Ventilatory Control During Wake and Sleep

Question 1

Treatments for moderate (15-29 events/hour) and severe (30+ events/hour) obstructive sleep apnea

Answer 1

CPAP is treatment of choice

Surgery (tracheostomy is only surgery that helps OSA)

Question 2

Daytime symptoms of obstructive sleep apnea

Answer 2

Excessive daytime sleepiness (debilitating)

Non-restorative sleep “I wake up as tired as when I went to bed”

Morning headache

Question 3

Which, baroreceptors, chemoreceptors, or both, work during sleep to control respirations?

Answer 3

Chemoreceptors only

Breathing during sleep is always worse in all people.

Question 4

Central sleep apnea symptoms

Answer 4

Insomnia

Daytime sleepiness

Fatigue

Question 5

True or false. In all people CO2 levels increase while asleep.

Answer 5

True.

Breathing during sleep is always worse in all people.

Question 6

Method for diagnosing central sleep apnea

Answer 6

Polysomnography (sleep study)

Question 7

Treatment options for central sleep apnea

Answer 7

Treat underlying condition

Supplement O2 to reduce Cheyne-Stokes

Acetazolamide

Question 8

Central sleep apnea is common in patients with this type of heart failure

Answer 8

HFrEF (systolic heart failure)

Question 9

Central sleep apnea is a failure of the CNS to properly adjust to changing O2 levels, CO2 levels, or both?

Answer 9

CO2 levels

Question 10

Risk factors (7) for obstructive sleep apnea

Answer 10

Obesity - biggest (45% of them have OSA)
Age (plateaus at 65)
Male
Head/craniofacial abnormalities
Poor physical fitness
Alcohol
Long list of diseases

Question 11

Which breathing pattern is most commonly seen in central sleep apnea?

Answer 11

Cheyne-Stoke breathing

Question 12

Is obstructive sleep apnea more common in men or women?

Answer 12

Men

(female risk increases after menopause though)

Question 13

It’s important to treat obstructive sleep apnea early to prevent these two big associated conditions

Answer 13

Hypertension

Atherosclerosis

(also decreased survival in CHF, arrythmias, stroke, metabolic syndrome, DM2)

Question 14

Gold standard for obstructive sleep apnea diagnosis

Answer 14

Polysomnography (sleep study)

Question 15

Nocturnal symptoms of obstructive sleep apnea

Answer 15

Snoring

Gasping/choking sensations that arouse from sleep

Question 16

Describe differences between central and obstructive sleep apnea

Answer 16

Central = activity ceases at the brainstem

Obstructive = airflow ceases at nose/mouth

Question 17

Treatments (4) for mild sleep apnea (5-14 events/hour)

Answer 17

Weight loss

Avoid alcohol 4-6 hours before bedtime

Sleep on side

Oral appliances

Question 18

Risk factors (two big ones, seven others) for central sleep apnea

Answer 18

Age (elderly)
Renal failure

Male, low BMI, prior stroke, CV disease, hypothyroidism, diabetes, neurologic disease