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Sleep Disorders
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  1. Sleep Disorders MODULE F

  2. Types of Sleep Disorders • Obstructive Sleep Apnea • Central Sleep Apnea • Mixed • Hypopnea

  3. Polysomnography • Early 1980’s sleep disorders were acknowledged by the medical community. • Sleep apnea • Apnea during sleep for periods of 10 seconds or longer with an apnea index of 5/hour. • Patient often has 30 or more episodes over a 4-6 hour period. • Apnea may last 20 – 90 seconds.

  4. Hypopnea • Decreased rate and depth of breathing. • Monitor Respiratory Disturbance Index (RDI). • Number of respiratory events per hour of sleep • Includes both apneas and hypopneas. • Usually 10 – 15 events/hour is significant.

  5. Stages of Sleep • 5 stages of sleep • Non-Rapid eye movement (Non-REM) • Stages 1-4 • Quiet or slow wave sleep • Rapid eye movement (REM) • Stage 5 • Active or dreaming sleep

  6. Stages of Sleep • Each stage is associated with characteristic: • Electroencephalographic (EEG) Patterns • Electro-oculographic Patterns (EOG) • Electromyographic Patterns • Behavioral Patterns • Breathing Patterns

  7. Non-REM Sleep • 4 Stages • Each progressing into a deeper sleep • Lasts 60 – 90 minutes • Most of the time is spent in phase 2

  8. REM Sleep – Stage 5 • Burst of fast alpha rhythms in the EEG tracing. • Respiratory rate decreases and Vt becomes shallow. • Hypoventilation and apnea. • Decrease in both the hypoxic and hypercapnic ventilatory response during REM. • Constitutes 20 – 25% of sleep time.

  9. REM Sleep • Rapid eye movement. • HR becomes irregular. • Dreaming occurs. • Paralysis of movement. • Arms, legs, intercostal & upper airway muscles. • Loss of muscle tone in the upper airway results in airway obstruction.

  10. REM Sleep • REM lasts 5 – 40 minutes and recurs every 60 –90 minutes. • More difficult to awake a person in REM.

  11. 40 Million People Suffer from Abnormal Sleep • Narcolepsy • Parasomnias • Nocturnal leg cramps (restless leg syndrome) • REM Behavior Disorders • Insomnia • Sleep Apnea

  12. Polysomnography • Overnight test done in a sleep clinic. • 6 ½ to 7 hours • Multiple monitors are used to assess the patient. • Patients are often videotaped.

  13. Monitoring • Respirations (nasal air-flow) • SpO2 • Respiratory Effort • Inductive plethysmography or esophageal balloon • Brain wave activity • Eye movement – electro-oculogram • Heart activity • Body position

  14. Summary of Results • # of apneas and hypopneas are summed and averaged over the night-time to calculate the average number of respiratory disturbances per hour. • Respiratory Disturbance Index • SpO2 levels below 85% are indicative of sleep apnea.

  15. Consequences of Sleep Apnea • Increase MVA’s • Increase work related accidents • Poor job performance • Depression/Inability to concentrate • Family Discord • Decreased quality of life

  16. Obstructive Sleep Apnea • Most common of the sleep apneas. • Partial or complete obstruction of the upper airway during sleep. • Absence of airflow at the nose/mouth but inspiratory efforts are present; O2 desaturation. • Can develop Cor Pulmonale.

  17. Obstructive Sleep Apnea • Symptoms • Loud habitual snoring, choking/gasping/snorts • Morning headaches • Daytime sleepiness (hypersomnolence) • Obesity • Hypertension • Nocturnal enuresis • Impotence • Personality changes/depression

  18. Obstructive Sleep Apnea • Profile • Upper body obesity • Neck size #17 or larger in men • Neck size #16 or larger in women • Hypertension • C/O daytime sleepiness

  19. Pickwickian Syndrome • Obesity • Excessive daytime sleepiness • Sleep apnea • Decreased pulmonary function • Chronic ventilatory failure • Hypoxic drive

  20. Central Sleep Apnea • Respiratory centers of the medulla fail to send signals to the respiratory muscles • Cessation of airflow at the nose and mouth, no inspiratory efforts & desaturation of Hb • Associated with CNS disorders • Accounts for 10% of all sleep apneas

  21. Mixed Apnea • Combination of Obstructive and Central • Begins as central apnea followed by obstructive apnea • Down’s Syndrome

  22. Hypopnea • No apnea • Decreased depth and rate of breathing

  23. History Examination of neck and upper airway Spirometry – flow volume loop ABG Hb Thyroid Function Chest x-ray EKG Sleep Study CT scan of upper airway or head Screening

  24. General Management • Weight Reduction • Behavior modification • Avoid alcohol, sedation, smoking • Sleep Posture • Oxygen therapy • Oral Appliance

  25. General Management • Surgical Procedures • Laser-assisted Uvulopalatopharynoplasty (LAUP) or UPPP • Mandibular advancement • Nasal operation • Tonsillectomy • Tracheostomy

  26. General Management • Non-invasive Ventilation • CPAP – most frequently prescribed therapy • BiPAP • NPV – Central Apnea • Continuous mechanical ventilation • Medication – REM Inhibitors • Phrenic Nerve Pacemaker – Central Apnea