hypopneas, or respiratory effort- related arousals (RERAs) per hour of sleep in asymptomatic pts. More than 75% of the apneas and hypopneas must be obstructive
  • 5 or more apneas, hyponeas, RERA’s per hour of sleep or signs of disturbed sleep in pts with symptoms More than 75% of the apneas and hyponeas must be obstructive
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23
Q

What is AHI

A

apnea- hypopnea index

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24
Q

What is the calculation used for in-laboratory sleep study

A

AHI=Number of apnea and or plus hyponeas/ TST(hours)

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25
Q

Example of AHI
Pt went apneic 200 times, they had 40 hypopneas and 8hrs of sleep

A

200+40=240
240/8=30
AHI= 30

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26
Q

CSA is diagnosed when the majority of the respiratory events are

A

central apnea or hypopneas

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27
Q

On the PSG there is an absence of….

A

nasal or oral air flow and thoracoabdominal movements

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28
Q

Pts w/ CSA are elevated carefully for the presence of

A

cardiac disease and lesions involving the cerebral cortex and the brain stem

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29
Q

_________ _________ is associated w/ CSA

A

Atrial fibrillation (A-Fib)

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30
Q

The AASM endorses in- home unattended, portable motoring, commonly called a

A

home sleep test (HST)

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31
Q

HST is a reasonable cost effective alternative for pts who have a likelihood of either

A

moderate or severe OSA

32
Q

Physical Examination for Sleep Apnea (2)

A
  • Apnea or Hypopnea
  • Cyanosis
33
Q

Chest XRAY (2)

A
  • Often normal
  • Right or left sided heart failure
34
Q

Cardiac Arrhythmias

A
  • Brady- tachycardia syndrome
  • Sinus arrhythmia
  • Sinus Bradycardia
  • sinus pauses
  • Atrioventricular block (second degree)
  • Premature ventricular contractions
  • Supraventricular tachycardia
  • Ventricular tachycardia
  • Atrial fibrillation
  • Sick sinus syndrome
35
Q

Once the diagnosis of OSA is confirmed and the severity determine the pt should be

A

educated about the risk factors, natural history, and long term consequences of OSA

36
Q

Help behavior modification areas includes:

A
  • weight loss
  • exercise
  • changing sleep position
  • abstaining from alcohol
  • avoidance of certain medication
37
Q

This is consider the first line of therapy for OSA

A

Positive airway pressure

38
Q

Positive can be delivered as:

A
  • CPAP
  • BPAP
  • APAP
  • PEEP
39
Q

The most common and the most effective treatment for OSA. This device provides positive airway pressure at level that remains constant throughout the ventilatory cycle in a spontaneous breathing pt

A

Continuous positive airway pressure (CPAP)

40
Q

Provides both inspiratory and expiratory positive airway pressure. Used if ventilatory failure is involved

A

Bilevel positive airway pressure (BPAP)

41
Q

Increases or decreases the level of positive airway pressure in response to change in airflow, change in circuit pressure, or vibratory snore

A

Autotitrating positive airway pressure (APAP)

42
Q

Defined as positive pressure at the end of expiration during either spontaneous breathing or MV

A

Positive end- expiratory pressure (PEEP)

43
Q

When PEEP is used for treating OSA, it can be achieved via a a disposal nasal device that permits unimpeded inspiration but

A

provides increases resistance on expiration

44
Q

Most oral appliance fall under one of the following categories:

A
  • A mandibular- repositioning device
  • a tongue retains device
45
Q

Designed to reposition the mandible forward or downward

A

Mandibular- reposition

46
Q

Holds the tongue in a more anterior position

A

Tongue retaining device

47
Q

Is the most effective in non obese pts who have OSA b/c of severe, surgically correctable, upper airway– obstructing lesion

A

Surgery

48
Q

This is a reasonable approach in a pt w/ OSA caused by tonsillar hypertrophy, particularly in children but occasionally adults

A

Tonsillectomy

49
Q

Is one of the most common procedure to treat snoring and sleep apnea

A

Uvulopalatopharyngoplasty (UPPP)

