Sleep-related respiratory disease Notes

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Apnea of prematurity

Sleep apnea

NOTES NOTES SLEEP–RELATED RESPIRATORY DISEASE GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Impaired capacity to breathe SIGNS & SYMPTOMS ▪ Apneic episodes (variable duration); fatigue; hypoxemia; hypercapnia DIAGNOSIS OTHER DIAGNOSTICS snoring, airflow, end tidal CO2, oxygen saturation, cardiac rhythm, body positioning ▫ Electroencephalography: sleep pattern ▫ Electrooculography: REM ▫ Electromyography: neck muscle tonicity ▫ Electrocardiography: heart rhythm ▫ Video monitoring: body positioning TREATMENT OTHER INTERVENTIONS ▪ Supportive, lifestyle modification Polysomnography ▪ Measure sleep patterns, rapid eye movements (REM), tonicity of neck muscles, APNEA OF PREMATURITY osms.it/apnea-of-prematurity PATHOLOGY & CAUSES ▪ Most common cause of apnea in preterm neonates ▪ Developmental disorder associated with decreased responsiveness to carbon dioxide ▪ Respiratory pauses of ≥ 20 seconds/shorter pause with bradycardia (< 100/minute), cyanosis, pallor, oxygen desaturation in neonates < 37 weeks gestational age (GA) CAUSES ▪ Immaturity of fetal brain areas responsible for breathing ▪ Incidence increases with degree of prematurity ▫ Most neonates < 28 weeks GA ▫ > ½ neonates 28–36 weeks GA SIGNS & SYMPTOMS ▪ Apneic episodes ≥ 20 seconds in first 72 hours post-birth ▫ Frequency increases 14–21 days postbirth OSMOSIS.ORG 943
▪ Bradycardia ▪ Hypoxemia TREATMENT DIAGNOSIS OTHER DIAGNOSTICS ▪ Monitor premature neonates ▫ Cardiorespiratory monitors, pulse oximetry ▪ Exclude other causes for apnea ▫ Metabolic disorders, neurological disorders, infections, antepartum drugs (e.g. opiates) ▪ Resolves spontaneously after 37 weeks postmenstrual age ▫ Postmenstrual age = postnatal age + GA age MEDICATIONS ▪ Methylxanthines ▫ Improve sensitivity to carbon dioxide, increase ventilations/minute, decrease periodic breathing events OTHER INTERVENTIONS ▪ Nasal CPAP SLEEP APNEA osms.it/sleep-apnea PATHOLOGY & CAUSES ▪ Irregular breathing patterns, shallow breathing and snoring during sleep. ▪ Apnea: momentary: pause in breathing ▪ Can last several seconds to several minutes ▪ More than five episodes an hour must occur ▪ Hypopnea: abnormally shallow breathing event TYPES Central sleep apnea ▪ Sudden failure of brain respiratory center’s generation of spontaneous breathing efforts ▪ Damage to brain respiratory centers→ ↑ respiratory drive → hyperventilation → CO2 (hypocapnia) → apnea → ↑ ↑ CO2(hypercapnia) → ↑ respiratory drive → hyperventilation ▪ Associated with Cheyne–Stokes respiration Obstructive sleep apnea ▪ Intermittent airway obstruction → 20–30 944 OSMOSIS.ORG second apnea → individual wakes from sleep ▪ Most common form of sleep apnea; peripheral problem; obstruction at oropharynx CAUSES Obstructive sleep apnea ▪ Obesity (most common) ▪ Hypertrophic adenoid glands/palatine tonsils ▪ Micrognathia (small chin, AKA underbite) ▪ Sedatives (excessive muscle relaxation— alcohol, sleeping pills) ▪ Allergies ▪ Hypothyroidism (obesity, less muscle tone) RISK FACTORS ▪ More common in individuals who are biologically male ▪ Incidence increases with age
Chapter 132 Sleep-Related Respiratory Disease COMPLICATIONS Obstructive sleep apnea ▪ Systemic hypertension ▪ Diabetes ▪ Anginal chest pain, arrhythmias, heart failure ▪ Pulmonary hypertension, cor pulmonale, respiratory failure SIGNS & SYMPTOMS ▪ Sleep deprivation, excessive daytime fatigue ▪ Headache, difficulty concentrating ▪ Morning headaches Central sleep apnea ▪ Nocturia ▪ Stress-induced insomnia ▪ Nocturnal anginal chest pain Obstructive sleep apnea ▪ Loud snoring ▪ Hypopnea ▪ Repeated arousals from sleep ▪ Decreased libido DIAGNOSIS OTHER DIAGNOSTICS ▪ Polysomnography TREATMENT MEDICATIONS ▪ Central sleep apnea: respiratory stimulants (acetazolamide, theophylline) SURGERY ▪ Obstructive sleep apnea: micrognathia, hypertrophic adenoids/tonsils OTHER INTERVENTIONS ▪ Continuous positive airway pressure (CPAP) ▪ Central sleep apnea: supplemental oxygen during sleep ▪ Obstructive sleep apnea: custom mouthpieces, weight loss Figure 132.1 A CT scan of the head and neck in the sagittal plane. The soft palate is elongated, thickened and abutts the posterior pharynx, leading to obstructive sleep apnea. OSMOSIS.ORG 945

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Sleep-related respiratory disease essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Sleep-related respiratory disease by visiting the associated Learn Page.