chapter 10 . quiz 1. 	Sleep disordered breathing (SDB)

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Questions and Answers

What is the defining characteristic of an apnea event?

  • Decrease in respiratory flow of 90% or more for at least 10 seconds (correct)
  • Decrease in SpO2 by at least 4%
  • Increase in PaCO2 by at least 10%
  • Decrease in respiratory flow by 30%

How is a hypopnea event characterized?

  • Decrease in respiratory flow by 40% with a Decrease in SpO2 of only 4% .
  • Increase in PaCO2 by at least 10%
  • Decrease in respiratory flow by 30% with a Decrease in SpO2 of only 3% .
  • Decrease in respiratory flow by 30% with a Decrease in SpO2 of only 4% . (correct)

What is a key characteristic of a respiratory event-related arousal?

  • Decrease in SpO2 by at least 3%
  • Flattening of the nasal pressure waveform (correct)
  • Increase in PaCO2 by at least 10%
  • Decreasing respiratory effort

When does a hypopnea event occur with a decrease in SpO2 of only 3%?

<p>When there is a decrease in respiratory flow of 40% from baseline (A)</p> Signup and view all the answers

What defines hypoventilation?

<p>Increase in PaCO2 by at least 10% (D)</p> Signup and view all the answers

What is the major determinant of minute ventilation during sleep?

<p>PaCO2 levels (D)</p> Signup and view all the answers

What can occur during sleep to offset critical hypoxia levels?

<p>arousal from sleep (B)</p> Signup and view all the answers

What is a common value for PaCO2 during stable sleep?

<p>45 mm Hg (C)</p> Signup and view all the answers

Which factor challenges ventilatory control during sleep stages and can lead to instability in breathing?

<p>Decreased arousal threshold (A)</p> Signup and view all the answers

What does loop gain assess in the context of ventilatory control?

<p>Propensity for periodic breathing (D)</p> Signup and view all the answers

Why does the ventilatory response differ between wakefulness and sleep?

<p>Decreased chemo sensitivity to CO2 during sleep (D)</p> Signup and view all the answers

Why are patients with high loop gain more vulnerable to disturbances in the feedback system during sleep?

<p>As a result of slight hypoventilation (C)</p> Signup and view all the answers

In the context of sleep disordered breathing, what event may occur due to marked reduction or cessation of brainstem respiratory motor output?

<p>Apnea event (A)</p> Signup and view all the answers

Which factor helps in specifying sleep disordered breathing into obstructive or central events?

<p>Predominant type of respiratory events (B)</p> Signup and view all the answers

How is the severity of sleep disordered breathing usually quantified?

<p>By the number of arousals per hour of sleep (D)</p> Signup and view all the answers

What defines the respiratory disturbance index (RDI) used to measure the severity of sleep disordered breathing?

<p>number of hypopneas, apneas, and arousals related to respiratory events per hour of sleep (D)</p> Signup and view all the answers

What is the key diagnostic criterion for obstructive sleep apnea (OSA)?

<p>15 or more predominantly obstructive events per sleep hour (D)</p> Signup and view all the answers

How is the severity of obstructive sleep apnea (OSA) typically measured?

<p>Using the Respiratory Disturbance Index (RDI) or Apnea-Hypopnea Index (AHI) (D)</p> Signup and view all the answers

What additional criteria can qualify a patient with 5-15 obstructive events per sleep hour as having obstructive sleep apnea (OSA)?

<p>Presence of comorbidities like hypertension (HTN) or atrial fibrillation (AF) (A)</p> Signup and view all the answers

How is respiratory disturbance quantified in the context of obstructive sleep apnea (OSA)?

<p>Using the Apnea-Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) (D)</p> Signup and view all the answers

What criterion helps in distinguishing between obstructive and central events in sleep disordered breathing?

<p>Pattern of airflow and respiratory effort during events (B)</p> Signup and view all the answers

What is a major risk factor for obstructive sleep apnea (OSA)?

<p>History of myocardial infarction (D)</p> Signup and view all the answers

What percentage of individuals undergoing bariatric surgery may experience OSA?

