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Chapter 19
Sleep and Breathing Assessment
| Question | Answer |
|---|---|
| Apnea-hypopnea Index (AHI) | the total number of apneas and/or episodes of reduced airflow occurring per hour of sleep |
| Arousal | an abrupt change in sleep stage from a deeper level to a lighter one, typically accompanied by an increase in EMG activity |
| Berlin Questionnaire | a screening questionnaire used to identify the risk for sleep disordered breathing |
| Central sleep apnea (CSA) | pauses in breathing resulting from temporary loss in the drive to breath |
| EEG Arousal | an abrupt shift in EEG frequency during sleep, usually lasting 3 seconds or more and commonly associated w/ the end of sleep-related obstructive events |
| Electroencephalogram (EEG) | the tracing of brain waves made by an electroencephalograph |
| Epworth Sleepiness Scale (ESS) | a short patient questionnaire used in diagnosing sleep disorders that assesses the magnitude of daytime somnolence |
| Excessive daytime sleepiness/somnolence (EDS) | an abnormal increased desire to sleep during the day as reported by a patient; a symptom of sleep disordered breathing |
| Hypopnea | generally refers to a reduction in the rate or depth of ventilation; as applied to diagnosis of sleep disordered breathing, a 30% or more reduction in measured airflow lasting at least 10 seconds |
| Micrognathia | small lower jaw |
| mixed sleep apnea (MSA) | a condition characterized by a combination of both central and obstructive sleep apnea |
| Montage | the arrangement or configuration of the various physiologic tracings on the PSG page or screen |
| Non-rapid eye movement (NREM) | sleep a type of sleep composed of 4 stages: 1,2,3,4; this is the type of sleep in which the sleeper does not dream, and it makes up the majority of sleep time in the normal sleeper |
| Obstructive sleep apnea (OSA) | intermittent pauses in breathing for more than 10 seconds resulting from upper airway blockage during sleep |
| polysomnogrm (PSG) | a sleep study used to diagnose sleep apnea and other sleep-related breathing disorders |
| Rapid eye movement (REM) | sleep the type of sleep in which dreaming is believed to occur |
| Respiratory effort-related arousal (RERA) | an arousal from sleep that follows a 10-second or longer sequence of breaths that are characterized by increasing respiratory effort, but that does not meet criteria for an apnea or hypopnea |
| Retrognathia | a recessed or small lower jaw |
| Sleep apnea | a pause in breathing of at lease 10 seconds during sleep |
| Sleep architecture | describes the structure and pattern of sleep and encompasses several variables |
| Sleep-disordered breathing | periods of an absence of or insufficient breathing during sleep |
| Slow wave sleep | consist of 3 and 4 of non-rapid eye movement sleep |
| Snoring | the hoarse or harsh sound that occurs when breathing is obstructed in some way during sleeping |
| STOP-BANG analysis | a measurement tool used to classify the severity of certain sleep disorders |
| Sudden infant death syndrome (SIDS) | a condition of unexplained death of an infant. Usually seen in infants between 6 week and 6 months of age. The incidence of this disease is decreased by not letting the young infant sleep in a prone (face down) position |
| How common is sleep apnea | - approx 40 million American have sleep disorders -18 million million of of those have some form of sleep apnea |
| What are the 2 phases of sleep? | NREM 75%, 3 stages REM 25% of sleep duration , commonly known as the "dream" stage |
| How long are the cycles from NREM to REM? | 60-90 mins |
| How many NREM stages are there | 3 |
| Professions of sleep diagnostics are | -Registered Polysomnographic Technologists (RPSGT) -Certified Polysomnographic Technicians (CPSGT) -Respiratory Therapist (RRT/CRT) |
| Define sleep | an active process w/ continuous stimulation of specific regions of the brain throughout the night |
| Stage 1 last how long before progressing to stage 2? | -2-10 minutes -5-10% of sleep stage |
| Stage 2 | - most common stage of sleep in adults sharp spikes called "k-complexes" & sleep spindles seen on EEG tracings -40-50% of total sleep period |
| Stage 3-also called Delta Sleep (combo of 3 & 4) | -deepest stage of sleep -Delta waves(slow brain waves) on EEG tracings -25% of sleep stage -restorative sleep |
| What values change during Stage 3 NREM? | Increased PaCO2- 2-4mmHg Decreased Ve- by 13-15% Decreased BP- by 5-14% |
| Percentage of time spent in stage____and _____increases with age while stage _____ decreases dramatically | -1 and 2 -3 |
| What occurs in REM? | Dreaming and Muscle Paralysis |
| What does the EEG look like for REM? | very similar to awake |
| What happens to musculature during REM? | Semi-paralysis This further reduces Ve Loss of muscle tone in upper airway Obstruction |
