Term
| What is Obesity-hypoventilation syndrome (formerly Pickwickian syndrome)? |
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Definition
| a syndrome characterized by severe obesity, daytime hypoventilation, and sleep-disordered breathing |
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Term
| What are Snoring, upper airway resistance syndrome (UARS), and OSA |
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Definition
| are due to upper airway obstruction of variable degree, leading to resistance to airflow during respiration(attempts to continue to breathe continue obstruction) |
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Term
| Does snoring always indicate an airway impairment? |
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Definition
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Term
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Definition
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Term
| What is upper airway resistance syndrome? (UARS) |
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Definition
| a clinical entity midway between primary snoring and obstructive sleep apnea (OSA) that is characterized by snoring, complaints of daytime sleepiness, and fragmentation of sleep |
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Term
| What does a PSG demonstrate in UARS? |
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Definition
| demonstrates some increase in ventilatory efforts, but the impairment is not severe enough to be classified as OSA |
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Term
| What is OSA characterized by? |
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Definition
| loud snoring, excessive daytime sleepiness, and episodes of compete cessation of breathing (apnea) or significantly decreased ventilation (hypopnea) due to airway obstruction during sleep, along with significant fragmentation of sleep architecture |
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Term
| What does a PSG deonstrate in sleep apnea? |
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Definition
| demonstrates abnormalities in sleep architecture, ventilation, and blood oxygen saturation |
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Term
| What is the underlying defect in sleep-related breathing disorders? |
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Definition
| an anatomically narrowed upper airway combined with pharyngeal dilator muscle collapsibility |
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Term
| What is vibration of the soft tissues? |
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Definition
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Term
| What is reduced ventilation? |
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Definition
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Term
| What is complete obstruction? |
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Definition
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Term
| Where can narrowing occur? |
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Definition
| anywhere from nasal cavity to the larynx, most connon s retropalatal and retroglossal areas |
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Term
| What are some signs of OSA? |
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Definition
-volume of upperairway tissues
include retrognathia, large tongue, long soft palate, and enlarged uvula, tonsils, and adenoids |
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Term
| What is the normal sleep parrern? |
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Definition
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Term
| What are the phases of sleep characterized by? |
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Definition
-electroencephalogram (EEG)
-eye movements |
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Term
| How does Non rem sleep occur? |
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Definition
| in 3 or 4 stages, mental inavtivity |
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Term
| What is Stage 1 NREM? How long does it last? |
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Definition
-A brief, transitional stage between wakefulness and sleep and from which the person can be easily aroused
-This stage lasts only a few minutes |
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Term
| What occurs in stage 2 N-rem? How long doe sit last? |
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Definition
-the initial stage of true sleep, from which arousal is more difficult
-EEG waves called sleep spindles, or K-complexes, identify this stage
-This stage lasts for 10 to 25 minutes |
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Term
| What is stage 3 NREM characterized by? How long does it last? |
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Definition
-Characterized by the appearance on the EEG of high-voltage, high-amplitude slow waves that last for a few minutes and then undergo transition into stage 4, with more frequent and higher-amplitude slow waves
-This stage lasts for 20 to 40 minutes |
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Term
| When does stage 4 occur? What is it called? |
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Definition
| stage 3 and 4 often combined, referred to as slow wave sleep (SWS) |
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Term
| What happens after NREM sleep? |
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Definition
| a period of lightening occurs called REM sleep |
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Term
| What is REM sleep characterized by? |
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Definition
characterized by asynchronous brain waves, an active brain, physiologic instability, and muscular inactivity
**brain activity like that when you are awake, low voltage** |
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Term
| When does dreaming occur? What happends after REM sleep? |
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Definition
-dreaming occurs in rem sleep
-sleep cycles between NREM and REM about 90 mins each |
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Term
| When does NREM sleep predominate? When does REM predominate? |
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Definition
NREM-earlier in the night
REM-later in the night |
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Term
| What may primary snoring be a risk factor for? |
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Definition
| type 2 diabetes, hypertension, carotid atherosclerosis, and stroke |
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Term
| What cardiovascular risks is OSA related to? |
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Definition
-OSA also has been shown to significantly increase the risk of stroke and death
-Patients with OSA have two- to four-fold greater odds of experiencing complex arrhythmias over those without the sleep disorder
-It is also thought that treatment of OSA may increase the survival rate among patients with heart failure
-A relationship between OSA, obesity, and metabolic syndrome has been noted |
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Term
| What is Epworth Sleepiness Scale? |
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Definition
-8 subjective questions to measure sleepiness
-each question answered on a scale of 1-3 |
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Term
| Which is more closly related to OSA thsn BMI? |
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Definition
