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Sleep apnea

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Sleep apnea

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Sleep apnea

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USMLE® Step 2 style questions USMLE

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 A 71-year-old Caucasian man is brought to the emergency department by his wife. The wife mentions that this is the second time she notices important breathing pauses while her husband sleeps. The patient's medical history is relevant for a recent hospitalization due to decompensated heart failure and an ischemic stroke 2 years ago. He currently takes low-dose aspirin, metoprolol, and furosemide. Upon further interrogation, the patient reports "lacking air" and extreme daytime tiredness. On physical examination, the patient looks pale. Auscultatory findings reveal a progressively faster breathing followed by breathing apneas. His temperature is 36.7°C (98.2°F), pulse is 91/min, respirations are 18/min, blood pressure is 130/61 mm Hg. Laboratory findings reveal a high carbon dioxide saturation of blood after awakening. Which of the following best explains this patient's findings?

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Transcript

Content Reviewers:

Rishi Desai, MD, MPH

Sleep apnea is a sleep disorder which causes irregular breathing and snoring patterns that can ultimately cause apnea, which is where a person momentarily stops breathing altogether.

The inability to get restful sleep can also lead to severe exhaustion.

Individuals can have obstructive sleep apnea, central sleep apnea, or features of both.

Obstructive sleep apnea is the most common form, and it develops when there’s a blockage of the airways.

Air has to go from the nose through the nasopharynx into the laryngopharynx, through the larynx and then into the trachea. Somewhere along that path, there might be a blockage in the flow of air.

Allergies might cause swelling of the tissue in the nasopharynx, or there might be swollen adenoid glands or tonsils because of an infection.

There might be a severe overbite which pulls the jaw back and blocks the airway.

In individuals that are overweight, there could be too much weight in the soft tissues of the neck, which can weigh down the airway especially when a person is lying down.

These problems are most obvious at night because hormonal changes at night cause the muscles around the airway to becomes slightly less stiff while sleeping.

This