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Sleep Disordered Breathing
Objectives ,[object Object],[object Object],[object Object]
Spontaneous Breathing ,[object Object],[object Object],[object Object]
Lung Unit ,[object Object]
Gas Exchange ,[object Object],[object Object]
O2 Transport  CO2 Transport ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diffusion affected by: ,[object Object],[object Object],[object Object],[object Object],[object Object]
V/Q ratio relationship between blood flow to an individual alveoli and airflow to that alveoli ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dissociation Curve ,[object Object]
Dissociation curve
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Capnography ,[object Object]
EtCO2 ,[object Object]
ETCO2 Assessment ,[object Object],A-B:  A near zero baseline—Exhalation of CO2-free gas contained in dead space. B-C:  Rapid, sharp rise—Exhalation of mixed dead space and alveolar gas. C-D:  Alveolar plateau—Exhalation of mostly alveolar gas. D:  End-tidal value— Peak CO2 concentration—normally at the end of exhalation. D-E:  Rapid, sharp downstroke—Inhalation
Wave form allows us to assess ,[object Object],[object Object],[object Object],[object Object],[object Object]
EtCO2 waveform ,[object Object],[object Object],[object Object]
Why are dissociation curve and EtCO2 important? ,[object Object]
Abnormal capnograms ,[object Object]
Abnormal capnograms ,[object Object],[object Object],                                                         
Abnormal Capnography ,[object Object],[object Object],                                                         
ABG Values 28 88 50 60 7.38 COPD 22-26 94-99 35-45 80-100 7.40 Normal HCO3 SaO2 PCO2 PO2 pH
[object Object]
Hypoventilation ,[object Object],[object Object]
Hyperventilation ,[object Object],[object Object]
Hypoxic Drive ,[object Object],[object Object]
Characteristics of Respiratory Events Not required Usually mild cyclic desats Crescendo-Decrescendo pattern Waz-wane May last 15-30 min or more Cheyne-Stoles Respiration Mandatory Not required   Slight increase, may crescendo to end of event   Slight decrease from baseline Respiratory Event Related Arousal Not required 4% required   Yes    30% from baseline 10-120 sec, Longer  hypo-ventilation Hypopnea Not required Common; not mandatory NO Absent Minimum 10 sec Central Apnea Not required Not required   Yes Absent Minimum 10 sec   Obstructive Apnea   Arousal Desaturation Effort Airflow Duration
Treatment of OSA ,[object Object],[object Object],[object Object],[object Object],[object Object]
Goals of Treatment ,[object Object],[object Object],[object Object]
Goals con’t… ,[object Object],[object Object],[object Object]
Titration Techniques ,[object Object],[object Object],[object Object],[object Object]
BiPAP ,[object Object],[object Object],[object Object],[object Object],[object Object]
Lung Volumes
[object Object]
Surgical Options ,[object Object],[object Object],[object Object],[object Object]
More surgical options ,[object Object],[object Object],[object Object],[object Object]
Oral Appliances ,[object Object],[object Object],[object Object]
 
 
[object Object],[object Object],[object Object],[object Object],[object Object]
Identified Risks ,[object Object],[object Object],[object Object],[object Object],[object Object]
Oral appliances, contraindications ,[object Object],[object Object],[object Object],[object Object]

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Sleep disordered breathing and sleep apnea

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  • 24. ABG Values 28 88 50 60 7.38 COPD 22-26 94-99 35-45 80-100 7.40 Normal HCO3 SaO2 PCO2 PO2 pH
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  • 29. Characteristics of Respiratory Events Not required Usually mild cyclic desats Crescendo-Decrescendo pattern Waz-wane May last 15-30 min or more Cheyne-Stoles Respiration Mandatory Not required Slight increase, may crescendo to end of event Slight decrease from baseline Respiratory Event Related Arousal Not required 4% required Yes  30% from baseline 10-120 sec, Longer  hypo-ventilation Hypopnea Not required Common; not mandatory NO Absent Minimum 10 sec Central Apnea Not required Not required Yes Absent Minimum 10 sec Obstructive Apnea Arousal Desaturation Effort Airflow Duration
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