Respiratory Sleep Disorders

Question 1

what is obstructive sleep apnoea (OSA)?

Answer 1

cessation of breathing at night due to respiratory tract closing periodically

Question 2

what can cause obstructive sleep apnoea?

Answer 2

obesity
neuromuscular disorders
narrow pharynx

Question 3

what can be symptoms of OSA?

Answer 3

daytime sleepiness
unrefreshing sleep
poor concentration
snoring

Question 4

how can OSA present at night time, depending on the level of obstruction?

Answer 4

snoring if not completely obstructed

O2 desaturation if complete obstruction

Question 5

what are the reasons for unrefreshing sleep and daytime somnolence in OSA patients?

Answer 5

microarousals of the brain to encourage breathing

Question 6

what investigations can be done to diagnose OSA?

Answer 6

history/examination
Epworth Sleepiness scale
Overnight sleep study

Question 7

what kinds of overnight sleep tests can be done for OSA diagnosis?

Answer 7

pulse oximetry
limited sleep studies
polysomnography (PSG)

Question 8

what treatments are available for OSA?

Answer 8

manage underlying cause (eg obesity)
CPAP
mandibular splint

Question 9

how common is obstructive sleep apnoea?

Answer 9

2% of men, 1% of women are affected

Question 10

what characterises narcolepsy?

Answer 10

cataplexy
hypnagogic hallucinations
sleep paralysis
excessive daytime somnolence

Question 11

what advice should be given to OSA patients?

Answer 11

OSA patients shouldn’t drive until the problem has been treated. DVLA should be notified of moderate/severe OSA

Question 12

what are normal/abnormal levels of nighttime O2 desaturation levels?

Answer 12

0-5 normal
5-15 mild
15-30 moderate
30> severe

Question 13

what is the prevalence and aetiology of narcolepsy?

Answer 13

0.05% of population affected
familial condition
associated with a certain haplotype

Question 14

what are the treatments for narcolepsy?

Answer 14

sodium oxybate
clomipramine
modafinil

Question 15

what characterises chronic respiratory failure?

Answer 15

high pCO2
low PO2
high bicarbonate
normal plasma pH

Question 16

what disorder should be considered in patients with chronic respiratory failure, if they are not obese or smokers?

Answer 16

neuromuscular disorders causing hypoventilation

Question 17

what tests should be done to diagnose neuromuscular disorders causing chronic respiratory failure?

Answer 17

lung function tests (sitting and standing)

assessing hypoventilation severity (oximetry, PSG)

Question 18

how can chronic respiratory failure caused by neuromuscular disorders be managed?

Answer 18

NIV at home (BiPAP)
Oxygen therapy
t-IPPV

Question 19

what is a normal sleep pattern in newborns?

Answer 19

16-18 hours sleep, wake up every 4 hours

no day/night sleep pattern

Question 20

what is a normal sleeping pattern in foetuses in utero?

Answer 20

increasingly regular periodic breathing

onset of REM sleep

Question 21

what is a normal sleeping pattern in 6 month old infants?

Answer 21

14-15 hour sleep, longer at night

1-2 naps during the day

Question 22

what is a normal sleeping pattern in 2 year old toddlers?

Answer 22

12 hour at night

1 daytime nap

Question 23

at what age is a child’s sleep the most efficient?

Answer 23

prior to adolescence

Question 24

what characterises teenage sleep patterns?

Answer 24

frequent awakenings, need more sleep than they get

Question 25

what are some common causes of sleeplessness in children?

Answer 25

- behavioural, parents' response has an impact - neurological disorders - effect of medicines

Question 26

what are some common causes of excessive somnolence in children?

Answer 26

- insufficient sleep - narcolepsy - obstructive sleep apnoea

Question 27

what are some main differences in obstructive sleep apnoea between children and adults?

Answer 27

- cause: swollen tonsils/adenoids (children) vs obesity (adults) - presentation: hypoventilation (children) vs apnoea (adults) - no daytime sleepiness (children) vs daytime sleepiness (adults) - breathing with mouth open (children), not adults

Question 28

what is a useful investigation to assess sleep disturbances in children?

Answer 28

polysomnography is Gold standard

Question 29

what are some neurological disorders which can cause sleep disturbances in children?

Answer 29

- Duchenne's muscular dystrophy - Down's Syndrome - Cerebral Palsy - Prader-Willi Syndrome

Question 30

what are some respiratory disorders which can cause sleep disturbances in children?

Answer 30

- chronic neonatal lung disease - cystic fibrosis - asthma

Question 31

what is the treatment of OSA in children?

Answer 31

remove smoke from environment CPAP if needed adenotonsillectomy weight loss

Question 32

what is the prevalence of OSA in children?

Answer 32

2% of kids (1:1 girls and boys)

Question 33

what are some complications of OSA in children?

Answer 33

- failure to thrive - cognitive deficits (ADHD) - may develop hypertension/cor pulmonale

Question 34

what neurological condition is more likely to present with OSA at night?

Answer 34

Down's syndrome

Question 35

What neurological conditions are likely to present with what sleep disturbance? disturbed sleep pattern or excessive daytime somnolence?

Answer 35

cerebral palsy - disrupted sleep prader-willi syndrome - increased daytime sleepiness down's syndrome - OSA Duchenne's muscular dystrophy - respiratory failure

Question 36

what type of management has significantly increased the QoL of children with Duchenne's Muscular dystrophy with regards to sleep patterns?

Answer 36

BiPAP machines

Question 37

what is the definition of primary snoring in children?

Answer 37

snoring without any other symptoms (eg hypoxia, hypercapnia, apnoea)

Question 38

what is a potential complication of snoring in children?

Answer 38

it may progress to OSA | it may require adenotonsillectomy

Question 39

what can be a sleep related symptom of chronic neonatal lung disease, and what is it similar to?

Answer 39

hypoxaemia during REM sleep | similar thing happens in COPD

Question 40

what is the average percentage of children who present with primary snoring?

Answer 40

about 10%