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Sleep Apnoea and Narcolepsy Flashcards

(48 cards)

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1
Q

What is obstructive sleep apnoea syndrome?

A

Recurrent episodes of upper airway obstruction leading to apnoea during sleep and is usually associated with snoring

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2
Q

What are the effects of OSAS on patients?

A

Typically unrefreshing sleep, daytime sleepiness and poor daytime concentration

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3
Q

What does somnolence mean?

A

Sleepiness

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4
Q

Explain the pathophysiology of OSAS?

A

Muscle relaxation, narrow pharynx and obesity can cause repeated closure of upper airway
This causes apnoeas and hypopnoeas which causes frequent microarousals

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5
Q

What is the outcome of repeated closure of upper airway?

A

Snoring
O2 desaturation
Apnoea and hypopnoea

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6
Q

Why is OSAS important?

A

Impaired QoL
Increased risk of road traffic accidents
Risk of hypertension, stroke and heart disease

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7
Q

How is OSAS diagnosed?

A

Clinical history and examination
Epworth questionnaire
Overnight sleep study

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8
Q

Explain the Epworth questionnaire?

A

Patients ranks questions 0-3 from would never doze to high chance of dozing

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9
Q

What is overnight oximetry measuring?

A

O2 saturation and pulse rate

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10
Q

What would oximetry look like if patient has sleep apnoea?

A

Repetitive desaturation
Pulse rate follows saturation

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11
Q

What equipment is in a limited sleep study (embletta)?

A

Thora movement, oximetry and nasal canula

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12
Q

What is central apnoea?

A

Less common
Not due to obstruction
Is lack of respiratory drive from brainstem

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13
Q

What is filled in when carrying out limited sleep study?

A

Sleep study report
Analysed by technician or computer

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14
Q

What is measured in a polysomnography?

A

Oronasal airflow, thorax movement, oximetry, body position, EEG, Audiovisual recording, EOG, EMG an ECG

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15
Q

What is an EEG?

A

Checks brain waves during the night - can tell if patient is actually asleep

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16
Q

What is an EOG?

A

AN electrooculogram measuring eye movement

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17
Q

What is EMG measuring?

A

Peripheral muscle

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18
Q

What is filled out after a polysomnography?

A

PSG report
Contains a hypnogram which shows the stage of sleep

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19
Q

What is the REM stage of sleep?

A

Dreaming stage so get rapid eye movements

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20
Q

What is stage 1-3 of sleep?

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A

1and 2 are asleep and 3 is deep

21
Q

What is W stage of sleep?

22
Q

How is OSA severity measured?

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A

Desaturation rate/AHI
0-5 is normal
5-15 is mild
15-30 is moderate
>30 is severe

23
Q

What is AHI?

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A

Total no. of apnoeas in sleep divided by hours of sleep

24
Q

What is the treatment for sleep apnoea?

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A

Identify exacerbating factors
Continuous positive airways pressure (CPAM)
Mandibular repositioning splint

25
What are some exacerbation factors that can cause sleep apnoea?
Overweight Alcohol Endocrine disorder
26
Explain the mechanism of CPAM treatment?
Creates positive pressure so tissues in mouth don't get stuck together in inspiration
27
How does mandibular repositioning splint help sleep apnoea?
Advance lower jaw forward so tongue is forward and creates more space at back of throat
28
Describe driving rules and sleep apnoea?
Advice patient to not drive or restrict driving Inform DVLA Once satisfactory treated should be allowed to drive
29
What is narcolepsy?
Rare long-term brain condition that causes a person to suddenly fall asleep at inappropriate times Usually presents at younger age then apnoeas
30
What is narcolepsy associated with?
Can be familial Associated with HLA types
31
Explain the clinical features of narcolepsy?
Cataplexy, excessive daytime sleepiness, hypnopompic hallucination and sleep paralysis
32
What is cataplexy?
Suddenly collapse during day and looks asleep Person is kind of aware Sudden muscle weakness
33
What investigations are used to diagnose narcolepsy?
Polysomnography MSLT Low CSF orexin tested by lumbar puncture
34
Explain MSLT investigation?
Multiple sleep latency test Patient asked to sleep in dark room and time to get to sleep is measured Under 6 mins is a sign
35
Explain the treatment of narcolepsy?
Modafinil Dexamphetamine Venlafaxine Sodium Oxybate
36
Describe chronic ventilatory failure
Elevated pCO2 and pO2 is less than 8kPA Type 2 resp. failure Normal blood pH Elevated bicarbonate
37
What are the causes of chronic ventilatory failure?
Airway disease, Chest well abnormalities, Respiratory muscle weakness, and central hypoventilation
38
What is airways diseases that cause chronic ventilatory failure?
COPD and bronchiectasis
39
What is a chest wall abnormality that cause chronic ventilatory failure?
Kyphoscoliosis
40
What are respiratory muscle weakness diseases that cause chronic ventilatory failure?
Motor neuron disease (ALS), muscular dystrophy and glycogen storage disease
41
What are central hypoventilation diseases that can cause chronic ventilatory failure?
Obesity hypoventilation syndrome and congenital central hypoventilation syndrome
42
What are typical symptoms of chronic ventilatory failure?
Breathlessness, orthopnoea, ankle swelling, morning headache, recurrent chest infection and disturbed sleep
43
Explain the term orthopnoea?
Breathlessness lying flat Usually with muscular condition
44
What are some examination findings for chronic ventilatory failure?
Reflects underlying disease Paradoxical abdominal wall motion in suspected neuromuscular disease Ankle oedema
45
Explain paradoxical abdominal wall motion
Weakness of diaphragm Wont contract properly so diaphragm drawn up Chest wall then moves down Opposite to normal
46
What investigations are done to diagnose neuromuscular disease?
Lung function Assessment of hypoventilation Fluoroscopic screening of diaphragm
47
What happens to FEV1 and FVC, and mouth pressure in neuromuscular disease?
FEV1 and FVC is reduced but ratio is higher as restrictive Mouth pressure on inspiration and expiration is reduced
48
Explain the treatment for chronic ventilatory failure?
Domiciliary non invasive ventilation O2 therapy Tracheoscopy ventilation - 24hr Not curable

Respiratory (24 decks)

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