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Principles 2 Test 2
Obstructive Sleep Apnea
| Question | Answer |
|---|---|
| What percentage of the adult SURGICAL population has OSA? | 22% |
| What percentage of bariatric patients have OSA? | 70% |
| What percentage of patients with OSA are undiagnosed? | 80% |
| What is the apnea hypopnea index (AHI)? | the number of abnormal respiratory events per hour of sleep |
| The AASM set minimal diagnostic criteria for OSA as an AHI of ___ and excessive daytime sleepiness. | 10 |
| What is considered the gold standard for diagnosis of OSA? | Polysomnography |
| What are the components of polysomnography? | EEG, airflow, oxygen saturation, respiratory effort, observation (for restlessness, leg movements) |
| How are the results of polysomnography reported? | using the AHI |
| According to the ASA, what is considered mild OSA? | AHI 6 - 20 |
| According to the ASA, what is considered moderate OSA? | AHI 21 - 40 |
| According to the ASA< what is considered severe OSA? | AHI > 40 |
| What are 7 symptoms of OSA? | Sleep arousal, loud snoring, daytime somnolence, fatigue, decreased cognition & intellectual function, concentration and memory problems, headaches |
| What are 5 risk factors for OSA? | male gender, middle age (> 40), obesity, central abdominal fat distribution, short mandible |
| For every 10 kg of weight, the risk for developing OSA increases ____ times. | 2 |
| What percentage of OSA patients are obese? | 60 - 70% |
| As BMI increases by 6 OSA risk increases by __ | 4 |
| Between waist circumference, neck circumference and BMI, which is a better indicator for OSA? | waist circumference |
| For every 15 cm increase in waist circumference, the risk for OSA increases __ times. | 4 |
| A difficult intubation is ___ times more likely to occur in an OSA patient. | 8 |
| What is the most common preoperative complication for patients with OSA? | oxygen desaturation |
| OSA patients have significantly increased pulmonary complications after orthopedic and general surgery. Why? | Related to increased opiate requirements for these surgeries |
| What percentage of OSA patients have systemic and pulmonary hypertension? | 50% |
| Obese patients have higher or lower leptin levels than normal weight patients? | higher |
| The fact that obese patients and those with OSA typically have higher leptin levels, but cannot adequately sense those higher leptin levels is referred to as what? | leptin resistance |
| True or False: one study found that CPAP use reduced leptin levels in OSA patients by improving leptin resistance. | True |
| True or False: radiographic studies found that even in wakefulness, pharyngeal airway was narrower in OSA patients. | True |
| ________ pressure is higher in OSA patients (in terms of airway). | Closing |
| How many different types of obstruction exist in OSA? | 3 |
| Do opioids cause any issues in OSA patients? If so, what are they? | Yes; increased sensitivity, opioids exacerbate OSA & prevent arousal from anesthesia |
| Does midazolam cause any issues in OSA patients? Is so, what are they? | Yes; can cause airway obstruction due to causing same closing pressure to occur as sleep does in these patients, increases frequency and duration of apnea events |
| Which volatile anesthetic is found to have an earlier return of protective reflexes than the others? | desflurane |
| What medication can be used to reduce opioid requirements in OSA patients? | dexmedetomidine |
| Which sedative can be used in OSA patients that causes less respiratory depressant effect? | ketamine |
| What are the 3 most common treatments for OSA? | CPAP, insertable dental appliances, surgical treatment |
| What are 7 screening tools to check for OSA? | STOP BANG, Epworth Sleepiness Scle, Snore Scale, Sleep Apnea Clinical Score, Berlin Questionnaire, P-SAP Score, ASA checklist |
| In reference to the ASA checklist, signs and symptoms in two or more categories indicates what? | increased probability of OSA |
| The STOP BANG scoring tool consists of what? | 8 yes or no questions that stratifies patients into high and low risk OSA categories |
| How many yes answers on the STOP BANG tool place a patient in the high risk for OSA category? | 3 or more |
| What do the letters in STOP BANG stand for? | snoring, tired, observed, blood pressure, BMI, age, neck, gender |
| True or False: mild hypercarbia improves tissue oxygenation and perfusion | True |
| According to the ASA taskforce, how much longer should you keep OSA patients post-op than non OSA patients? | 3 hours |
| How long after last airway obstruction or hypoxemia event should you keep an OSA patient? | 7 hours |
| Evidence indicates a higher STOP BANG score means a higher probability of _______________ | severe OSA |
Created by:
Mary Beth
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