Obstructive Sleep Apnoea Flashcards
Define Obstructive Sleep Apnoea
irregular breathing at night due to intermittent closure/collapse of the pharyngeal airway causing apnoeic episodes during sleep WITHOUT daytime sleepiness
Define obstructive sleep apnoea syndrome
Recurrent episodes of complete or partial obstruction of the upper airway airway during sleep, causing apnoea (complete airflow obstruction with temporary absence or cessation of breathing) or hypopnoea (decreased airflow)
What is the aetiology of obstructive sleep apnoea
Dynamic narrowing of the upper airway during sleep
This can be triggered by neuromuscular mechanisms within an anatomically small upper airway
Anatomical narrowing may be mediated by maxillomandibular anomalies or adenotonsillar hypertrophy (most common in children)
Increases in lateral pharyngeal, soft palatal and tongue tissue mass is commonly seen in obesity, which would also narrow the airway
What are the risk factors for obstructive sleep apnoea
Obesity
Adenotonsillar hypertrophy
Craniofacial abnormalities e.g.
- Retrognathia (abnormal jaw positioning with mandible set back from the maxilla)
- Micrognathia (undersized lower jaw)
- Cleft palate
Neuromuscular disease e.g. cerebral palsy
Down’s syndrome, achondroplasia, Prader-Willi syndrome
What is the epidemiology of obstructive sleep apnoea
Peak incidence between 2-8 years of age
Equal prevalence in boys and girls
What are the symptoms of obstructive sleep apnoea
Night:
Loud snoring
Apnoeic episodes (episodic cessation of breathing terminated by a loud snore)
Gasping or choking during sleep
Poor sleep quality
Nocturnal enuresis
Restlessness and sudden arousals from sleep, laboured breathing, unusual sleep posture (for example with neck hyperextended)
Day:
Daytime somnolence or fatigue
Morning headache
Reduce cognitive performance, behavioural problems, hyperactivity
Impaired concentration, reduced school performance
Mouth breathing
What are the signs of obstructive sleep apnoea on examination
General: Obese, Mouth breathing, Nasal speech
ENT: Maxillomandibular anomalies, Micrognathia, Retrognathia, Macroglossia
What investigations should be done for obstructive sleep apnoea
Ask carers to record a video of sleep
STOP-Bang questionnaire: 8 items to assess snoring, sleeping, apnoea etc.
Epworth Sleepiness Scale: 8 items that assesses daytime sleepiness
Bedside: sats
Other:
- Polysomnography (PSG): monitors O2, sats, airflow + ECG/EMG/chest/abdo movements
- Portable multichannel sleep tests
- Awake or drug-induced sleep fibreoptic endoscopy
What Polysomnography (PSG) suggests obstructive sleep apnoea
Occurrence of 15 or more episodes of apnoea or hypopnoea during 1 hour of sleep, on average, indicates significant OSA
Mild: AHI 5–14 per hour.
Moderate: AHI 15–30 per hour.
Severe: AHI more than 30 per hour.
What is the management for obstructive sleep apnoea
Nasopharyngeal obstruction + regular snoring → referral to paediatric ENT (ideally within 4 weeks)
Congenital development disorder or associated condition or obesity → referral to paediatritian
Adenotonsillar hypertrophy → Adenotonsillectomy to correct the anatomic obstruction causing symptoms. This procedure is usually curative in children
Second line: CPAP therapy
What are the complications of obstructive sleep apnoea
Behavioural problems
Irritability
Reduced concentration
Reduced school performance
Faltering growth (in severe cases)
Pulmonary hypertension
Nocturnal hypoxaemia
What is the prognosis for obstructive sleep apnoea
In the majority of cases of uncomplicated OSAS, treatment with adenotonsillectomy resolves symptoms