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Respiratory (LECTURE NOTES) > Sleep Related Breathing Disorders > Flashcards

Sleep Related Breathing Disorders Flashcards

1
Q

What does OSAS stand for

A

Obstructive sleep apnoea syndrome

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2
Q

What are some of the consequences of OSAS

A

Quality of life
daytime sleepiness
poor concentraiton
decreased cognitive function

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3
Q

OSAS is a risk factor for what 3 conditions

A

Cardiovascular disease

Stoke and hypertension

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4
Q

What might sleep aggrevate

A

Pre-existing respiratory disease and specific breathing disorders may arise during sleep

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5
Q

Where is the respiratory centre

A

In the medulla

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6
Q

Why does the respiratory centre become less responsive to chemical and mechanical stimuli during sleep

A

Because it receives less stimulation from higher cortical centres

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7
Q

What is really important in diseases associated with hypercapnic respiratory failure (COPD, neuromuscular disease and thoracic cage disorders)

A

The sleep related oxygen desaturation

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8
Q

What is the treatment for sleep related breathing disorders

A

To manage the underlying respiratory disease

Avoid aggravating factors (alcohol or sedative medication)

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9
Q

Is oxygen always beneficial and why?

A

It may alleviate oxygen desaturation but it may provoke further hypoventilation and carbon dioxide retention

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10
Q

How is long term ventilatory support given

A

As domiciliary nocturnal non invasive positive pressure ventilation

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11
Q

What triggers the ventilator to deliver additional tidal volume under positive pressure

A

The spontaneous respiratory efforts of the patient

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12
Q

What can control of nocturnal desaturation by NIPPV improve

A

Quality of sleep, nocturnal symtoms
Daytime symptoms
Gas exchange

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13
Q

What is a main cause of ventilatory failure

A

Kyphoscoliosis

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14
Q

What is OSAS

A

A condition of sleep related pharyngeal collapse in which recurrent episodes of upper airways occlusion occur during sleep causing diminution or cessation of airflow in the pharynx provoling arousals and sleep fragmentation resulting in daytime sleepiness

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15
Q

What plays an important role in maintaining the patency of the upper airway

A

The oropharyngeal dilator muscles

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16
Q

What plays an important role in maintaining patency of the upper airways

A

The oropharyngeal dilator muscles

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17
Q

What happens to the muscle tone during deep sleep

A

There is reduced muscle tone

18
Q

What can result in narrowing of the upper airways

A

Fat deposition in the neck from obesity
bone morphology
soft tissue deposition (hypothyroidism
Enlargement of tonsils or adenoids in children

19
Q

What can result in narrowing of the upper airways

A

Fat deposition in the neck from obesity
bone morphology
soft tissue deposition (hypothyroidism
Enlargement of tonsils or adenoids in children

20
Q

How is apnoea terminated

A

By a brief arousal from sleep

21
Q

What are some daytime symptoms of OSAS

A 
Excessive sleepiness
Poor concentration
irritability 
morning headaches 
loss of libido
22
Q

What type of scale is useful in assessing the likelihood of falling asleep in various situations

A

The Epworth sleepiness scale

23
Q

Who do patients with OSAS have to advise

A

Driving licence authority

24
Q

What might the bed partner report

A

Loud snoring

Witnessed apnoeas and restless sleep

25
Q

What does examination focus on

A

Obesity
Increased neck circumference
anatomical abnormalities reducing pharyngeal calibre
nasal obstruction (polyps and deviated septum)

26
Q

What are some of the CV complications of OSAS

A 
Hypertension
MI 
Stoke 
Cardiac arrhythmias 
Structural cardiac changes 
Cardiac failure
27
Q

What is OSAS often associated with

A

Hormonal changes - reduced testoesterone and growth hormone levels

28
Q

What does CPAP stand for

A

Continous positive airway pressure

29
Q

What does definitive assessment of OSAS require

A

Polysomnography

30
Q

What all is measured during a polysomnography

A 
EEG - the stage of sleep 
EOG - Detects rapid eye movement 
Thermistor - airflow at the nose and mouth and ribcage and abdominal  
Oximetry - oxygen desaturation
ECG - heart rate
31
Q

When is OSAS usually diagnosed

A

When there are more than 15 apnoeas or hypopnoeas per hour, each lasting 10 second

32
Q

What is an important treatment for patients who are overweight

A

Weight loss

33
Q

What sleeping position should be discouraged

A

Sleeping on the back

34
Q

What is now the first choice treatment for OSAS

A

Nasal CPAP applied via a tight fitting nasal mask

35
Q

How does the CPAP work

A

It acts by splinting the pharyngeal airway open, counteracting the tendency to collapse

36
Q

What pharmacological treatments are effective in OSAS

A

Moafinil
Protroptylline
Progesterone
Acetazolamide

37
Q

What does uvulopalatopharyngoplasty involve

A

The surgical excision of redundant tissue of the soft palate, vuvla and pharyngeal walls

38
Q

What is the purpose of uvulopalatopharyngoplasty

A

To increase the calibre of the pharyngeal airway

39
Q

What happens in central sleep apnoea

A

Cessation of airflow at the nose and mouth which is associated with a lack of respiratory muscle activity

40
Q

What happens in central sleep apnoea

A

Cessation of airflow at the nose and mouth which is associated with a lack of respiratory muscle activity

Respiratory (LECTURE NOTES) (19 decks)

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