Epidemiology & Risk Factors/ Screening
Define OSA and OSA syndrome.
repeated episodes of upper airway closure during sleep causing recurrent oxyHb desaturation and sleep fragmentation.
OSA syndrome: combination of OSA and resulting symptoms.
Name any atypical presenting features of OSA and especially prevalent in?
Insomnia and Fatigue
Especially prevalent in women
Q. Which screening tools is used to assess for pre-op eval of patients with OSA
(name all components)
A. STOP-BANG
What is the first line treatment for moderate to severe OSA and Contraindication of it
CPAP
C/I: Cheyne Stokes breathing
Which question from the ROS is recommended by AASM to screen for OSA in the clinic
Asking all adults whether they are dissatisfied with their sleep, or have day time sleepiness
how does OSA affect mood?
increased risk of depression and irritability
Which scale has been adopted by many insurance plans for preauthorization of sleep study?
Epworth Sleep Scale
What to specify when writing a script for CPAP machine (name 2)
Specifications for the pressure settings
Mask type
Associated device supplies
Why are people of east Asian decent more prone to developing OSA?
Because of differences in the facial bone structure
Name 2 clinical features that suggest a central cause of sleep apnea
Observed episodes of apnea and nocturnal gasping
What do you consider a relative contraindication for HSAT
other causes of OxyHb desaturation e.g CHF, chronic lung disease, or high likelihood of a central cause of sleep apnea
Name 3 surgical procedures to help with OSA
Nasal septoplasty or turbinate reduction
Uvulopalatopharyngoplasty
Maxillomandibular Advancement
Tracheostomy
Name 2 diseases, that commonly occur with OSA
Treatment resistant HTN, A fib, CHF, Stroke, T2DM
what patient population may benefit from evaluation and Rx of OSA, even if asymptomatic.
pts with HTN refractory to 5 or more medications.
What is the difference between AHI and REI
AHI: Number of apnea hypopnea episodes per hour of sleep
REI: Number of apnea hypopnea episodes per hour of recording
Define “adequate adherence criteria” for CPAP
4 or more hours of use per night on 70% of the nights
Persons of which occupation should be regularly screened for OSA?
Commercial truck drivers and public transit operators
Name 3 PE findings that suggest Upper Airway narrowing
Neck circumference >16 in in women and >17 in in men
Tonsillar hypertrophy
A modified mallampati of 3 or 4
Enlarged or elongated uvula
High or arched palate
Retrognathia
Signs of nasal obstruction (polyps, septal deviation, turbinate hypertrophy)
What do you mean by “Split night” sleep study
In which an initial diagnostic recording of at least 2 hours that documents OSA is immediately followed by CPAP titration
What to do if daytime sleepiness persists despite optimal trial of CPAP
Modafinil
Armodafinil
Solriamfetol