[03.20] CMD - Obstructive Sleep Apnea V2.pdf

At night at the patient's usual bedtime

When does a polysomnography study occur?

Grade 3

What tonsillar size grade is defined as tonsils enlarged beyond the pillars but not to the midline?

Genioglossus Advancement

What surgical procedure advances the primary muscle of the tongue forward to increase the upper airway size?

Higher tonsillar grade

What physical exam finding in children is highly correlated with obstructive sleep apnea?

Decrease during sleep onset

What happens to the activity of pharyngeal dilating muscles when a person falls asleep?

Systemic hypertension, pulmonary artery hypertension, myocardial infarction, stroke, cardiac arrhythmias, and chronic hypoxic pulmonary vasoconstriction

What are six specific cardiovascular complications of OSA?

Cigarette smoking

What specific upper airway irritant increases mucosal inflammation and edema to worsen airway obstruction?

Sleep Position Trainer and Positional Belt

What are two commercial devices shown in the figures used to train patients to avoid sleeping on their back?

Oropharyngeal area

In an MRI of an OSA patient, where is airway narrowing most clearly seen?

BMI, Age, Neck circumference, and Gender

What do the letters in the BANG portion of the STOP-BANG questionnaire stand for?

Insomnia, excessive daytime sleepiness, OSA, breathing difficulties during sleep, and sleep behavior disturbances

What are five clinical indications for performing polysomnography?

Dietary modification for weight loss, body position restriction, and avoidance of alcohol/substances

What are three behavioral management strategies for OSA?

Nasal surgery

What general class of surgery, including septoplasty, is offered to patients with septal deviation?

Compensatory pressure reflexes

What mechanisms increase pharyngeal dilator activity when an OSA patient is awake to maintain airway patency?

Kissing tonsils

What is the colloquial term for tonsils graded as size 4?

Two to seven times

By how many times is the risk of vehicular accidents increased in patients with untreated OSA?

Depressant influence

What type of influence does alcohol have on the activity of pharyngeal dilating muscles?

Minimal frequency of events

For what specific group of patients is oxygen therapy useful as a standalone treatment during sleep?

Pierre Robin syndrome

What congenital condition is characterized by micrognathia, posterior displacement of the tongue, and airway obstruction?

Obstructive Sleep Apnea

What is defined as the intermittent obstruction of the upper airway during sleep despite continued respiratory effort?

Daytime hyperactivity

What behavioral symptom manifests in children with sleep apnea instead of appearing sleepy?

Diagnostic, CPAP Titration, and Split Night

What are the three types of sleep studies?

Oral appliances

What class of devices is indicated for primary snoring, mild OSA, or patients intolerant of CPAP?

At least three percent

What is the minimum oxygen desaturation percentage required to count a reduction in airflow as a hypopnea if no arousal occurs?

Sudden cardiac death

What catastrophic cardiovascular event is a severe complication of OSA?

Weight loss surgery

As part of combination therapy, oral appliances are used alongside what surgical intervention for obstructive apnea?

Greater than forty centimeters

What is the neck circumference threshold in centimeters for a point on the STOP-BANG questionnaire?

Lung Center of the Philippines

Where is the homey sleep laboratory featured in the lecture images located?

Four point one to seven point five percent

What is the prevalence of OSA in the Asian population based on recent large-scale studies?

Anesthesiologists

Which medical specialists particularly use the Mallampati classification for pre-operative planning?

Personality change, intellectual impairment, and impotence

What are three systemic, psychological, or sexual complications that can present as part of adult OSA?

Increases tongue volume

By what mechanism do acromegaly and hypothyroidism increase the risk of OSA?

Obesity

What is the most common clinical risk factor for Obstructive Sleep Apnea?

Receding chin

What facial profile finding is associated with non-obese OSA patients?

Further relax the upper airway dilator muscles

How do alcohol and sedative-hypnotic drugs increase the risk of airway collapse in OSA?

Pneumatic or air splint

What mechanical term describes how positive airway pressure functions to keep the upper airway open?

Significant cardiac arrhythmias

What cardiovascular complication is an indication for performing a tracheostomy in severe sleep apnea?

Witnessed obstructive events

What clinical presentation is characterized by a bed partner observing apnea, interrupted snoring, or gasping during sleep?

Hypoxemia, reoxygenation, hypercapnia, increased intrathoracic pressure, frequent arousals, and sleep deprivation

What are the six nocturnal pathophysiologic mechanisms activated in sleep apnea?

Stentorian snoring

What is the most common clinical symptom of Obstructive Sleep Apnea in adults?

Sympathetic activation, metabolic dysregulation, left atrial enlargement, endothelial dysfunction, systemic inflammation, and hypercoagulability

What are the six cardiovascular disease mechanisms activated in OSA?

Genetics

What non-modifiable inherited risk factor is linked to the development of OSA?

Obese

What is the typical physical build of children and women diagnosed with OSA?

Glossoptosis

What is the medical term for the posterior displacement or retraction of the tongue, as seen in Pierre Robin syndrome?

Very loud snoring

What is defined as stentorian snoring?

Greater than fifteen point seven inches

What is the neck circumference threshold in inches for a point on the STOP-BANG questionnaire?

Respiratory effort and arousal or short awakening

What do decreased oxygen and increased carbon dioxide lead to in a sleeping OSA patient?

Male

What gender receives a point on the STOP-BANG questionnaire?

Asians suffer from a more severe degree of OSA

For the same severity of obesity, how does the severity of OSA in Asians compare to Caucasians?

