Sleep Disordered Breathing Flashcards
REM features
Rapid eye movements Erratic breathing Atonia Increased upper airway resistance Increased cerebral blood flow Desynchronus EEG: similar to wakefulness Variability in HR, RR, BP Reduced hypoxic, hypercapnoeic drive
60% newborn sleep
Non-REM sleep
Features
Reduced not absent tone
Reduced cerebral blood flow
Synchronised EEG
Regular HR, RR, BP
Stage 2 sleep
EEG features
Sleep spindles K complexes (from 6 months)
Stage III and IV sleep
Slow, regular HR, RR Reduced minute ventilation Flat EMG 3: 20-50% delta waves 4: >50% delta waves
( high amp, low frequency <4Hz)
Little eye movement
Drowsy if woken
GH secretion, reduced TSH & ACTH
Hering Breuer reflex
Reduced ventilatory drive with increased stretch
Apnoea on cpap
Central apnoea more common in …. sleep
non-REM
4 types of sleep disordered breathing
Primary snoring
Obstructive hypoventilation syndrome
Upper airway resistance syndrome
OSA
Rate of OSA T21
50-100%
5 craniofacial syndromes
Apert Pfeiffer Crouzon Treacher-Collins Pierre Robin
Monitoring in PSG
EEG EOG Nasal EtCO2 Nasal oral airflow Chin and leg EMG Microphone ECG Respiratory effort : RC and AB SpO2 Camera & observer
Key differences between central and obstructive apnoea on PSG
Central in non-REM
Obstructive in REM
Obstructive: desaturation w increased effort
Paradoxical RC & AB movement
Both: no airflow
Ondine’s curse
1:100,000
Associated with hirsprungs
Brainstem disorder
Reduced chemoreceptor response to hypoxia hypercarbia
Worse in non-REM
(Cf neuromuscular & CLD which are worse in REM sleep)
Affect of neuromuscular disease on
TV
VC
Chest wall compliance
Lung volumes
Monitor which parameter
Predicts…
Decreased
Decreased
Increased
Decreased
VC
<40% : nocturnal hypoventilation
<25% : daytime hypoventilation
