Chapter7BodySystems-KingwoodApplicationServer.ppt

Chapter 31 Sleep Apnea Sleep Apnea Despite the fact that the clinical manifestations of sleep apnea have be described for centuries, it was not until the early 1980s that it became acknowledged by the medical community Stages of Sleep and Characteristic Cardiopulmonary Patterns Two major sleep stages during normal sleep Non–rapid eye movement (non-REM) sleep Quiet or slow-wave sleep Rapid eye movement (REM) sleep Active or dreaming sleep Non-REM Sleep Usually begins immediately after dozing off Four stages of non-REM sleep Each progressing into a deeper sleep Stages 1 and 2 The ventilatory rate and tidal volume continually increase and decrease—brief periods of apnea may occur The ECG shows increased slow-wave activity and loss of alpha rhythm Cheyne-Stokes respiration is common in older adult males, especially at high altitudes Stages 3 and 4 Ventilation becomes slow and regular Minute ventilation is commonly 1 to 2 L/min less than during the quiet wakeful state Typically the: PaCO2 levels are higher (4-8 mm Hg) PaO2 levels are lower (3-10 mm Hg) pH is lower (0.03-0.05 unit) Stages 3 and 4 Normally, non-REM sleep lasts 60 to 90 minutes Typically, an individual moves in and out of all4 stages during non-REM sleep Most of the time is spent in stage 2 Stages 3 and 4 An individual may move into REM sleep, at any time, directly, from any of the 4 non-REM sleep stages The lighter 1 and 2 stages, however, are the most common levels just before REM sleep REM Sleep During this period, sudden burst of fast alpha rhythms Ventilatory rate becomes rapid and shallow Sleep-related hypoventilation and apnea are commonly seen during this period REM Sleep In normal adults, apneic periods occur as often a five times per hour These apneic periods may last 15 to 20 seconds with no discernible effects In normal infants: Apneas are shorter—about 10 seconds long REM Sleep A marked reduction occurs in the: Hypoxic ventilatory response Hypercapnic ventilatory response The heart rat