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Chapter 19

Sleep and Breathing Assessment

QuestionAnswer
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