Upper Respiratory Disorders

Question 1

Obstructive Sleep Apnea (OSA)

Answer 1

• Sleep breathing disorder
• Trying to breathe with decrease or no airflow
• Muscles relax during sleep, cause soft tissues in the back of the throat to collapse
  
  • block the upper airway

Question 2

Obstructive Sleep Apnea vs Central Sleep Apnea

Answer 2

• OSA:
  
  • airflow stops
  • but neural neural signals still activate respiratory muscles
    
    • result: change in pleural pressure while decreased airflow

Question 3

OSA: Signs and Symptoms:

Answer 3

• Loud snoring
• excessive daytime sleepiness
• Observed episodes of breathing cessation during sleep
• Abrupt awakenings accompanied by gasping or choking
• Wake up with dry mouth or sore throat
• morning headache
• decrease in:
  
  • attention
  • vigilance
  • concentration
  • motor skills
  • verbal and visuospatial memory
• sexual dysfunction or decreased libido

Question 4

Hypopnea

Answer 4

reduction in breathing

Question 5

Apnea

Answer 5

Complete pause in breathing of 10 seconds or more associated with decrease in blood oxygenation

Question 6

Classification of OSA:

Answer 6

• Classified by Apnea-hypopnea index (AHI)=the number of apnea and hypopnea events per hour of sleep
  
  • mild: 5-15 episodes/hr
  • Moderate: 15-30 episoders/hr
  • Severe: >30 episodes/hr

Question 7

What occurs with a polysomnograph?

Answer 7

• Pulse-Ox used to illustrate time of apnea
• decrease in blood oxygen level=Disturbs REM sleep(not in deep sleep)
  
  • red box

Question 8

OSA treatments:

Answer 8

• CPAP-Continuous positive airway pressure
  
  • standard treatment option for moderate to severe cases of OSA
• Oral Appliances
  
  • effective treatment optino for people with mild to moderate OSA
• Surgery
  
  • when noninvasive treatment such as CPAP or oral appliances have not be successful
• Behavioral changes:
  
  • Mild cases
    
    • weight loss
    • change from sleeping on back to side
• OTC remedies:
  
  • nasal dilator strips, sprays
  • not recommended
• Positive therapy:
  
  • mild OSA
  • stay off back while sleeping and raise head

Question 9

How common is OSA?

Answer 9

• Prevalence:
  
  • mild: 3-28%
  • Moderate or severe: 1-14%
  • 80-90% undiagnosed

Question 10

What are the risk factors for OSA

Answer 10

• Ethnicity:
  
  • more prevalent in African Americans than Caucasians
• Sex:
  
  • Men x2-3>women
• Pregnant women in 3rd trimester are more at risk than non pregnant
  
  • resolves after delivery
• Can occur in children
  
  • enlarged tonsils and adenoids
• Age:
  
  • increases with age beginning at mid life
• BMI
• Family history
• Alcohol use
• smoking
• nasal congestion
• menopause

Question 11

OSA effects and outcomes:

Answer 11

• Cardiovascular/cerebrovascular morbidity and mortality:
  
  • possible mechanisms:
    
    • HTN
    • episodic hypoxia leading to vascular injury and atherosclerosis
    • chronic sympathetic hyperactivity
    • elevated fibrinogen and homocysteine levels

Question 12

What is rhinitis/sinusitis

Answer 12

• inflammation of the lining inside the nasal cavity and sinuses

Question 13

What is Acute Sinusitis

Answer 13

Acute Sinusitis:

• symptoms lasting less than 4 weeks
• begin as a common cold and go away by 7-10 days
  
  • but some develop bacteria linfection

Question 14

What is Chronic Sinusitis

Answer 14

• aka Chronic rhinosinusitis
• symptomatic for 12+ weeks even with treatment

Question 15

Characterize rhinitis associated with allergens

Answer 15

• allergic Rhinitis
  
  • caused by allergen
  • Symptoms:
    
    • runny nose with thin, watery discharge
    • itchy eyes, nose, throat
    • no fever
  • Seasonal

Question 16

Treatment for Allergic Rhinitis?

Answer 16

• intranasal corticosteroids
• oral or topical antihistamines
• decongestants
• intranasal cromolyn (Nasalcrom)
• intranasal anticholinergics
• leukotriene receptor antagonists

Question 17

Characterize Non-allergic rhinitis

Answer 17

• no cause, other causes must be ruled out
• Symptoms:
  
  • cough
  • sneezing
  • congested or runny nose
  • similar to allergic rhinitis but NO ITCH

Question 18

Types of non-allergic rhinitis

Answer 18

• Infectious
  
  • viral (cold or flu)
    
    • croup most common in children
    • Diptheria most deadly
• Vasomotor
  
  • Hypersensitive blood vessels in nose
  • triggered by:
    
    • chemical irritants
    • change in temp or himidity
    • spicy foods
    • alcohol consumption
    • stress
• Atrophic
  
  • mucosa on nasal turbinates becom thin, hard and dry
  • increases risk of infeciton
  • more likely with nasal surgery

Question 19

What is anaphylaxis

Answer 19

• serious systemic allergic response that can cause shock (Hypotension)
• can be fatal

Question 20

Signs of Anaphylaxis

Answer 20

• Red rash (hives)
• swollen throat
• wheezing
• chest tightness
• trouble breathing and swallowing
• vomiting
• diarrhea
• stomach cramping
• pale or red face

Question 21

What causes mortality with anaphylaxis

Answer 21

• Cause of death=respiratory arrest and cardiovascular collapse from shock
• Mechanism:
  
  • sudden, massive mast cell or basophil degranulation
    
    • IgE mediated, IgG mediated, immune compmlex/complement-mediated, non-immunologic

Question 22

Common causes of upper airway obstruction in children:

infectious vs non-infectious

acute vs chronic

Answer 22

• Infectious:
  
  • acute:
    
    • croup
    • diptheria
    • bacterial tracheitis
    • Retropharyngeal abscess
    • Peritonsillar abscess
    • Acute severe tonsilitis
    • infectious mononucleosis
    • Epiglottitis
  • Chronic:
    
    • Chronic Tonsillitis
    • Adenotonsillar hypertrophy
• Non-infectious:
  
  • Acute:
    
    • airway burns (Caustic or thermal)
    • upper airway foreign body
    • angioneurotic edema of upper airway
    • trauma
    • vocal cord paralysis
  • Chronic:
    
    • larngomalacia (age specific in infants)
    • Vascular ring
    • Neoplasms of upper airway (hemangioma, cystic hygroma cysts of larynx)
    • Tracheal stenosis

Question 23

Possible causes of upper airway obstruciton in adults:

Answer 23

• Infectious etiologies
• Foreign body aspiration
• Iatrogenic causes of acute upper airway obstruction can occur from instrumentation or surgery
  
  • complications of:
    
    • endotracheal intubation
    • Post-op hemorrhage following tracheostomy
    • head and neck surgery
• Inhalation injuries
  
  • edema from burns, smoke inhalation
• Hemorrhage

Question 24

Why is obstruction more common in upper airway disorders than lower airway

Answer 24

• OBstruction common to all upper airway disorders
• pharynx and larynx are only pathways for airflow into lower airways
• What would happen to O2 and CO2 in lungs and blood?
  
  • O2 levels decrease in lungs and blood
  • CO2 levels increase