Sleep Apnoea and Neuromuscular Respiratory Failure

Question 1

what is apnoea?

Answer 1

this is the cessation of breathing for 10 seconds

Question 2

what can cause repeated closure of the upper airway?

Answer 2

muscle relaxation
narrow pharynx
obesity

Question 3

what is the relevance of sleep apnoea in adults?

Answer 3

> impaired quality of life
marital disharmony
associated with hypertension and an increased risk of stroke
risk to safety (sleepy driving)

Question 4

how would you diagnose sleep apnoea?

Answer 4

> clinical history and exam
Epworth questionnaire
overnight sleep study

Question 5

what does the polysomnography measure?

Answer 5

> oronasal airflow
> thoracoabdominal movement
> oximetry
> body position
> EEG (establishing that the patient is asleep)
> EDG
> EMG
> ECG

Question 6

what would be a normal de-saturation rate?

Answer 6

0-5

Question 7

if a patient has a saturation rate of 5-15 what is their severity?

Answer 7

mild

Question 8

what desaturation rate would point to moderate sleep apnoea?

Answer 8

15-30

Question 9

if a patient has a desaturation rate of more than 30 what would their severity be?

Answer 9

severe

Question 10

name some exacerbating factors that could be managed to reduce sleep apnoea

Answer 10

> weight reduction
avoidance of alcohol within 6 hours of sleeping
diagnosis and treatment of endocrine disorders

Question 11

what treatment can be given to patients suffering from sleep apnoea?

Answer 11

> management of exacerbating factors
continuous airways pressure
mandibular repositioning splint (increases room in the mouth to reduce snoring

Question 12

what are the clinical features of narcolepsy?

Answer 12

> cataplexy (falling to the ground)
excessive daytime somnolence
hypnagogic hallucinations
sleep paralysis

Question 13

what is the treatment of narcolepsy

Answer 13

> modafinil
clomipramine
sodium oxybate

Question 14

in chronic ventilator failure what would you expect the pCO2 and pO2 to be?

Answer 14

CO2 should be elevated and O2 should be below 8kPa.

Question 15

what is the aetiology of chronic ventilator failure?

Answer 15

> airway disease (COPD, bronchiectasis)
chest wall abnormalities (kyphoscoliosis)
respiratory muscle weakness (motor neuron disease)
central hypoventilation

Question 16

what are the symptoms of chronic ventilator failure?

Answer 16

> breathlessness
> orthopnoea
> ankle swelling
> morning headache
> recurrent chest infections
> disturbed sleep

Question 17

if you suspected neuromuscular disease what would you look for on examination?

Answer 17

paradoxical abdominal wall motion, have the patient lie flat and look at abdominal wall movement

Question 18

what investigations would you carry out if you suspected neuromuscular disease?

Answer 18

> lung function: lying and standing VP, mouth pressures.

> assessment of hypoventilation: early morning ABG, overnight oximetry, transcutaneous CO2 monitoring

Question 19

what is the treatment for chronic ventilator failure?

Answer 19

> domicillary non-invasive ventilation

> oxygen therapy

Question 20

what is periodic breathing?

Answer 20

in infants there is a cessation in breathing movement, this is normal.

Question 21

how would you assess a child for sleep disturbances?

Answer 21

>polysomnography
> direct behavioural observation
> time-lapse video
> movement sensors in cot mattress
> oxygen/co2 monitering

Question 22

what is the definition of primary snoring?

Answer 22

snoring without apnoea, hypoventilation. hypoxia, hypercardia and daytime symptoms

Question 23

what is the morbidity of OSAS?

Answer 23

> failure to thrive
neurocognitive defects
systemic hypertension
cor pulmonale

Question 24

what is the obstructive pattern of OSAS in children?

Answer 24

hypoventilation

Question 25

what is the treatment of OSAS in children?

Answer 25

> adenotonsillectomy
weight loss
avoidance of environmental tobacco smoke

Question 26

name some respiratory disorders that cause sleep disturbance in children

Answer 26

> chronic neonatal lung disease
cystic fibrosis
asthma

Question 27

name some neurological disorders that cause sleep disturbance in children

Answer 27

> cerebral palsy
down syndrome
prader-willi syndrome
neuromuscular disease