A2- Sleep Breathing Disorders Flashcards Preview

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Flashcards in A2- Sleep Breathing Disorders Deck (28)
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1
Q

Why is sleep disorders important?

A
  • It is very common. 1 in 8 have sleep apnoea
  • affects other medical conditions eg risk of stroke, MI, AF, asthma,DM, HF, depression
2
Q

What is sleep apnoeas?

A

A group of conditions that are characterised by abnormal breathing during sleep.

3
Q

Sleep apnoea can be classed into two main classes? What are they?

A

Obstructive

Central

4
Q

What is the difference bwteen obstructive and central sleep apnoea?

A

Obstructive: (airway is partially or completely blocked)

Failure of thr upper airwya to maintain adequate patency when the upper airway dilator muscles relax with sleep.

Central: (patient fails to make any effort to breathe) IT is to do with your brain

5
Q

What can cause central sleep apnoea?

A

HF, Morphine,

6
Q

What does the term obstructive sleep apnoea syndrome suggest?

A

is used to describe the occurence of obstructive abnormalities on a sleep study combined with symptoms, usually excessive daytime sleepiness.

7
Q

ANother word for sleep apnoea?

A

Hypopnoea syndrome

8
Q

What are these examples of?

A

Overnight (8hr) Oximetry Tracings

9
Q

Cheyne Stokes ventilation is a type of______

A

Central apnoea

10
Q

Ix for OSA

A

Oximetry- fails/falls off finger sometimes

Respiratory polygraphy- more channels so more information =. Detects breathing and efforts as well as heart rate and sats. Can look at legs as well.

Polysomnography- should only be for non respiratory sleep problems such as narcolepsy or leg movements.

11
Q

Management for OSA other than CPAP

A

Treating underlying disorder (acromegaly, hypothyroidism (if they are snoring and not changing weight check TFTs))

Stop evening alcohol and sedatives (depress/relax upper airway muscles)

Stop smoking- because it causes swelling and narrowes the airway

Lost weight-

Posture training- (avoid supine position)

Dental Devies/mandibular advancement devices

Surgery

Nasal continuous postive airway pressure.

12
Q

Mandibular Advancement Devices

A

Device that can be placed in your mouth- pulling the lower jaw forward so it increases phargeal space

13
Q

Increasing rates of obesity is causing hyperventilation

TRUE OR FALSE

A

FALSE

hypoventilation

14
Q

How does obesity affect hypoventilation?

A

Inability of the respiratory muscles to cope with added load of fat on chest wall and abdmonial contents whilst supine.

Often misdiagnosed as OSA

Patients often describe increasng discomforti with breathin whilst supine and adopt other positons eg

  • lots of pillows
  • recliner chair
  • hospital bed at home
15
Q

Other signs and symptoms of OHS (obesity hypoventilation syndrome)

A

morning headache

Swollen ankles

Signs of cor pulmonale- heart failure fue to respiratory problems with central cyanosis and increasing peripheral oedema

CXR- Enlarged heart

Echo- Dilated RV

ABG- Raised BE or bicarbonate

16
Q

What is CPAP

A

It is continuous air pressure.

It improves hypoxia.

Recuits underventilated or collapsed lung units

Increase FiO2 (oxygenation in the blood)

Splints the upper airway

Offloads work of breathing

17
Q

What is NIV/BIPAP

A

Non-invasive ventilation

Bilevel positive airway pressure.

reduces hypercapnia.

Will also improve hypoxia and may be better tolerated than CPAP

Offloads work of breathing and resets chemoreceptors and therefore the response to rising Pco2.

18
Q

What does NIV do?

A

Reduces pCO2 and resets chemoreceptors and therefore restores the ventilatory response to CO2 rises.

Rest the inspiratory muscles and recruits atelecatic (partial collapse) lung

EPAP- overcomes PEEP, delaying airway collapse

IPAP- reduces work of breathing and assists inspiration.

19
Q

What does NIV do?

A

Reduces pCO2 and resets chemoreceptors and therefore restores the ventilatory response to CO2 rises.

Rest the inspiratory muscles and recruits atelecatic (partial collapse) lung

EPAP- overcomes PEEP, delaying airway collapse

IPAP- reduces work of breathing and assists inspiration.

20
Q

Narcolepsy is not a respiratory sleep problem

TRUE OR FALSE

A

TRUE

21
Q

What is Narcolepsy?

A

Excessive sleepiness during day/night due to a nuerological condiion caused by failure of neurotransmission in a tiny subset of brain neruoens (orexin/hypocretin). (damage)

genetic susceptibility-HLA DQB1

form of autoimmune disease

22
Q

FUnction of orexin/hypocretin (brain neurones)

A

Keeps you awake

maintance balance and posture while you are awake

23
Q

What can cause narcolepsy

A

it is autoimmune

it can also be triggered by head injury/disease or even infection (influenza)- this can cause further damage to the orexin/hypocreatin neurones

24
Q

Consequences

Loss of orexin/hypocreatin causes…

A
  1. excessive daytime sleepiness
  2. Loss of control of REM sleep which is associated with loss of muscle tone
  3. That can causes sleep onset dreaming/hypnagogic hallucinations
  4. sleep paralysis
  5. cataplexy- suddent onset loss of muscle tone during wakefulness in response to intese emotions such as a good laugh, great antcipation etc varies from a slight droopng of the face and neck to apparently passing out and fallin on the floor.
25
Q

Diagnosis of Narcolepsy?

A

History- cataplexy virtually diagnostic

HLA typing- DQB1

MSLT-

Sleep Study

CSF orexin levels

26
Q

Tx for narcolepsy

A

Sleepiness- Non Pharmacological: scheduled naps, regular sleep/wake cycle. Pharmacological- amohetamines, modafanil, trycylics.

Cataplexy- Tricyclics (clomipramine, voloxazine, imipramine, fluoxetine

27
Q

Latest drugs fro narcolepsy?

A

Also pitolisant

H3 receptor antagonist/iverse agonist

28
Q

other management for narcolepsy

A