Fragmented sleep and resulting excessive daytime sleepiness

What do repeated apneas, hypopneas, snoring, desaturations, and frequent arousals clinically explain?

Similar to the general population

How does the mortality rate of CPAP-compliant patients compare to the general population?

Mallampati classification

What simple non-invasive airway assessment system is used to predict the likelihood of difficult intubation?

Number of apneas plus number of hypopneas divided by total sleep time in minutes, multiplied by sixty

What is the mathematical formula to calculate the Apnea/Hypopnea Index?

Snoring or noisy breathing

What is a common respiratory presentation of pediatric sleep apnea during sleep?

Twelve centimeters of water and upwards

At what pressure did hypopneas completely disappear during REM sleep in the split-night study example?

Tracheostomy

What surgical procedure serves as a last resort for severe OSA with morbid obesity or severe craniofacial deformity?

Flat maxillary plane

What midface skeletal finding is an anatomical clue in non-obese OSA patients?

Flow generator, tube, and nasal mask interface

What are the three main parts of a CPAP machine?

Supine position

What body position assumed during sleep contributes directly to decreased lung volume?

Lateral recumbent

In what body position should an OSA patient sleep to significantly ameliorate airway obstruction?

Supine position

In what sleeping position is the airway most blocked in OSA patients due to the effects of gravity?

Uvulopalatopharyngoplasty

What does the surgical abbreviation UPPP stand for?

Neuromuscular disorders

In children, sleep apnea can commonly occur in the presence of what class of systemic diseases?

Hypothyroidism and acromegaly

What are the only two diseases where pharmacological treatment is effective in reducing sleep apnea?

Zero

According to the lecturer, what is the lowest possible grade for tonsillar size, despite the diagram starting at 1?

Eighty-seven percent

What percentage of sleep apnea patients also present with metabolic syndrome?

Continuous Positive Airway Pressure

What does the medical acronym CPAP stand for?

Middle-aged obese men

What is the classic demographic and physical appearance of OSA patients?

Posterior pharyngeal wall

With what structure does the tongue come into contact when it relapses posteriorly during supine sleep?

Narrowed upper airways

What do a higher tonsillar grade in children and a higher Mallampati score in adults clinically signify?

CPAP Titration study

Which type of sleep study involves a technician adjusting the CPAP level on a separate night to find the optimal pressure?

First half of the night

During which portion of a split-night study is the diagnosis of sleep apnea established?

Postmenopausal status

What hormonal status in women is a clinical risk factor for OSA?

Morning confusion

What cognitive symptom occurs in the morning due to chronic sleep deprivation in OSA?

Repositioning the mandible indirectly pulls the tongue forward

How does a Mandibular Repositioning Device prevent airway collapse if it is attached to the lower jaw?

Untreated patients younger than fifty years of age

What specific cohort with OSA suffers from excess mortality due to cardiovascular causes?

US-FDA

Which regulatory body approved the hypoglossal nerve stimulator for moderate to severe OSA?

Seventy percent or less

At what oxygen saturation threshold during sleep is a tracheostomy indicated in severe OSA?

Morning dry mouth or sore throat

What two oral symptoms occur in the morning because OSA patients tend to breathe through their mouth?

Grade 2

What tonsillar size grade is defined as tonsils extending to the pillars?

Hypopnea event

What is defined as a reduction of airflow of at least thirty percent from baseline lasting at least ten seconds, with either desaturation or arousal?

Physically restless sleep

What nocturnal physical state is a common clinical presentation of OSA in adults?

Apnea/Hypopnea Index

What does the medical acronym AHI stand for?

Tongue Retaining Device

Which oral appliance functions by directly holding the tongue in a forward position using a suction bulb?

Unacceptable desaturation

What oxygenation finding during sleep is an indication for adjunctive oxygen therapy?

Useful adjunct

How is the role of oxygen therapy classified when combined with CPAP or BiPAP?

Decreased oxygen and increased carbon dioxide

What blood gas changes occur as a result of airway collapse during sleep?

Severe facial deformity or mandibular deficiency

What skeletal abnormality accompanied by daytime sleepiness is an indication for tracheostomy?

Severe sleepiness

What daytime symptom is highly common in adults with OSA, though patients may be unaware of it?

Increased endothelin and decreased vagal tone

What two physiological changes occur during sympathetic activation from sleep arousals, contributing to cardiovascular complications?

STOP-BANG questionnaire

What screening tool is used to identify patients at moderate to severe risk of sleep apnea and for pre-operative assessment?

Diagnostic study

Which type of sleep study is an investigative test to confirm the diagnosis and determine the severity of sleep apnea?

FLW, THO, and ABD

What are three channels on a PSG representing airflow, thoracic effort, and abdominal effort that normalize with CPAP?

Split Night study

Which type of sleep study combines a diagnostic study and a CPAP titration study into a single night?

At least thirty percent

What is the minimum reduction in airflow required to classify an event as a hypopnea?

Enlargement of the hypopharyngeal airway

What anatomical change is achieved when the hypoglossal stimulator moves the tongue forward?

Non-invasive treatments have failed, surgically correctable abnormality, patient preference, or CPAP adjunct

What are four clinical situations where surgical intervention is indicated for OSA?

At least ten seconds

What is the minimum duration required to classify a respiratory event as an apnea or hypopnea?

Excessive bulk of soft tissue and problems with craniofacial anatomy

What are the two broad mechanisms that reduce the cross-sectional area of the upper airway lumen in OSA?

Maxillomandibular Advancement

What surgical procedure moves both the maxilla and mandible forward to widen the airway?