Term
| How can you clinically detect Obstructive Sleep Apnia or Hypoapnia? |
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Definition
Apnea is lack of airway measured at nose and meath for 10 seconds longer during sleep despite effort to breathe
1) Decrease in oxyhemoglobin saturation
2) ECG changes |
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Term
| How is the apnea/hypopnea index (AHI) used to rate OSAH syndrome severity? |
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Definition
Remember, OSAH is AHI >10 plus symptoms of daytime sleepiness/ or hypertension
Help determine type of treatment.
MIld= 5-15 events per hour of sleep
Moderate= 15-30 events per hour
Severe= >30 events per hour |
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Term
| What populations are most effected by OSAH? |
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Definition
1) Men > Women
2) AA > Caucasians
3) > Post-menapause
4) > Obesity |
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Term
| What is the basic pathophysiology of OSAH? |
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Definition
Airway closure with negative intrathoracic pressure
1) Airway size determined by craniofacial structure/function and obesity
2) In sleep, muscle tone decreases and airway collapse becomes an issue.
3) Ventilatory related arousal is precipitated by airway resistance (snoring), hypopnea or apnea.
4) Persistant sympathetic arousal to wake patients up leads to CVD over time. |
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Term
| Why might you see elevation of C-reactive protein in OSAH? |
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Definition
| Intermittent hypoxia because of ischemia-reperfusion leads to expression of markers of oxidative stress. |
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Term
| What are the important co-morbidities of OSAH? |
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Definition
1) CV
- prevents normal decrease in BP and HR
- toll over time can lead to hypertension, HF, MI or stroke.
2) Metabolic
- Elevated leptin inhibits neuropeptide Y synthesis, which is a stimulator of food intake
3) Neurocognitive
- Sleepiness and cognitive function
- Depression |
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Term
| What is the typical clinical presentation of a patient who suffers from OSAH? |
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Definition
- Nightly loud snoring
- breathing pauses during sleep
- choking
- daytime sleepiness |
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Term
| How do you definitively diagnose OSAH? |
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Definition
Need labs for objective measurement.
Portable polysomnography is typical
EEG, bilateral electroculogrpahic and submental electromyographic (chin) activity.
Cardiopulmonary measures are also taken. |
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Term
| What are the recommended treatments for OSAH? |
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Definition
1) First-line is positive pressure ventilation (CPAP) to treat airway closure
- improves insulin sensitivity, LVF, pulmonary hypertension, endothelial function and mortality.
- Adherence is issue because of nasal dryness (humidifiers added)
2) Oral Appliance (OAP)
- increase upper airway size and prevent collapse
- takes a long time, compliance is poor and effectiveness is not 100%
- Tongue-retaining (TRD) and mandibular advancement (MAD)
3) Surgical therapy
- Tracheostomy (bypass upper airway)
- Reconstruction of upper airway (better cosmetically, but less certain results) |
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