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Principles 2 Test 2

Obstructive Sleep Apnea

What percentage of the adult SURGICAL population has OSA? 22%
What percentage of bariatric patients have OSA? 70%
What percentage of patients with OSA are undiagnosed? 80%
What is the apnea hypopnea index (AHI)? the number of abnormal respiratory events per hour of sleep
The AASM set minimal diagnostic criteria for OSA as an AHI of ___ and excessive daytime sleepiness. 10
What is considered the gold standard for diagnosis of OSA? Polysomnography
What are the components of polysomnography? EEG, airflow, oxygen saturation, respiratory effort, observation (for restlessness, leg movements)
How are the results of polysomnography reported? using the AHI
According to the ASA, what is considered mild OSA? AHI 6 - 20
According to the ASA, what is considered moderate OSA? AHI 21 - 40
According to the ASA< what is considered severe OSA? AHI > 40
What are 7 symptoms of OSA? Sleep arousal, loud snoring, daytime somnolence, fatigue, decreased cognition & intellectual function, concentration and memory problems, headaches
What are 5 risk factors for OSA? male gender, middle age (> 40), obesity, central abdominal fat distribution, short mandible
For every 10 kg of weight, the risk for developing OSA increases ____ times. 2
What percentage of OSA patients are obese? 60 - 70%
As BMI increases by 6 OSA risk increases by __ 4
Between waist circumference, neck circumference and BMI, which is a better indicator for OSA? waist circumference
For every 15 cm increase in waist circumference, the risk for OSA increases __ times. 4
A difficult intubation is ___ times more likely to occur in an OSA patient. 8
What is the most common preoperative complication for patients with OSA? oxygen desaturation
OSA patients have significantly increased pulmonary complications after orthopedic and general surgery. Why? Related to increased opiate requirements for these surgeries
What percentage of OSA patients have systemic and pulmonary hypertension? 50%
Obese patients have higher or lower leptin levels than normal weight patients? higher
The fact that obese patients and those with OSA typically have higher leptin levels, but cannot adequately sense those higher leptin levels is referred to as what? leptin resistance
True or False: one study found that CPAP use reduced leptin levels in OSA patients by improving leptin resistance. True
True or False: radiographic studies found that even in wakefulness, pharyngeal airway was narrower in OSA patients. True
________ pressure is higher in OSA patients (in terms of airway). Closing
How many different types of obstruction exist in OSA? 3
Do opioids cause any issues in OSA patients? If so, what are they? Yes; increased sensitivity, opioids exacerbate OSA & prevent arousal from anesthesia
Does midazolam cause any issues in OSA patients? Is so, what are they? Yes; can cause airway obstruction due to causing same closing pressure to occur as sleep does in these patients, increases frequency and duration of apnea events
Which volatile anesthetic is found to have an earlier return of protective reflexes than the others? desflurane
What medication can be used to reduce opioid requirements in OSA patients? dexmedetomidine
Which sedative can be used in OSA patients that causes less respiratory depressant effect? ketamine
What are the 3 most common treatments for OSA? CPAP, insertable dental appliances, surgical treatment
What are 7 screening tools to check for OSA? STOP BANG, Epworth Sleepiness Scle, Snore Scale, Sleep Apnea Clinical Score, Berlin Questionnaire, P-SAP Score, ASA checklist
In reference to the ASA checklist, signs and symptoms in two or more categories indicates what? increased probability of OSA
The STOP BANG scoring tool consists of what? 8 yes or no questions that stratifies patients into high and low risk OSA categories
How many yes answers on the STOP BANG tool place a patient in the high risk for OSA category? 3 or more
What do the letters in STOP BANG stand for? snoring, tired, observed, blood pressure, BMI, age, neck, gender
True or False: mild hypercarbia improves tissue oxygenation and perfusion True
According to the ASA taskforce, how much longer should you keep OSA patients post-op than non OSA patients? 3 hours
How long after last airway obstruction or hypoxemia event should you keep an OSA patient? 7 hours
Evidence indicates a higher STOP BANG score means a higher probability of _______________ severe OSA
Created by: Mary Beth