Pulmonary Rehab and Sleep Apnea Flashcards

Flashcards for Pulmonary Rehab and Sleep Apnea

Referral Requirements for Pulmonary Rehab

Physician signed orders, diagnosis, patient demographics, insurance, most recent history and physical, and any prior diagnostic testing

Common Obstructive Diseases Treated in Pulmonary Rehab

COPD, persistent asthma, diffuse bronchiectasis, cystic fibrosis

Common Restrictive Disorders Treated in Pulmonary Rehab

Interstitial lung diseases, interstitial pulmonary fibrosis, occupational or environmental lung disease, sarcoidosis, connective tissue diseases, hypersensitivity pneumonitis, ARDS survivors, kyphoscoliosis

Various Lung Disorders Treated in Pulmonary Rehab

Lung cancer, pulmonary hypertension, before and after thoracic and abdominal surgery, before and after lung volume reduction surgery, ventilator dependency, obesity-related respiratory disease

PFT Criteria for COPD Patient Approval for Pulmonary Rehab

Fev1 less than 80%, fev1/fvc% less than 70%

Importance of Interview Process in Pulmonary Rehab

Establishes trust and credibility, obtains medical history: respiratory, comorbidities, surgical, family, medical resource use, medications, allergies, smoking, occupational exposures, substance abuse, and social support

Components of Physical Assessment for Pulmonary Rehab

Vital signs, height/weight(BMI), breathing pattern, accessory muscle use, breath sounds, cardiac rhythm/rate/murmurs, digital clubbing, upper/lower extremity evaluation, frailty, grip strength

Other Important Assessments for Pulmonary Rehab Success

Symptom assessment, musculoskeletal and exercise, pain, ADL, nutrition, supplemental oxygen, education, psychological

Exercise Prescription Components in Pulmonary Rehab

Mode, exercise frequency, exercise duration, exercise intensity, oxygen saturation and titration, strength training, progression

Components of the Treatment Plan in Pulmonary Rehab

Assessment, intervention, and goal in areas of physical concern, exercise prescription, nutrition, psych/social, co-morbidities/core components, oxygen

Physiological Variables Measured During Polysomnography

Airflow, ventilatory effort, cardiac rhythm, tibial EMG leads, and arterial O2 saturation

Obstructive Sleep Apnea (OSA)

A condition in which five or more apneic periods occur per hour of sleep, characterized by occlusion of the oropharyngeal airway with continuous efforts to breathe

Adverse Side Effects of Untreated OSA

Increased risk for mild pulmonary hypertension, stroke, nocturnal arrhythmias, heart failure, systemic hypertension, myocardial infarction, and overall mortality

Symptoms of OSA

Snoring, gasping, or choking during sleep. Excessive daytime sleepiness, morning headaches, excessive fatigue, nocturnal GERD, apneas reported by bed partner, sleep fragmentation, nocturia, decreased concentration/memory loss, and erectile dysfunction

Treatment Goals for OSA

Eliminate apnea, hypopnea, and snoring. Normalize O2 saturation and ventilation, improve sleep architecture and continuity

OSA Polysomnography Interpretation

Effort detected but no airflow, with or without desaturation

CSA Polysomnography Interpretation

No effort and no airflow, with or without desaturations

Central Sleep Apnea (CSA)

Absence of breathing as a result of the medullary depression that inhibits respiratory movement, which becomes more pronounced during sleep. Heterogeneous group of disorders, characterized by periodic breathing

Characteristics of CSA

Waxing and waning of respiratory drive, noted by an increase then a decrease in f and Vt, Cheyne-Stokes respiration

Disorders/Diseases Commonly Associated with CSA

CHF or stroke

Symptoms and Common Breathing Patterns Noted in CSA

Severe type of periodic breathing. Cheyne-Stokes respiration

Treatment for CSA

Behavioral interventions and risk counseling, positional therapy, medical interventions: positive pressure therapy, CPAP therapy, BiPAP therapy, advanced modes of bilevel, autotitrating devices, side effects, and troubleshooting strategies

Gold Standard for Diagnosing Sleep Apnea

PSG-polysomnogram/ home sleep apnea test(HSAT): overnight study required for definitive diagnosis. Respiratory events seen on PSG or HSAT must be at least 10 seconds to be scored

"Split Night" Study

A type of sleep study that combines a diagnostic polysomnogram with a CPAP titration

AHI- Apnea Hypopnea Index

Normal:

STOP BANG Questionnaire

Detecting sleep apnea

Titration Techniques Utilized for CPAP/BIPAP in a Patient with OSA

Use a computer algorithm to adjust the level of CPAP in response to dynamic changes in airflow or vibration caused by airway collapse, snoring, or both

Treatment Options for Sleep Apnea

Behavioral interventions and risk counseling, positional therapy, medical interventions: positive pressure therapy, CPAP therapy, BiPAP therapy, advanced modes of bilevel, autotitrating devices, side effects, and troubleshooting strategies