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Sleep - Coggle Diagram

- - - - Witnessed apnoeas
      - Snoring
      - Nocturnal choking
      - Distrubed unrefreshed sleep
      - Thirst during night
      - Noctural diuresis, enuresis
      - Nocturnal sweating
      - Nasal congestion
      - Excesssssive salivation
      - GI reflux
      - Impotence
    - - Excessive daytime sleepiness (men)
      - Fatigue (women)
      - Morning dry mouth
      - Morning headache
      - Difficulty concentrating
      - Irritability mood changes
  - - - Hypopnoea - reduction of 230 or less
      - Apnoea
      - AHI Apnoea Hypopnoea Index
        
        Number of events per hour
        
        5 per hour - Normal
        
        5-15 - mild
        
        15-30 moderate
        
        30 - severe
        
        ⭐ Exam
      - First Night Effect
        
        Poor sleep in new environment (hospital)
    - - Wear probe overnight
      - Record (1) O2 sats and (2) HR
    - - Watch PAT
        
        Single use at home
        
        Periphral arterial tone
      - Acoustic Signals
        
        Sternal notch and listens to breathing
      - Mandibular movement analysis
  - - - CPAP
        
        Prevents collapse
        
        Positives
        
        Relaible
        
        Improved sypmtoms
        
        May improve CV outcomes
        
        Study
        
        Effect of CPAP on SBP
        
        Reduction in all cause mortality in CPAP use
        
        HTN endpoint
        
        CPAP will have reduction in blood pressure
        
        CPAP for CAD : A Bigger RCT - The SAVE study
        
        Trial on people without OSA symptoms lol so no change in outcomes
        
        CPAP group were only using it for 2 hrs
        
        Adherance
        
        Uncomfortable and difficult to use
        
        50% adherance rates
        
        Continous positive airway pressure therapy
      - Mandibular advancement Device
        
        Increases potrusion of mandible and increases space at back of throat
      - Inspire Device
        
        Pacemaker for tongue
        Hypoglossal nerve stimulated
        Opens airway
        
        Doenst work
        
        VEry obese
        
        Upper airway anatomy abnormal
    - - Symptom tx
        
        Sleepiness
        
        Solriamfetol - narcolepsy drug
      - Disease tx
        
        Ventilatory instability / drive
        
        Sleep fragmentation
        
        Upper airway collapse
        
        Atomozetine and Oxybutinin
        
        Being studied
        
        GLP1
        
        Tirzepatide
    - - Anatomicaldevice + Pharm
    - - Controversial
      - Lean person with massive tonsils - take out
      - If not lean - don't do a surgery
      - May have no benefit
      - May disimprove - scar tissue in airway
  - - - OSA more likely to have CVS issues and die / Cardiovascular death
      - Dose relationship
  - - - Intermittent hypoxia / Sleep fragmentation → Sympathetic excitation
      - Intermittent hypoxia / Sleep fragmentation → Metabolic dysregulation
      - Inflammation, Oxidative stress, sympathetic excitation, and metabolic dysregulation causes CVD
      - Intermittent hypoxia / Sleep fragmentation → Inflammation and Oxidative stress
    - - Enhanced venous retun due to exaggerated negative intrathoracic pressure - Increased preload - pressure on high
      - Hypoxic PA - vasoconstriction - pulmonaru hypertension
    - - HTN
      - Coronary artery disease (CAD)
      - Stroke
      - HF
- - - - Heart failure
      - Cresendo decresendo breathing
    - - Respiratory depression