A&P Sleep Disorders Notes

Nasal Septum

The Wall that separates the nose from the left and right side

Obstructive Sleep Apnea Syndrome

Patrial Upper Airway Obstruction

Complete Upper Airway Obstruction.

released in the body, it can cause a chain of events: inflammation, mucosal swelling and mucus production

located on either side of the throat in the oropharynx

Located superiorly (upward) on the back wall the nasopharynx Adeniod

UPPP-uvulopalatopharyngoplasty)

continuous positive airway pressure (CPAP)

Obstructive: complete obstruction (closure) of the airway

Sleep: occurs during different stages of sleep

Apnea: cessation (stopping) breathing, or air flow for 10 seconds or longer

Syndrome: two or more things occurring (the common cold is a syndrome: cough, sneeze, ache, etc)

Patients suspected of having OSAS often c/o excessive daytime sleepiness during waketime hours

accidental kicking and hitting of the bed partner by the OSAS patient

although the patients airway has collapsed and obstructed, the patient, although asleep, still tries to breathe. Therefore, you will see their rib cage and belly still move in an attempt to overcome the obstruction and resume breathing

if you don't breathe, ventilation decreases and there is less oxygen inspired into the lungs. If there is less oxygen in the lungs, then there is less oxygen "saturating" the blood and the tissues are deprived. **Normal oxygen saturation is 95-97% as reflected by SpO2 or saturation/pulse/oxygen equipment. Also the same as oxyhemoglobin saturation.

Blood Oxygen Saturation

small movements of air through a partially obstructed airway with thoracoabdominal movement decreasing by at least 50%

tidal volume; a normal breath; normally 500 ml or 0.5 L (half a liter).

- the time it takes to breathe inhale and exhale; normally 4 to 5 seconds

semi-consciousness and movement that occurs as the brain attempts to wake the body and clear the air passage (transient = comes and goes...).

Increased Respiratory Efforts - working harder to breathe, using the thoracic and abdominal muscles

Increased Respiratory Efforts

SaO2 means they actually drew blood to measure the oxygen saturation directly

SpO2 is measured with a harmless clip applied to the finger;

SaO2 - text is referring to SpO2. They are very similar. SpO2 is measured with a harmless clip applied to the finger; SaO2 means they actually drew blood to measure the oxygen saturation directly

- a shifting of the stages of sleep due to arousal; therefore the patient will experience changes in their stages of sleep as the brain arouses the body in an effort to clear the obstruction.

- the brain (Central Nervous System) is not telling the respiratory muscles to work to breath, therefore breathing does not occur.

can lead to central apnea due to bad changes occurring to nerve centers which decrease the "reflexive" response to breathe.

Prolonged obstructive apnea

- decline in health

death

- disease or unhealth caused to the body

the blood pressure of body vessels (systemic) and the lung vessels (pulmonary)

- short term

long term

A normal blood pressure for an adult is 120mmHg/80 mmHg (the high 120 is the systolic pressure and the low 80 is the diastolic pressure). During periods of apnea, the patients blood pressure rises which is significant of the heart pumping faster due to the decrease oxygen saturations and increased work of breathing.

the amount (partial pressure) of oxygen in the blood; typically 80-100 mmHg or torr

neural bodies in the carotid artery that sense changes in blood pressure, oxygen levels and carbon dioxide levels. The carotid chemoreceptors then tell the brain to dilate (enlarge) the vessels to decrease blood pressure, or to constrict the vessels (vessels become narrower) to increase blood pressure

a fancy way to describe how vessels dialte or constrict to make changes in blood pressure or "resisitance"

air in the lungs that is unable to be exhaled

the heart is divided into a left half, which pumps blood to the body, and a right half, which pumps blood through the lungs. So when you think about it, the heart is actually two separate pumps! The left and right halves are separated by a wall, called the inter-ventricular septum.

subatmospheric pressure = "sucking in"

- supra atmospheric pressure = "blowing out"

excessively high blood pressure for a long amount of time

a disease or disorder with an unknown cause

Ameliorative - to improve

body changes due to chemicals

- body changes due to pressures

decreased oxygen in the body

- decreases in oxygen levels cause the body to increase blood pressure. If you increase blood pressure, more blood and oxygen will travel to the tissues. Kind of like adding more pressure to a water hose to get the water to squirt out faster

atrial natriuretic peptide

a hormone, that when released, will cause the kidneys to excrete urine. If the patient frequently urinates, that lowers the amount of flood in the body. If you lower the amount of fluid in the body, the blood pressure may drop.

increased levels of carbon dioxide in the blood

- elevated blood pressure in the lung vasculature that doesn't go away

- this is when the right side of the heart fails and looses its pumping ability. It the right heart doesn't pump well, then there is less blood to enter the lungs to pick up oxygen and release carbon dioxide. Oxygen can't enter the system, so the patient becomes hypoxic. Carbon dioxide builds up in the body and the patient becomes hypercapnic.

- an unstable heart rhythm and/or rate

hypoxia + hypercapnea => pulmonary hypertension => right heart failure => decreased cardiac output => decreased transport of oxygen to the tissues, including the brain

- think of it as skipping a beat, or two, or three; this form of arrythmia can lead to asystole

- excessively high heart rate; so fast that the heart doesn't have time to fill with blood

electroencephalogram

blood entering and feeding the brain

cessation of breathing causing elevated carbon dioxide levels and decreased oxygen levels; ultimately causes death

- blood entering and feeding the heart muscle

- decreased blood flow (perfusion) to the heart muscle (myocardium)

you remember that increased levels of carbon dioxide causes vascular constriction in the lungs; the opposite happens in the brain vasculature...increased levels of carbon dioxide causes dilation of vessels in the brain.

- a unit of measurement used to express esophageal pressure changes; the pressure inside the esophagus is proportional to thoracic pressure changes

- muscle activity tracing using an electromyogram

used to describe the product of respiratory rate times tidal volume

(resp rate x tidal volume) Do you remember the normal volume of a tidal volume? Ans: 500 ml

So for example, if the patient's total respiratory rate is 15 breaths a minute, the rr = 15

if the patient's tidal volume = 500 ml, then

respiratory rate (15 ) breaths per minute X Tidal volume (500 ml) = 7500 ml per minute