sleep disorders

what are the 2 types of sleep related breathing disorders?

1. UARS

2. OSA

what does UARS stand for?

upper airway resistance syndrome

what does OSA stand for?

obstructive sleep apnea

what does PS stand for?

primary snoring

what is PS considered?

a sleep disorder

when does PS occur?

1. without necessarily causing obstruction

2. with normal ventilation

which gender has a higher prevalence of PS?

males

does PS result in loss of sleep/sleepiness during the day?

no

what is the primary symptom of UARS?

snoring

what are symptoms of UARS?

1. snoring

2. some daytime sleepiness

3. not complete obstruction

what is hypopnea?

30% reduction of airflow

what is midway between snoring and OSA?

UARS

what is the minimum duration of OSA?

10 seconds

what is apena?

cessation or near complete cession of airflow

what percent of airflow is considered OSA?

less than 70%

what percent of the population is affected by OSA?

35%

what ages are affected by OSA?

30-69 years old

what are symptoms of OSA?

1. loud snoring

2. daytime sleepiness

3. disruption of sleep cycle

what is the cause of OSA?

narrowed upper airway together with pharyngeal dilator collapsibility

what is resistance to airflow expressed as?

1. snoring

2. hypopnea

3. apnea

what is snoring?

vibration of soft tissues

what is hypopnea?

hypoventilation

what is apnea?

complete obstruction

what causes anatomical narrowing?

1. septal deviation

2. enlarged turbinates

3. hypertrophic adenoids

4. enlarged tonsils

5. elongated soft palate

6. enlarged tongue

7. excessive lymphoid tissue

what are turbinates?

tissues that lines nasal cavity

what are factors of pharyngeal collapsibility?

1. pressure balance

2. intraluminal pressure

3. complex etiology

what is pressure balance?

balance between external and internal pressure from pharyngeal muscles

what should intraluminal pressure be greater than?

external pressure

why should intraluminal pressure be greater than external pressure?

to allow the airway to remain open

what is complex etiology?

refers to cause of external pressure being greater

what does external pressure being greater create?

collapsibility

what are risk factors of OSA?

1. gender

2. obesity/BMI

3. neck circumference

4. genetic predisposition

5. ethnicity

6. age

7. retrognathia

8. mallampati score

9. poor sleep/nocturia

10. morning headache/bruxism

which gender does OSA have a predilection towards?

male

when are women more prone to OSA?

after menopause

what percent of individuals with OSA are obese?

70%

70% of individuals with OSA are what?

obese

what neck circumference is an indication of OSA for men?

17+ inches

what neck circumference is an indication of OSA for women?

16+ inches

what age is OSA most prevalent in?

50-59 years old

what is mallampati score?

size of tongue vs oropharyngeal opening

what is nocturia?

condition of waking up 1(+) times during the night to pee

what are the 2 different states of normal sleep pattern?

NREM and REM

what does NREM stand for?

non-rapid eye movement sleep

what does REM stand for?

rapid eye movement sleep

what happens during REM?

1. dreaming

2. brain blocks signals to muscles to not act out dreams

what is active during REM?

brain

what is inactive during REM?

muscles

how is NREM measured?

in waves (EEG)

how is REM measured?

in waves (EEG)

how many cycles of sleep happens per night?

4-6 cycles

how long does each cycle of sleep last?

average of 90 minutes

what does OSA disrupt?

sleep

what happens to sleep pattern during OSA?

gets constantly interrupted, inadequate REM sleep

what does OSA lead to?

1. sleepiness

2. lack of alertness

3. irritability

4. poor concentration

5. lack of libido

   1. memory loss

how many times are OSA patients more likely to cause an accident?

8x

what cardiovascular effects are OSA associated with?

1. hypertension

2. strokes

3. cardiovascular disease

4. congestive heart failure

5. pulmonary hypertension

6. cognitive decline

what are signs and symptoms of sleep apnea?

1. sleeping

2. snorting

3. gasping

4. breath holding

what do EEGs test/diagnose?

brain waves

what do EOGs test/diagnose?

eye movement

what do EMGs test/diagnose?

jaw and leg movements

what do ECGs test/diagnose?

heart rate and rhythm

what does pulse oximetry test/diagnose?

O2 saturation, breathing effort

what does AHI stand for?

apnea-hypopnea index

what does RDI stand for?

respiratory disturbance index

what does PSG stand for?

polysomnography

what is a polysomnography?

overnight sleep studies to measure and diagnose

what does PAP stand for?

positive airway pressure

what are 5 different approaches to treatment?

1. behavior modification

2. positive airway pressure

3. oral appliances

4. surgical intervention

5. implantable device

what should you avoid at nighttime for OSA?

1. alcohol

2. sedatives

3. muscle relaxants

what are treatment options for OSA?

1. weight loss

2. aerobic exercise

3. nasal dilator strips

4. sleep position training (PST)

what is the gold standard for OSA treatment?

PAP

what does PAP do?

produces positive intraluminal pressure along pharyngeal airway

what does CPAP stand for?

continuous positive air pressure

what does BPAP/BiPAP stand for?

bi-level positive air pressure

what is BPAP/BiPAP?

alternates delivery of high pressure during inhalation and lower pressure during exhalation

what is APAP?

varying pressure

which method of PAP is most common?

CPAP

when are oral appliances recommended?

for mild cases or severe cases that do not comply with CPAP

what are the types of oral appliances used for OSA?

1. tongue retaining devices

2. hoseless “mini-CPAP)

what do implantable devices for CPAP do?

stimulates a nerve located in the chest responsible for sending signals to the diaphragm to stimulate breathing

what medications can be used to treat daytime sleepiness?

sunosi (solriamfetol)

what can OSA lead to in pediatrics?

1. health issues similar to adults

2. hyperactivity

3. neurological/cognitive disabilities

4. poor academic performance

what are risk factors of pediatric OSA?

1. failure to thrive

2. bedwetting

3. bruxism

what is treatment for pediatric OSA?

surgical intervention - remove tonsillar and adenoid tissue

what is central sleep apnea?

cessation of breathing from a disorder of the CNS

what happens during central sleep apnea?

brain temporarily stops sending signals to muscles that control breathing

what is the STOP-bang questionaire?

test to measure “sleepiness” and identify risk factors/level of risk

how should DHs help patients with sleep apnea?

1. risk factors (neck circumference/anatomical risk factors)

2. screening questionnaire (STOP-bang)

3. evaluations (referrals for OSA evaluations)