10. Sleep Related Breathing Disorders - Sarm

• Obstructive Sleep Apnea (OSA) the entire upper airway is blocked causing air flow to stop.
• cheyne-stroke breathing can be due to

  • heart failure
  • CNS disease
• cheyne stokes breathing - normal at the beginning

  • high altitude
• sleep apnea or hypopnea

  • pharyngeal muscle weakness
  • pharynx collapse passively during inspiration
• Sleep apnea - should have daytime somnolence

  • because it disrupts sleep
• sleep apnea

  1. repeated stop breathing for 10 sec during sleep
  2. disrupt sleep
  3. daytime somnolence
• Obstructive sleep apnea treatment is weight loss
• diagnosis of sleep apnea is sleep study
• Sleep apnea will have normal PaO2 during the day
• What should be excluded for sleep apnea/hypopnea syndrome?

  • seizure
  • narcolepsy
  • depression
• obstructive type apnea syndrome - ventilatory effort persists but no airflow occurs due to transient upper airway obstruction
• other complications of sleep apnea syndrome

  • arterial HTN
  • pulmonary HTN
  • impotence
• sleep apnea syndrome

  • nasal obstruction by deviated nasal septum
  • poor nasal airflow
• sleep apnea syndrome treatment

  • weight loss
  • avoidance of alcohol
• central sleep apnea - treatment with use of respiratory stimulants
• CPAP is continuous

  • when pt is done with treatment its hard for pt to breathe on their own
• central sleep apnea - first line therapy

  • nasal CPAP
  • mask is connected to an air compressor placed over nose
• oral appliance therapy - maintain tongue or jaw in anterior position
• UPPP - pharyngeal soft tissue resection

  • amputation of free edge of soft palate and uvula
• BIPAP vs CPAP

  • BIPAP - deliver higher air pressure when you breathe in
  • easier to breathe out than CPAP
  • CPAP - delivers same amount of pressure at all times