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RESP - 1 > Sleep Apnoea > Flashcards

Sleep Apnoea Flashcards

1
Q

What is obstructive sleep apnoea?

A

Recurrence episodes of upper airway obstruction leading to apnoea during sleeping

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2
Q

What are consequences of sleep apnoea?

A 
Heavy snoring
Unrefreshing sleep
Day time somnolence
Compensated resp. acidosis
HTN
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3
Q

What are predisposing factors for OSA?

A

Obesity
Macroglossia: acromegaly, hypothyroidism, amyloidosis
Large tonsils
Marfan’s syndrome

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4
Q

What is the pathophysiology of sleep apnoea?

A

Muscle relaxation, narrow pharynx, obesity –> repeated closure of upper airway –> oxygen desaturation and snoring, apnoea/hyponeas –> frequent microarousals –> poor concentration and day time somnolence

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5
Q

Why is OSA important?

A 
Reduced QoL
Martial dysharmony
Increased risk of RTAs
Associated with risk of hypertension 
Increased stroke and CV risk
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6
Q

How to do you assess someone with OSA?

A

History and exam
Epworth sleepiness scale
Multiple sleep latency test

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7
Q

What is the multiple sleep latency test?

A

Measures time taken to fall asleep in a dark room using EEG criteria

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8
Q

What diagnostic tests are used to diagnose OSA?

A

Sleep studies (polysomnography) - ranges from monitoring of pulse oximetry at night to full polysomnography with EEG, respiratory airflow, thoraco-abdominal movement, snoring and pulse oximetry

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9
Q

What score on the Epworth scale is considered excessive sleepiness?

A

> 11/24

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10
Q

What is the AHI?

A

Apnoea hypnoea index (number of apnoea/hypnoeas per hour of sleep)

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11
Q

How is the severity of OSA measured?

A

AHI

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12
Q

What AHI is considered normal?

A

<5

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13
Q

What AHI is considered mild OSA?

A

5-15

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14
Q

What AHI is considered moderate OSA?

A

15-30

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15
Q

What AHI is considered severe OSA?

A

=>30

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16
Q

What is involved in the management of OSA?

A

Weight reduction
Avoid alcohol (worsens OSA and snoring)
Diagnose + treat endocrine disorders (e.g. hypothyroidism, acromegaly)
CPAP is first line for mod-severe OSA
Intra-oral devices (e.g. mandibular advancement) can be used in CPAP not tolerated/mild OSA with no daytime sleepiness

17
Q

How does CPAP help treat OSA?

A

Keeps airway patent

18
Q

What patients need to inform the DVLA about their OSA?

A

Those with OSA what is causing excessive daytime sleepiness

19
Q

What is nacrolepsy?

A

Chronic sleep boundary disorder that affects control of sleep and wakefulness with rapid eye movement sleep intrusion into wake state

20
Q

What is the classic triad of nacrolepsy?

A

NB this is only seen in 10-15% of cases

  • Excessive daytime sleepiness
  • Cataplexy
  • Sleep paralysis/hypnagogic/hypnopompic hallucinations
21
Q

What is cataplexy?

A

Sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)

Can range from knees buckling to collapse

22
Q

Low levels of what protein is associated with nacrolepsy?

A

Orexin (hypocretin) a protein which is responsible for controlling appetite and sleep patterns

23
Q

What HLA allele is associated with nacrolepsy?

A

HLA-DR2

24
Q

What is sleep paralysis?

A

Immobility on arousing from sleep (can be associated with hypnopompic hallucinations)

25
Q

When does nacrolepsy tend to present?

A

In teenage years

26
Q

What do you see on EEG with narcolepsy?

A

Multiple sleep latency

27
Q

How is narcolepsy treated?

A

Daytime stimulants (e.g. modafinil) and nighttime sodium oxybate

28
Q

Define chronic ventilatory failure

A

Raised PaCO2 (>6kPa)
pO2 <8kPa
Normal blood pH
High bicarbonate

29
Q

What are aetiologies of ventilatory failure?

A

Airway disease - COPD, bronchiectasis, OSA
Chest wall deformities, e.g. kyphoscoliosis
Respiratory muscle weakness - ALS, muscular dystrophy
Central hypoventilation - obesity hypoventilation syndrome

30
Q

What are symptoms of chronic ventilatory failure?

A 
SoB
Orthopnoea
Ankle oedema
Morning headache
Recurrent chest infections
Disturbed sleep
31
Q

What is orthopnoea?

A

Breathless while lying flat

32
Q

What examination findings might you see in chronic ventilatory failure?

A

Paradoxical abdominal wall movements - neuromuscular disease

Ankle oedema - hypoxic cor pulmonale

33
Q

How should you investigate chronic ventilatory failure as a result of neuromuscular dsease?

A

Lying + standing VC
Mouth pressures/NSIP
Overnight oximetry
Transcutaneous CO2 monitoring

34
Q

How should chronic ventilatory failure secondary to a neuromuscular disease be managed?

A

Domicillary NIV

O2 therapy

RESP - 1 (27 decks)

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