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Terms in this set (47)OSA big picture Pliable or misproport. large structures in upper airway collapse when airway dilators lose tonic waking input Collapse causes reduction (hypopnea) or cessation of airflow (apnea) during struggle to breathe against a closed airway Hypoxia and hypercapnia prompt brieg arousals during which recovery breathing occurs sleep architecture is disputed and phys stress is increased OSA= Most common sleep related disorder Occurs when posterior airspace gets too tight during sleep preventing normal breathing sleep apnea Open mouth breathing signs of obstructed breathing Prevalence of OSA is __________ Daytime impairment symptoms are ________ Increasing common complaints (fatigue) link to medical disease Two main reason to care about OSA 1. DAYTIME NUEROCOGNITIVE IMPAIRMENT 2. ELEVATED CARDIOVASCULAR RISK******* Exploring reason #1 : common questions to ask? 1. Assessing daytime neurocognitive impairment: When things slow down during the day do you feel liek you are fighting to stay awake? how satisfied are you with your sleep? memory.concentration ADD moodiness/depression The Subjective way to see if patients are having a sleep problem The epworth sleepiness scale Epworth sleepiness scale; pathologic degree? >10/24 suggests pathologic degree of daytime sleepiness Exploring reason #2 Refractive HTN How to assess for OSA Snoring Physical exam points when assessing for OSA Nasopharynx Posterior oropharynx Exam of nose in OSA Inferior turbinate hypertrophy (LOOK FOR THINGS THAT MAY CREATE DIFFICULTY BREATHING THRU NOSE) Mouth exam for OSA 7 things 1. Tonsils Friedman Tonsillar Classification SHOW KNOW EACH PIC and number 0-4+ 0= no tonsils visible or surgically absent High arched hard palate suggests? (finish) Maxillary insufficiency Crowds Bilateral posterior maxillary crossbite suggests? Maxillary insufficiency Mallampati classification (assessment of how crowded is the airway- post oropharynx) Head is neutral, ask pt. to protrude tongue maximally, DO NOT ASK THE PT. TO PHONATE (ahhh) Class 1: can see all of the soft palate and uvula, easy to visualize the post oropharyngeal wall class 2: Tip of uvula lies behind tongue class 3: barely able to see the base of the uvula class 4: Cannot see anything but hard palate HIGHER MALLAMPATI HIGHER LIKELIHOOD OF OSA Crowded posterior oropharynx ... Retrognathia The forgotten risk factor for OSA (tongue closer to posterior oropharynx; when lie down loses normal tone) Tongue scalloping May increase likelihood of OSA Most imp. PHYSICAL predictor of OSA Large neck circumference Men 17 inches (31%) Dont neglect the rest of the exam! General CV exam DX of OSA Gold standard Polysomnography - in lab overnight Data set for Polysomnography EEG Most common metric used to predict future risk from OSA AHI (Apnea-hypopnea Index) AHI >30 is strongly associated with increased all cause mortality Reported with polysongo reading AHI <5 AHI 5-14 AHI 15-29 AHI >30 how many times pt. has apnic episode or hyponic episode while on polysono. No OSA Mild OSA Moderate OSA Severe OSA AHI_____ is abnormal if CV risk factors or daytime impairment sx present AHI___ associated with increased long term mortality ****AHI _________ ahi >5 ahi >15 AHI >30 Symptoms but low AHI still = OSA ... Higher AHI more likely to die of CARDIOVASCULAR event ... IMP: Increased in mortality noted in sleepy and non sleepy patients *************** (not all pts. w/ sleep apnea will be sleepy the next day) ... Also consider ... 5 things to think about before order PSG 1. Does this patient have significant circadian misalignment? 2. Is the patient on supp 02 3. Is the patient medically stable? 4. Medications: Will this be representative night? 5. What will you do with the results? Hint: you can always call your friendly neigh sleep me specialist and as if PSG is app. How to order a polysomnogram: Four key pieces of info to tell us..? ... 6 things to consider when crafting a tx plan 1. rationale for disease 2. medical mandate for definitive tx 3. patient anatomy 4. financial considerations 5. response to tx 6. is tx plan acceptable First line tx for OSA 1st line: CPAP (contin. positive airway pressure) Weight loss should accompany CPAP Oral appliances Position therapy Surgery Oxygen How does CPAP work? Positive pressure is delivered via one of many interfaces (masks) Helps posterior oropharynx stay open Barrier to tx w/ CPAP Open mouth breathers ) Why should someone use CPAP? 1. improve daytime impairment sx's Four questions to ask about CPAP Are they using it? Are they tolerating it? Is it making things better? Do they truly need it? CPAP Follow up Compliance Tolerability Improvement in sleep quality, daytime impairment symptoms What to do with the patient who doesnt do well with CPAP? 1. determine where the failure takes place 2. re-assess why tx is being recommended** 3. can the problem be worked around? 4. if tx is necessary are there other options 5. Oral appliances for OSA (slide) Effective in pts Surgical tx for OSA tonsilectomy/adenoidectomy (KEY TX option for pediatrics pts with OSA) Definitive tx for OSA
Tracheostomy (IF VERY SEVERE) Other considerations for OSA Weight loss Position therapy Oxygen Which mechanism best describes etiology of OSA Cardinal feature of OSA Physical exam finding with highest correlation with OSA Polysomnogram reading that denotes severe osa most common treatment of osa Posterior airway collapse during sleep Sleepiness, poor concentration, nocturnal snorts Large neck circumference AHI of 30 (severity determined by AHI index) positive airway pressure a 40 yr old man presents for eval of frequent awakenings at night and daytime fatigue. A polysomnogram is performed and reveals 18 apneic episodes per hour of sleep. What is strongly associated with the dx? Unstable HTN Sets found in the same folderPANCE QUESTIONS FROM PEARL BOOK17 terms babyxhil2PLUS Health Teaching/Health Promotion59 terms gpierre920 Nursing Exam 6- Oxygenation143 terms Achrystal PVD & PAD Practice Questions24 terms Sking0919 Other sets by this creatorGU2 terms babyxhil2PLUS Internal Medicine EOR208 terms babyxhil2PLUS Hematology59 terms babyxhil2PLUS Psychoses47 terms babyxhil2PLUS Recommended textbook solutions Clinical Reasoning Cases in Nursing7th EditionJulie S Snyder, Mariann M Harding 2,512 solutions
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What causes upper airway restriction?Causes. The airway can become narrowed or blocked due to many causes, including: Allergic reactions in which the trachea or throat swell closed, including allergic reactions to a bee sting, peanuts and tree nuts, antibiotics (such as penicillin), and blood pressure medicines (such as ACE inhibitors)
What breathing disorders are caused by sleep apnea?Sleep-related breathing disorders or sleep-disordered breathing are characterized by abnormal respiration during sleep. They are grouped into obstructive sleep apnea (OSA), central sleep apnea, sleep-related hypoventilation, and sleep-related hypoxemia disorder.
What is the most common site of upper airway collapse in OSA?Although the velopharynx was the most common site of obstruction (in 89% of patients), most patients (72%) had multiple sites of obstruction.
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Which is a cause of upper airway impairment associated with obstructive sleep apnea Quizlet
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