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R+S phys > Monitoring and Measurement of Sleep Apnoea > Flashcards

Monitoring and Measurement of Sleep Apnoea Flashcards

1
Q

What is Sleep Apnoea?

A
  • Full or partial collapse of Upper airway during sleep

- Leading to sleep arousal

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2
Q

Name some symptoms of SA?

A
  • Snoring
  • Restless Sleep
  • Nocturia
  • Wake choking
  • Depression
  • Unrefreshing sleep
  • Decreased libido
  • Daytime Somnolence
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3
Q

What is the most common sleep-related breathing disorder?

A
  • OSA (obstructive sleep apnoea)

- Increasing with rising levels of obesity and also bc more people are actually being diagnosed now

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4
Q

What are some pre-disposing factors for SA?

A
  • Obesity
  • Age
  • Gender
  • Ethnicity (ACS)
  • Prevalence in Asia for SA is similar to USA bc of craniofacial anatomy
  • Airway size/shape
  • Upper airway muscle function
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5
Q

What is the link between obesity and OSA?

A

-Risk of OSA correlates with increasing BMI

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6
Q

What are some factors affecting Upper airway shape/size?

A
  • Obesity (increased neck size)
  • Smoking
  • Upper airway lesions

-Skeletal abnormalities
(Retrognathia and Cranio-facial deformity)

  • Smoking
  • Hormonal (Goitre)
  • Supine sleeping position
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7
Q

What are 3 factors affecting Upper airway muscle function?

A
  • Sleep Deprivation
  • Alcohol and sedative usage
  • Neurological disorders
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8
Q

How can we measure OSA?

A
  • Accurate history is vital
  • Identify features of OSA
  • Rule out alternative diagnoses
  • Assess impact on QoL
  • Ideally partner/parent/family member present
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9
Q

What sort of history would you want to know to discuss OSA?

A
  • General medical and drug history
  • Alcohol intake?Smoker?
  • Physical examination
  • For pre-disposing factors
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10
Q

What is the Mallampati Score?

A
  • Guide to increased likelihood of OSA

- Basically looking at the mouth to see how much of the tonsils you can see and how occluded it is

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11
Q

How can Sleep Questionnaires be useful?

A
  • Measure daytime symptoms and QoL
  • Most common is ESS (Epworth)
  • Others include sleep diaries/QSQ/FOSQ/Beck depression inventory
  • They are used in new and follow up patients to assess response to treatment
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12
Q

What is ESS score?

A

Epworth Sleep Score

-Looks at risk of dozing

  • Normal 0-9
  • Midl 10-15
  • Significant 16-24
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13
Q

What is SF-36?

A
  • Questionnaire with 36 questions related to QoL

- NO sleep component

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14
Q

What is FOSQ?

A

Functional Outcome in Sleep

-Assess impact of Sleep Disorders

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15
Q

What is Beck Depression Inventory?

A
  • Similar to ESS

- High score more likely to deal with depression

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16
Q

What are 3 ways we can monitor Sleep?

A
  • Overnight Oximetry
    (SpO2 + HR)

-Limited Sleep Study
(Variety) (seen on placement)

-Full Polysomnography
(Resp parameters + EEG + EOG + EMG

17
Q

Define an Apnoea?

A
  • Cessation fo airflow (Greater than or equal to a 90% reduction)
  • Minimum of 10s
  • Obstructive if effort to breathe is maintained
  • Central if absence of respiratory effort
18
Q

Define an Hypopnea?

A
  • Reduction in airflow signal with an Ox Desaturation
  • Greater than or equal to 30% reduction in airflow
  • Min 10s
19
Q

Advantages of Oximetry?

A
  • Simple
  • Minimal invasion
  • Cheap
  • Suitable to use at home
20
Q

Disadvantages of Oximetry?

A
  • Limited info
  • Single Measurement no other data if it falls for eg
  • Sensitivity good but specificity poor
21
Q

What parameters do we look for with Oximetry?

A
  • Dips in SpO2

–>greater than or equal to 4% drop

–>more than 10 events per hour suggest respiratory disturbance

-Pulse rate

–> HR rises by more than or equal to 6BPM

–> If there’s more than 15 events per hour it is significant

22
Q

What are some sources of error?

A
  • Poor Signal
  • Movement Artefact
  • Sampling frequency
  • Data smoothing
23
Q

What does a Limited Sleep Study involve?

A
  • Nasal Flow
  • Chest and Abdomen bands to measure respiratory effort
  • Oximeter
  • Snoring via mic
  • Body Position
  • Video/Sound (sometimes)
  • ECG (if required)
24
Q

What are some sources of error with limited sleep studies?

A
  • Nasal airflow could be nasal blockage
  • Band movement may be high with high BMI patients
  • Backround noise could affect snoring measurement
  • Body position may be incorrect can confirm with video
  • Sound/Video must be time synchronised and IR is essential
25
Q

Advantages of Polygraphy?

A
  • Wider range of data compared to pulse ox
  • Can be used at home
  • Can add extra channels
26
Q

Disadvantages of Polygraphy?

A
  • Still limitation of data

- More intrusive to patient ‘normal sleep’

27
Q

What extra parameters does Full PSG have?

A
  • EEG
  • EOG
  • EMG
28
Q

What is EEG?

A
  • Electroencephalography

- It measures electrical activity of brain placed on scalp and can determine sleep stages

29
Q

What is EOG?

A
  • Electrooculography

- Assists in determining sleep stage (REM)

30
Q

What is EMG?

A
  • Electromyography
  • Chin electrodes determine REM using muscle atonia
  • Leg electrodes to screen for PLM’s
31
Q

Sources of error for full PSG?

A
  • Poor Skin preparation
  • Sweat artefact
  • Body Hair
32
Q

Advantages of PSG?

A
  • Gold Standard
  • Full picture of sleep
  • confirms REM-related OSA
  • Useful when patient history is mix of sleep disorders
33
Q

Disadvantages of PSG?

A
  • Expensive
  • In-hospital test
  • Lots of data not all necessary for simple respiratory screening
  • Uncomfortable for patient
34
Q

OSA and driving?

A
  • Patients obliged to inform DVLA

- Wisconsin study found 7X more likely to have Motor accidents

R+S phys (17 decks)

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