Sleepiness

Question 1

What are the potential causes of excessive daytime sleepiness?

Answer 1

1. Inadequate total sleep time: insomnia/restless leg syndrome
2. Poor quality sleep: sleep apnea
3. Medical/psychiatric
4. Sleep disorders: narcolepsy

Question 2

What are the best predictors of obstructive sleep apnea on history and physical exam

Answer 2

1. History: hypersomnolence, snoring, witnessed apneas, choking/gasping, hypertension
2. Physical: High BMI, large neck circumference, older, male sex, retrognathia, palate position

Question 3

What are the consequences of severe OSA?

Answer 3

1. Hypertension
2. Increased CAD
3. Increased mortality (stroke, MI)
4. Cor pulmonale
5. may have co-existing obesity hypoventilation

Question 4

What causes a central apnea?

Answer 4

1. Destablizing event such as high altitude, heart failure, sleep onset (changes feedback loop)
2. Damage to respiratory control center (neuro or drugs)

Question 5

What are the chronic hypoventilation syndromes?

Answer 5

1. Obesity hypoventilation “wont breathe”, affects resp rate

2. Lung disease “cant breathe”-affects tidal volume

Question 6

What are the diagnostic criteria for OSA ?

Answer 6

1. AHI>5 + daytime hypersomnolence

Question 7

How should different severities of OSA be treated?

Answer 7

1. AHI 5-15/hour: treat if symptoms warrant
2. AHI >15= treatment will benefit
3. AHI >30 =should treat
4. OSA +hypoventilation- make sure to monitor

Question 8

What are the treatment options for OSA

Answer 8

1. Behaviour + lifestyle +oral appliance

2. CPAP

Question 9

obesity hypo ventilation

Answer 9

1. Chronic under breathing leading to hypoxia during awake periods
2. May see SX of OSA as well as more profound heart issues?
3. Tests: chest X-ray, ABGs (hypercapnia/hypoxemia?) CBC (thyroid and hemoglobin levels), polysomnography (help decide on BPAP VS CPAP), PFTs (rule out other lung disease)
4. Avoid excessive oxygen therapy, may reduce drive to breathe