| What 3 thing have been associated with disruptions of REM sleep? | Variable HR BP Arrhythmias |
| What is EDS? | Excessive Daytime Sleepiness |
| What are some signs and symptoms of SDB? | -nonspecific & unremarkable -obesity or normal body habitus -normal skin coloring -normal respiratory rate -Non-discernible features |
| Severe or Chronic sign of SDB? | -cor pulmonale (abnormal enlargement of the right side of the heart) -congestive heart failure (CHF) |
| What is the Technical definition of Sleep Apnea? | -Cessation of breathing for at least 10 seconds -A decrease in O2 Sats by 4% -An EEG change at least 3 seconds in length |
| What is the most common finding associated with sleep apnea? | -Snoring -excessive daytime sleepiness (EDS) |
| Snoring can be found in all age groups and in a serious indicator for a __________ and ____________. | Medical exam and possible sleep study |
| Patient/ Family interview commonly reveals what 2 symptoms? | Snoring and (EDS) |
| What 2 tests can be utilized to determine sleep info? | Epworth Sleepiness Scale (ESS) Berlin Questionnaire |
| What does the Epworth Sleepiness Scale (ESS) determine? | 1 to 6 = appropriate no EDS 7 to 8= average score 9 or > = seek a sleep specialist immediately |
| What does the Berlin Questionnaire determine? | -limited to risk factors of sleep apnea -general questionnaire for the sleep physician/lab usage |
| What is a Polysomnogram? | Diagnostic sleep study |
| What does Polysomnogram provide? | Various physiologic parameters |
| What are some of the parameters measured? | ECG tracings= 1 channel EEG tracings =4 channels R/L eye =2 channels Chin movement =1 channel R/L leg = 2 channels Snoring, Airflow, Thoracic- abdominal movement, Spo2, HR, Body Position = 7 channels |
| What is a montage? (gained from a total of how many channels?) | Consist of a minimum of 17 channels of information |
| If SDB is seen during study, the patient may be placed on? | CPAP, FOR (OSA) BIPAP, FOR (CSA) OR ASV |
| After the PSG has been interpreted the patient may return to the sleep lab for? | a second study to perform a full night titration study to find appropriate positive pressure levels |
| Apnea-hypopneaIndex (AHI) interpretation | -Adult- AHI >5 w/ 4% drop in Spo2 is abnormal -AHI of 5-15= mild sleep sleep apnea -AHI 15-30 = moderate sleep apnea -AHI > 30 = severe sleep apnea -Infants/children AHI >1 w/ etCO2>53 or SpO2 <92% is abnormal |
| What is the criteria for Hypopnea and what is Hypopnea? | Decreased airflow from 30-50% baseline airflow for at least 10 seconds SpO2 Sats decreased 3-4%or EEG arousal of 3 sec. Breathing abnormally low volumes |
| What are the criteria for Apnea? | More than 50% decrease in airflow for 10 seconds |
| What is the Apnea-Hypopnea index? | AHI # of times hypopneas and apneas occur each HOUR of sleep |
| What is OSA and How it's severity measured via airway opening? | Obstructive Sleep Apnea Airflow stops Measureable thoracic effort O2 Sats fall EEG shows arousal Pt wakes to correct pH and O2 Sats Mallampati scale |
| What other findings indicate OSA? | Large tonsils micrognathia-small mandible Deviated Septum Retrognathia (recessed lower jaw) |
| What is CSA? How is it diagnosed? | Central Sleep Apnea Apnea longer than 10sec. Lack of central drive to breathe Most common in children |
| Signs and symptoms of OSA | -loud snoring -breathing pauses during sleep -fall asleep driving -hard time staying awake -poor memory -moody -sluggish -morning headaches -depresion |
| CSA is failure of ___________(primary) AND ____(secondary) drive. | Hypercapnic Hypoxic |
| What are some etiology of CSA (complex): | Stroke or Brainstem Lesion Encephalitis Radiation to brain stem Injury to brain stem |
| What are some signs and symptoms of CSA? | Cheyne-Stokes breathing (most common) Sleepiness Frequent awakenings Often associated w/ Neuro disorders -difficulty swallowing -change in voice -body weakness BODY MORPHOLOGY??? SIDS??? |
| What is MSA? | Mixed Sleep Apnea both OSA and CSA PSG often detects OSA 1st |
| What is Upper airway Resistance syndrome (UARS)? | Upper Airway Resistance Syndrome Doesn't necessarily cause the pt to wake, just increase the airways resistance causes loss of sleep CPAP usually is effective |
| What is different about Infants and Children with Sleep Apnea? | They may show both tiredness and hyperactivity Socially withdrawn Aggressive behavior Short attention span and poor academic performance |
| What aged infants is CSA common in? | Premature less than 37 weeks |
| What mystery occurrance in infants to some scientists think may be associated with CSA? | SIDS |
| Management of sleep apnea | weight reduction sleep posture sleep on side with head elevated oxygen for CSA reduction of alcohol/sedating medications before bedtime |
Created by:
ginger0701
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