Obstructive Sleep Apnea and Ventilation Support

Define obstructive sleep apnea (OSA)

Narrowing of the upper airways during sleep that impairs normal ventilation

sxs of OSA

• excessive daytime sleepiness

• snoring, choking, gasping during sleep

• morning headaches

• difficulty with sleep maintenance

diagnosis of OSA

requires polysomnography (sleep study)

major consequences of untreated OSA

increases risk of:

• motor vehicle crashes

• attention, memory, and cognitive problems

• moodiness, irritability

• depression

• CV: HTN, arrhythmias, CAD, HF, stroke

• pulmonary hypertension

• metabolic syndrome

• diabetes

• fatty liver disease

Mnemonic: "OSA's DAMN CRASH"

O – Obesity-related issues (like fatty liver disease)
S – Stroke
A – Arrhythmias

D – Depression, diabetes
A – Attention, memory, and cognitive problems
M – Moodiness, irritability
N –

C – Cardiovascular disease (HTN, CAD, HF)
R – Road accidents (motor vehicle crashes)
A –
S – Syndrome, Metabolic
H – Hypertension (pulmonary)

OSA Tx 1st line

Positive airway pressure (PAP) therapy

• Continuous Positive Airway Pressure (CPAP)

  • worn during sleep, in-home use

  • opens airways by providing continuous air pressure (same during inspiration and expiration) to prevent upper airway collapse

  • DOES NOT DELIVER O2

Identify 2 clinical scenarios in which BiPAP would be used

Bilevel Positive Airway Pressure (BiPAP)

• Noninvasive ventilation

• provides oxygenation and ventilation by forcefully pushing air into the airways, opening the alveoli to increase gas exchange

• drawbacks

  • claustrophonic

  • high aspiration risk

  • uncomfortable high pressure

• common clinical scenarios

  • acute decompensated HF with pulmonary edema

  • hypercapnic respiratory failure (severe COPD)

Identify 3 clinical scenarios in which intubation would be used

• reason to use→ full control over oxygenation and ventilation

• common clinical scenarios

  • respiratory failure

  • obtunded (=no respiratory effort)

  • during surgery