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31 Cards in this Set
- Front
- Back
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What is the definition of apnea?
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cessation of airflow for 10 or more seconds
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What is the definition of hypopnea?
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a 50% drop in airflow for 10 or more seconds, resulting in either arousal from sleep or a greater than 4% drop in O2 sat
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What is the apnea index? the hypopnea index? the RDI?
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apnea index is the number of apneas per hour of sleep, hypopnea index is the number of hypopneas per hour of sleep, respiratory disturbance index is the sum of AI and HI
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What RDI value indicates sleep apnea?
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greater than or equal to 5
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What is the difference between OSA and OSA syndrome?
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OSA is absence of airflow despite persistent ventilatory effort. OSAS refers to findings of OSA in combination with sleep deprivation or cardiopulmonary dysfunction
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What is upper airway resistance syndrome?
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UARS refers to increased ventilatory effort due to upper airway narrowing, leading to sleep fragmentation, arousals, and daytime somnolence but without apnea, hypopnea, or O2 desats.
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What are the two most important pharyngeal dilator muscles?
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genioglossus and tensor palatini
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How is nasal obstruction implicated in sleep-disordered breathing?
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causes a switch to oral route for breathing changes the dynamics of the upper airway and predisposes to its collapse
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Where are the most common locations where snoring is generated?
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posterior edge of the soft palate, uvula, tonsillar pillars
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How can daytime somnolence be measured?
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multiple sleep latency testing (MSLT): normal is 10-15 minutes, OSA or narcolepsy is 5 minutes or less.
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What are the cardiovascular consquences of OSA?
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1) systemic hypertension
2) cardiac arrhythmia 3) pulmonary hypertension, polycythemia, and cor pulmonale |
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What are anatomic abnormalities that predispose to OSA?
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1) nasal obstruction
2) adenotonsillar hypertrophy 3) macroglossia 4) micrognathia 5) retrognathia |
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Does family history increase risk of OSA?
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Yes, risk increases with the number of affected family members and is fourfold greater if three relatives are affected
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What endocrine abnormalities predispose to OSA?
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hypothyroidism and acromegaly
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Where is the most common site for airway collapse
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retropalatal region
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What is the Muller maneuver?
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Position FOE just above the segment to be evaluated. Have the patient inspire a closed airway and end-expiration. A greater than 40% narrowing of the airway at the level of tongue base/hypoharynx suggests poor outcome with UPPP.
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What are findings on cephalometry that correlate with dx of OSA?
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low hyoid bone position, long and thick soft palate, diminished size of posterior airway space, increased distance from the tip of tongue to base of vallecula
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What is the gold standard for diagnosing OSA?
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laboratory polysomnography
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What tests comprise the laboratory polysomnography?
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1) EEG
2) EOG to differentiate REM from non-REM 3) ECG 4) O2 sat monitor 5) nasal-oral airflow 6) chest and abd wall function 7) leg movements |
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What is a split-night study?
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first half is devoted to diagnosis of OSA, second half is devoted to CPAP titration and initiation of therapy
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What RDI and O2 sat values are associated with increased mortality and morbidity?
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RDI>20, O2 sats < 86%
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What is compliance rate of CPAP?
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50% use CPAP for 4 hours or more at least five nights/week. Only 20% use CPAP all night.
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What are the categories of surgical intervention for OSA?
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1) nasal surgery
2) palatopharyngeal surgery 3) hypoharyngeal/tongue base surgery |
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What are the various palatopharyngeal surgeries?
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1) LAUP - LASER-assisted uvuloplatoplasty
2) Somnoplasty - RF volume reduction of soft palate 3) Tonsillectomy 4) Uvulopalatopharyngoplasty |
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What are the indications for LAUP or somnoplasty?
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RDI<15, O2sats > 86%
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What are the particularly useful data obtained from sleep study?
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1) RDI
2) lowest O2sat 3) duration of desats 4) associated cardiac arrythmia 5) associated arousal |
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How effective is UPPP for curing snoring?
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90%
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How effective is UPPP for curing OSA?
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40-50%: Sher et al. showed 41% response rate
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What is the definition of surgical success for curing OSA?
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1) >50% reduction of apnea index
2) drop of RDI to below 20 events / hour of sleep |
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What are some potential complications of UPPP?
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1) bleeding
2) VPI 3) nasopharyngeal-palatal stenosis 4) mild dryness in throat 5) sensation of persistent mucus in throat 6) dysphagia |
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What are the various hypopharyngeal/tongue base surgeries?
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1) lingual tonsillectomy
2) midline glossectomy 3) hyoid myotomy and suspension with genioid tubercle advancement 4) mandibular advancement 5) maxillomandibular advancement 6) tracheotomy |