| neck circumference(greater than 16 inches) |
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Term
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Definition
| tests done to test for OSA(over night study) |
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Term
| OSA is characterized by what? |
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Definition
| apnea-hypopnea index (AHI) or the respiratory disturbance index (RDI) |
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Term
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Definition
| by adding all of the apneic episodes together with all of the hypopnic episodes that occurred during the night and then dividing this total by the number of hours slept |
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Term
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Definition
| respiratory effort–related arousals (RERAs) are added to the apneas and hypopneas |
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Term
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Definition
| The cessation or near-complete cessation of airflow for a minimum of 10 seconds |
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Term
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Definition
| An episode of greater than 30% reduction in amplitude in thoracoabdominal movement or airflow from baseline, with a greater than 4% oxygen desaturation |
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Term
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Definition
| Episodes that include a clear drop in respiratory airflow, increased respiratory effort, and a brief change in sleep state (arousal) but do not meet the criteria for apnea or a hypopnea |
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Term
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Definition
| if the AHI or RDI is greater than 5/hour and symptoms of excessive daytime sleepiness, witnessed nocturnal apneas, or awakening with choking, breath holding, or gasping are noted |
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Term
| What does The multiple sleep latency test (MSLT) test? |
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Definition
| the ability to fall asleep |
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Term
| What does The maintenance of wakefulness test (MWT) assess? |
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Definition
| the ability to stay awake |
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Term
| What is the treatment for primary snoring? |
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Definition
| Treatment is elective and essentially is a personal decision commonly motivated by the effects of snoring on a spouse or bed partner |
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Term
| Should people with UARS get treatment? |
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Definition
| The patient should receive treatment to alleviate the problems associated with snoring, as well as those resulting from sleep fragmentation and resultant sleepiness |
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Term
| Should people with OSA receive treatment? |
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Definition
| The patient requires treatment—not only to alleviate snoring and sleepiness but to prevent or treat the numerous adverse health effects associated with the disease |
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Term
| what are the 4 approaches to treatment for OSA? |
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Definition
1.Behavioral modification-weight loss, nasal dilators, sleeping sitting up, no sedatives before bed
2.Positive airway pressure (PAP)modalities- causes positive pressure in nasal passageway(continuous, bilevel, automatic/adjusting)
3.Use of oral appliances-primary treatment, for people who don't like PAP
4.Surgery-Tracheostomy, removal of tonsils or adnoids in children |
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Term
| What is the gold standard of treatment for OSA? |
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Definition
| positive airway pressure(PAP) |
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Term
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Definition
| CPAP provides air continuously throughout inspiration and exhalation at a single, set pressure, expressed in cm H2O |
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Term
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Definition
| consists of two set pressures, with use of a higher pressure during inhalation and a lower pressure during exhalation |
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Term
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Definition
| has pressures that vary continuously according to what is required at a particular moment to maintain airway patency |
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Term
| What are some adverse reactions of PAP's? |
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Definition
| mask leaks, skin ulceration or irritation under the mask, epistaxis, rhinorrhea, nasal congestion, sinus congestion, dry eyes, conjunctivitis, ear pain, and claustrophobia |
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Term
| What are the two basic types of oral appliances? |
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Definition
-Mandibular advancement devices (MADs)
-Tongue-retaining devices (TRDs) |
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Term
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Definition
| engage the mandible and reposition it in an anterior or forward position |
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Term
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Definition
| directly engage the tongue and hold it in a forward position |
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Term
| How many types of OA's are there? |
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Definition
| over 70, less than half approved by the FDA, less only approved for snoring |
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Term
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Definition
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Term
| What are TRDs made of? What shape are they? |
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Definition
| silicone, in the shape of a bulb or cavity, only 1 design approved by FDA |
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Term
| Does long term use of OA's cause TMJ problems? |
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Definition
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Term
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Definition
| CPAP works better but many do not like it |
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Term
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Definition
-primary snorers
-mild to moderate OSA who do not like CPAP or who it does not work on |
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Term
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Definition
| yes they are almost uniformly effective in curing OSA |
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Term
| Which type of sleep provides physical restoration? Psychic restoration? |
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Definition
-NREM sleep provides physical restoration
-REM sleep provides psychic restoration |
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Term
| See slide 38 for labratory outcomes |
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Definition
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