<p>77.5% (B)</p> Signup and view all the answers

Which symptom is NOT commonly associated with nighttime in obstructive sleep apnea (OSA)?

<p>restorative sleep (D)</p> Signup and view all the answers

Who is more susceptible to obstructive sleep apnea (OSA) following surgery?

<p>Individuals with a history of stroke (A)</p> Signup and view all the answers

In which group can obstructive sleep apnea (OSA) be prevalent up to 24% without daytime symptoms?

<p>Men aged 30-60 (A)</p> Signup and view all the answers

What serious medical consequences are associated with Obstructive Sleep Apnea (OSA)?

<p>Hypertension, Myocardial Infarction, Stroke, Diabetic Neuropathy (A)</p> Signup and view all the answers

What brain structures atrophy in patients with OSA leading to cognitive impairment?

<p>Hippocampal areas (C)</p> Signup and view all the answers

What cardiovascular effect is potentially associated with even asymptomatic OSA?

<p>Altered daytime autonomic regulation (D)</p> Signup and view all the answers

How can the atrophy of brain structures relevant for cognition and memory be influenced in OSA patients?

<p>It can be partially reversed by adequate treatment (B)</p> Signup and view all the answers

Which of the following is a potential consequence of cognitive dysfunction in OSA patients?

<p>Increased likelihood of motor vehicle accidents (C)</p> Signup and view all the answers

What is the role of upper airway dilator muscles in respiratory events during OSA?

<p>Stabilizing the upper airway by balancing negative pressure generated by the respiratory pump (D)</p> Signup and view all the answers

What is the main consequence of decreased airway dilator muscle activity during OSA?

<p>Airway collapse with persisting respiratory effort (C)</p> Signup and view all the answers

Which muscles are part of the upper airway dilator muscles involved in OSA?

<p>Genioglossus and tensor palatini (C)</p> Signup and view all the answers

What is the function of the genioglossus muscle in response to negative pharyngeal pressure during inspiration?

<p>Reflexively stabilizing the upper airway (B)</p> Signup and view all the answers

How do upper airway dilator muscles help maintain airway patency?

<p>By balancing dilating forces with collapsing forces (B)</p> Signup and view all the answers

What is the primary function of respiratory pump muscles during the breathing cycle?

<p>Generate negative intraluminal pressure (C)</p> Signup and view all the answers

What can further increase the collapsing effects of excessive pharyngeal extraluminal soft tissue in obese patients?

<p>Craniofacial abnormalities (C)</p> Signup and view all the answers

Which position makes the upper airway more vulnerable to collapse due to gravitational effects?

<p>Supine (D)</p> Signup and view all the answers

How can excessive intravenous fluid administration affect upper airway patency?

<p>Increase neck circumference (A)</p> Signup and view all the answers

What determines the extraluminal pressure antagonized by the upper airway dilator muscle contraction during inspiration?

<p>Size and shape of the bony enclosure (A)</p> Signup and view all the answers

How does nocturnal redistribution of fluid from lower extremities into the neck affect upper airway collapsibility?

<p>Increases upper airway collapsibility (B)</p> Signup and view all the answers

How do higher end-expiratory lung volumes affect upper airway resistance in awake healthy humans?

<p>Decrease upper airway resistance (B)</p> Signup and view all the answers

What do stretching forces on the fixed trachea due to longitudinal traction result in?

<p>Decreased upper airway resistance (A)</p> Signup and view all the answers

How does lung inflation during inspiration affect the carina?

<p>Forces it into a more caudal position (C)</p> Signup and view all the answers

What is the primary function of the respiratory pump during the breathing cycle?

<p>Generating negative intraluminal pressure (D)</p> Signup and view all the answers

What accounts for the majority of lung volume change during quiet respiration?

<p>diaphragm (B)</p> Signup and view all the answers

What happens when the intraluminal pressure in the upper airway becomes negative?

<p>The airway collapses (D)</p> Signup and view all the answers

critical airway pressure (Pcrit) in individuals with obstructive sleep apnea (OSA) ?