50
Q

Device that stimulates the hypoglossal nerve (XII), which in turn activates the genioglossal muscle (the tongue) to contract and increase the latency of the upper airway

A

Implant able upper airway stimulator

51
Q

HypERventilation- related CSA is the

A

most common

52
Q

_______ has customarily been the first- line therapy for pts w/ hypERventilation- related CSA

A

CPAP

53
Q

Pts who do not respond well to CPAP should receive a trial of

A

adaptive servoventilation (ASV) w/ the variable positive airway pressure adapt (VPAP Adapt)

54
Q

_______ w/ a back up RR is the first line therapy for pts w/ hyPOventilation CSA

A

BPAP

55
Q

B/c of hypoxemia- related cardiopulmonary complications of sleep apnea (arrhythmia and pulmonary hypertension)….

A

nocturnal low-flow oxygen therapy is sometimes used to offset or minimize the oxygen desaturation

56
Q

In any pt who does not tolerate or benefit from positive airway pressure or supplement oxygen during sleep , a respiratory stimulant such as

A

acetazolamide or theophylline maybe tried pts w/ CSA

57
Q

Questions from the back
What is (are) another name(s) for non- rapid eye movement (non REM) sleep?

A
  • Slow- wave sleep
  • Quiet sleep
58
Q

During non-REM sleep, ventilation becomes slow and regular apnea-hypopnea index (AHI)

A

Stage N3

59
Q

Moderate sleep apnea is said to be present when the apnea-hypopnea index (AHI) is

A

15-30 episodes per hour

60
Q

During periods of apnea, the pt commonly demonstrates which of the following at the termination of apnea events

A
  • Decreased cardiac output
  • Transient pulmonary hypertension
61
Q

Periods of severe apnea are commonly associated w/ which of the following?

A
  • Ventricular tachycardia
  • Sinus bradycardia
  • Premature ventricular contraction
  • Sinus arrhythmia
62
Q

During REM sleep, there is paralysis of the:

A
  • Arm muscles
  • Upper airway muscles
  • Leg muscles
  • Intercostal muscles
63
Q

Normally, REM sleep constitutes about what percentage of the total sleep time?

A

20% to 25%

64
Q

Which of the following therapy modalities is therapeutic for OSA

A

CPAP

65
Q

Which of the following has customarily been the first-line therapy for pts w/ hypERventilation- related CSA

A

CPAP

66
Q

How long do normal periods of apnea during REM sleep last?

A

15 to 20 seconds

67
Q

While a formal polysomnographic diagnosis of the precise type and severity of sleep apnea is being made (i.e obstructive, central, or mixed sleep apnea), which of the following respiratory care would be most safely used?

A

APAP

68
Q

Mallampati classification
Class 1:

A
  1. Soft palate, fauces, uvula pillars are easily seen
69
Q

Mallampati classification
Class 2:

A
  1. Soft palate, fauces, portion of uvula are seen
70
Q

Mallampati classification
Class 3:

A
  1. Soft palate, only the base of the uvula are seen
71
Q

Mallampati classification
Class 4:

A
  1. Only the hard palate can be seen
72
Q

Sings and symptoms associated w/ OSA

A
  • Loud snoring
  • Abrupt awakenings accompanied by SOB
  • Lack of concentration
  • Memory impairment
  • Nausea
  • Insomnia
73
Q

Mild OSA is defined as an
Pts are often

A
  • AHI between 5 and 15 respiratory events per hour of sleep
  • asymptomatic
74
Q

Moderate OSA is defined as an
Pt is usually

A
  • AHI between 15 and 30 respiratory events per hour of sleep
  • aware of daytime sleepiness and feels the need to nap during the day
75
Q

Severe OSA is defined as an
pts have

A
  • AHI of more than 30 Respiratory events per hour and or SpO2 below 90% for more than 20% of the total sleep time
  • significantly daytime sleepiness, and often fall asleep during the day

Cadiopulmonary Medicine (24 decks)

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