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</p> Signup and view all the answers

    What defines hypoventilation?

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

    What is the major determinant of minute ventilation during sleep?

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

    What can occur during sleep to offset critical hypoxia levels?

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

    What is a common value for PaCO2 during stable sleep?

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

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

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

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

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

    What percentage of individuals undergoing bariatric surgery may experience OSA?

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

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

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

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

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

    What cardiovascular effect is potentially associated with even asymptomatic OSA?

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

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

    <p>Supine</p> Signup and view all the answers

    How can excessive intravenous fluid administration affect upper airway patency?

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

    How does lung inflation during inspiration affect the carina?

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

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

    <p>diaphragm</p> Signup and view all the answers

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

    <p>The airway collapses</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.</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</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</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</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</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</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</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</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</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</p> Signup and view all the answers

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

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

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

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

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

    <p>Tonsillectomy</p> Signup and view all the answers

    When is a tonsillectomy recommended for children with OSA?

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

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

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

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

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

    what is The most common subtype of Central Sleep Apnea ?

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

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

    <p>congestive heart failure</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.</p> Signup and view all the answers

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

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

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

    <p>Low</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%</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</p> Signup and view all the answers

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

    <p>hypercapnia</p> Signup and view all the answers

    What is a characteristic feature of patients with OHS ?

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

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

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

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

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

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

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

    Which condition is NOT a known mechanism of alveolar hypoventilation?

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

    Treatment options for patients with ○ Obesity hypoventilation syndrome (OHS) include ?

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

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