<p>upper airway in patients with OSA may even collapse at a positive Pcrit. (B)</p> Signup and view all the answers

In patients with obstructive sleep apnea (OSA), what type of pressure is required to reopen a paralyzed airway?

<p>Positive intraluminal pressure (D)</p> Signup and view all the answers

Which input contributes to the restoration of breathing following apnea by sensing negative pressure generated by the respiratory pump?

<p>Sensors in the upper airway (B)</p> Signup and view all the answers

What can independently restore tone to respiratory muscles during obstructive apneas?

<p>Hypercarbia and upper airway negative pressure (C)</p> Signup and view all the answers

What determines the level of drive provided to respiratory muscles in the context of restoring breathing after apnea?

<p>Summation of stimuli in the central pattern generator output (D)</p> Signup and view all the answers

What is the main benefit of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA)?

<p>improved quality of life (C)</p> Signup and view all the answers

How does the application of CPAP or BPAP typically help in treating sleep-disordered breathing (SDB)?

<p>It reverses underlying pathology (A)</p> Signup and view all the answers

Why is patient adherence to CPAP treatment for OSA often limited?

<p>Because of local side-effects at the nose or face (C)</p> Signup and view all the answers

What is a major drawback of applying high pressure during CPAP treatment?

<p>Causes discomfort to the patient (C)</p> Signup and view all the answers

What factor determines the range of CPAP level required for the treatment of OSA?

<p>Severity of OSA (C)</p> Signup and view all the answers

How does successful treatment of obstructive sleep apnea (OSA) impact cardiovascular risk?

<p>Reduces cardiovascular risk (D)</p> Signup and view all the answers

What function do some treatment devices offer to help patients fall asleep more easily?

<p>Gradually increasing treatment pressure (D)</p> Signup and view all the answers

In which patients is bilevel treatment with reduced expiratory pressure and high inspiratory pressure useful?

<p>Patients with difficulties exhaling against high CPAP (D)</p> Signup and view all the answers

What type of CPAP devices can improve treatment success in patients with variable severity of sleep disordered breathing?

<p>CPAP devices with dynamic pressure levels (A)</p> Signup and view all the answers

What do auto-titrating devices measure to adjust airway pressure for hypopnea?

<p>Oropharyngeal wall vibration and inspiratory flow limitation (D)</p> Signup and view all the answers

Which patients may require noninvasive ventilation with predefined respiratory frequency or timing?

<p>Patients with predominantly central apneas (B)</p> Signup and view all the answers

What is the primary method recommended for most patients with OSA?

<p>CPAP therapy (D)</p> Signup and view all the answers

Which type of oral appliance for OSA treatment involves repositioning the mandible without protrusion?

<p>Tongue-retaining device (C)</p> Signup and view all the answers

What is a recommended treatment for adults with OSA due to tonsillar hypertrophy?

<p>Tonsillectomy (D)</p> Signup and view all the answers

When is a tonsillectomy recommended for children with OSA?

<p>For children with adenotonsillar hypertrophy (A)</p> Signup and view all the answers

Which intervention for OSA involves causing genioglossus muscle contraction to increase airflow?

<p>Hypoglossal nerve stimulation (C)</p> Signup and view all the answers

Although OSA is more common in the older population, it occurs in children with a peak in the incidence between?

<p>2- 5 years old (C)</p> Signup and view all the answers

What is not recommended as a primary treatment for OSA but may be used adjunctively in some patients?

<p>$O_2$ therapy (C)</p> Signup and view all the answers

What distinguishes Central Sleep Apnea (CSA) from Obstructive Sleep Apnea (OSA)?

<p>absence of respiratory effort in CSA compared to Presence of respiratory effort in OSA (D)</p> Signup and view all the answers

Which of the following comorbidities is commonly associated with Central Sleep Apnea (CSA)?

<p>Congestive Heart Failure (CHF) (C)</p> Signup and view all the answers

What characterizes Cheyne-Stokes Respiration (CSR) seen in patients with Central Sleep Apnea (CSA)?

<p>Crescendo-decrescendo pattern of hyperventilation followed by hypopneas or apneas (C)</p> Signup and view all the answers

Which group has a higher prevalence of Central Sleep Apnea with an increased loop gain, specifically showing Cheyne-Stokes Respiration (CSR)?

