1 / 43

Sleep Disorders

Sleep Disorders. MODULE F. Types of Sleep Disorders. Obstructive Sleep Apnea Central Sleep Apnea Mixed Hypopnea. Polysomnography. Early 1980’s sleep disorders were acknowledged by the medical community. Sleep apnea

duer
Télécharger la présentation

Sleep Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related