<p>Patients with Congestive Heart Failure (CHF) (D)</p> Signup and view all the answers

What is a potential respiratory therapy option for patients experiencing Cheyne-Stokes Respiration (CSR)?

<p>Noninvasive ventilation like bilevel positive airway pressure (BiPAP) (D)</p> Signup and view all the answers

What is a distinguishing characteristic of Cheyne-Stokes Respiration (CSR) found in patients with Central Sleep Apnea?

<p>Occurs mainly in the supine body position (A)</p> Signup and view all the answers

What is the best treatment for patients experiencing Cheyne-Stokes Respiration (CSR)?

<p>adequate treatment of CHF (D)</p> Signup and view all the answers

what is The most common subtype of Central Sleep Apnea ?

<p>CSR in high loop gain (B)</p> Signup and view all the answers

CSR is defined as a crescendo-decrescendo pattern of hyperventilation between 20 and 30 seconds in duration, followed by 10 to 40 seconds of hypopneas or apneas , usually occurring during ?

<p>NREM sleep stage 1 and 2 (A)</p> Signup and view all the answers

Central Sleep Apnea (CSA) most commonly occur in patients with?

<p>congestive heart failure (A)</p> Signup and view all the answers

CSR is defined as a crescendo-decrescendo pattern of hyperventilation between 20 and 30 seconds in duration, followed by 10 to 40 seconds of hypopneas or apneas

<p>CSR is more common in men and worse in the supine body position. (C)</p> Signup and view all the answers

What is a characteristic of Periodic Breathing induced by high altitude?

<p>Hypoxia with increased controller gain (C)</p> Signup and view all the answers

What distinguishes Idiopathic Central Sleep Apnea (CSA) from other forms of CSA?

<p>Hypocapnia with high controller gain (A)</p> Signup and view all the answers

In individuals with Idiopathic CSA, what tends to be the usual PaCO2 levels?

<p>Low (A)</p> Signup and view all the answers

What percentage of patients with a BMI of 50 kg/m2 or higher may experience obesity hypoventilation syndrome (OHS)?

<p>Up to 50% (A)</p> Signup and view all the answers

Which of the following is a common characteristic of obese patients with OHS ?

<p>Nocturnal and daytime alveolar hypoventilation (A)</p> Signup and view all the answers

What is one potential consequence of abolishing the compensatory respiratory drive in obese individuals ?

<p>hypercapnia (D)</p> Signup and view all the answers

What is a characteristic feature of patients with OHS ?

<p>Normal CO2 response (B)</p> Signup and view all the answers

What is the main defining characteristic of obesity hypoventilation syndrome (OHS)?

<p>Combination of nocturnal and daytime alveolar hypoventilation (D)</p> Signup and view all the answers

What is a potential cause of alveolar hypoventilation leading to hypercapnia in OHS?

<p>Leptin resistance (D)</p> Signup and view all the answers

In obese patients with OHS, what percentage of individuals may also experience OSA?

<p>90% (D)</p> Signup and view all the answers

Which respiratory parameter is typically reduced in patients with obesity hypoventilation syndrome (OHS)?

<p>Expiratory reserve volume (C)</p> Signup and view all the answers

Why does severe obesity lead to an increase in respiratory drive ?

<p>To compensate for abnormal chest wall mechanics and maintain eucapnia (A)</p> Signup and view all the answers

What is the difference between obese patients and patients with OHS ?

<p>OHS patients has decrease in respiratory drive (B)</p> Signup and view all the answers

What is a common cause of alveolar hypoventilation leading to hypercapnia in patients with obesity hypoventilation syndrome (OHS)?

<p>Central hypoventilation (B)</p> Signup and view all the answers

Which condition is NOT a known mechanism of alveolar hypoventilation?

<p>Pulmonary embolism (C)</p> Signup and view all the answers

Treatment options for patients with â—‹ Obesity hypoventilation syndrome (OHS) include ?

<p>weight loss and NIV. (A)</p> Signup and view all the answers

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