Sleep Apnoea and Neuromuscular Respiratory Failure

Question 1

What is obstructive sleep apnoea?

Answer 1

Recurrent episodes of upper airway obstruction leading to apnoea during sleep

Question 2

What is OSA associated with?

Answer 2

Heavy snoring
Unrefreshing sleep
Daytime somnolence / sleepiness
Poor daytime concentration
Increased risk of RTAs
HTN
Stroke
Heart disease
Marital disharmony

Question 3

What is apnoea?

Answer 3

The cessation of breathing for at least 10 seconds

Question 4

What is hypopnoeas?

Answer 4

Complete cessation of breathing

Question 5

What is microarousals?

Answer 5

Moving from a deep to a light sleep

Question 6

Diagnosis of OSA

Answer 6

History and exam
Epworth questionnaire
Overnight sleep study
- pulse oximetry
- limited sleep study
- full polysomnography

Question 7

What does Epworth study look at?

Answer 7

Assess how sleep the person is

Question 8

What Epworth score is considered abnormal?

Answer 8

Score of 11 or more

Question 9

What does pulse oximetry look at?

Answer 9

Pulse rate
Oxygen sats

Question 10

What does the limited sleep study look at?

Answer 10

Band round chest
Abdomen and tubes measure nasal air flow

Question 11

What does full polysomnography look at?

Answer 11

Oronasal air flow
Thoracoabdominal movement
Oximetry
Body position
EEG
Audio visual recording
EOG
EMG
ECG

Question 12

What does EMG look at?

Answer 12

Peripheral muscle

Question 13

What looks at severity of OSA?

Answer 13

Desaturation rate / AHI

Question 14

Treatment of OSA

Answer 14

Identify exacerbating factors
- weight reduction
- avoidance of alcohol
- diagnose and treat endocrine disorders (e.g. hypothyroid, acromegaly)
CPAP
Mandibular repositioning splint if cant tolerate CPAP

Question 15

What does CPAP stand for?

Answer 15

Continuous positive airway pressure

Question 16

Driving and OSA

Answer 16

If have excessive daytime somnolence not to drive or restrict driving and inform DVLA
Once satisfactory treated, should be allowed to drive

Question 17

Is narcolepsy common?

Answer 17

No

Question 18

Who gets narcolepsy?

Answer 18

Familial sometimes
HLA associations
Teenagers

Question 19

Presentation of narcolepsy

Answer 19

Cataplexy
Excessive daytime somnolence
Hypnagogic hallucinations
Sleep paralysis

Question 20

What is cataplexy?

Answer 20

Collapse suddenly and they are asleep - vaguely aware of what is going on

Question 21

What are hypnagogic hallucinations?

Answer 21

Frightening visual hallucinations where they go to sleep or when they are coming around from sleep

Question 22

What is sleep paralysis?

Answer 22

Feeling of being unable to move

Question 23

Treatment of narcolepsy

Answer 23

Modafinil
Clomipramide (for cataplexy - an antidepressant)
Sodium oxybate (xyrem)

Question 24

Features of chronic ventilatory failure

Answer 24

Elevated PaCO2 > 6.0kPa
Pa02 < 8kPa
Normal blood pH
Elevated bicarbonate

Question 25

Causes of chronic ventilatory failure

Answer 25

Airway disease - COPD - Bronchiectasis - OSA Chest wall abnormalities - kyphoscoliosis Respiratory muscle weakness - motor neurone disease (ALS) - muscular dystrophy Central hypoventilation - obesity hypoventilation syndrome - central hypoventilation syndrome (Ondines curse)

Question 26

Presentation of chronic ventilatory failure

Answer 26

SOB Orthopnoea Ankle swelling Morning headache Recurrent chest infections Disturbed sleep

Question 27

Definition of orthopnoea

Answer 27

Breathlessness when lying flat

Question 28

Investigations of neuromuscular disease causing chronic ventilatory failure

Answer 28

Lung function - lying and standing VC - mouth pressures / SNIP Assessment of hypoventilation - early morning ABG - overnight oximetry - transcutaneous CO2 monitoring

Question 29

Treatment of chronic ventilatory failure

Answer 29

Domicilliary non invasive ventilation (NIV) Oxygen therapy (t-IPPV)

Question 30

Infant respiratory pattern

Answer 30

Periodic / apneic breathing before 36 weeks PCA Increased regular respiratory after 36 weeks

Question 31

Sleeping in newborns

Answer 31

16 - 18 hours sleep Sleep wake states alternate in 3 - 4 hour cycles Then start to adapt to light - dark / social cues

Question 32

Sleeping in 6 month olds

Answer 32

14 - 15 hours sleep 2 longer sleep periods at night 1 - 2 daytime naps

Question 33

Sleeping in 2 year olds

Answer 33

12 hour sleeps 1 day time nap

Question 34

Pre pubertal childrens sleep

Answer 34

Highly efficient sleep Get into routines

Question 35

Adolescence sleep

Answer 35

Increased awakenings Need more / obtain less

Question 36

Assessment of childrens sleep

Answer 36

Polysomnography Direct behavioural observation Time lapse video Movement sensors in cot mattress Oxygen / CO2 monitoring

Question 37

When is napping and enuresis abnormal?

Answer 37

After 3 - 5 years

Question 38

What is enuresis?

Answer 38

Wetting the bed

Question 39

What is an abnormal sleep pattern for a 1 year old?

Answer 39

8 hours a night and no naps

Question 40

Who is sleep walking normal in?

Answer 40

Toddlers

Question 41

Unarousable from sleep children vs adults

Answer 41

Children - normal Adults - abnormal

Question 42

REM sleep child vs adult

Answer 42

Children go straight into REM sleep, adults dont

Question 43

Other normal phenomena in children

Answer 43

Sleep walking Sleep terrors Hypnic jerks

Question 44

Causes of sleeplessness

Answer 44

Mainly behavioural problems Asthma Medication Neurological disorders

Question 45

What is a hormone used to induce sleep?

Answer 45

Melatonin

Question 46

Excessive sleepiness causes

Answer 46

Insufficient sleep OSAS Narcolepsy

Question 47

What does narcolepsy have a deficiency of?

Answer 47

Orexin

Question 48

What is primary snoring?

Answer 48

Snoring without - apnoea - hypoventilation - hypoxia - hypercapnia - daytime symptoms

Question 49

Prevalence of primary snoring

Answer 49

10%

Question 50

What may primary snoring lead to?

Answer 50

OSAS

Question 51

What may be a possible treatment for primary snoring?

Answer 51

Adenotonsillectomy

Question 52

What does OSAS stand for?

Answer 52

Obstructive sleep apnoea syndrome

Question 53

Who is OSAS commonest in and why?

Answer 53

Pre school child - adneoids

Question 54

Consequences of OSAS in children

Answer 54

FTT Neurocognitive defects / ADHD Systemic HTN Cor pulmonale

Question 55

Are children common mouth breathers?

Answer 55

Yes

Question 56

Treatment of OSAS in children

Answer 56

Adenotonsillectomy CPAP Weight loss Avoid environmental tobacco smoke

Question 57

Respiratory disorders in children causing sleep problems

Answer 57

Chronic neonatal lung disease - hypoxaemia in REM sleep - cardiac complications CF - less REM / more awakenings Asthma - worse at night

Question 58

Neurological disorders causing sleep problems in children

Answer 58

CP - fragmented sleep / delayed onset Down syndrome - OSAS Prader willi syndrome - excessive daytime sleepiness Neuromuscular disease (duchennes MD) - death due to resp failure - nocturnal desaturtation assosiated with FVC < 1 litre

Question 59

What do patients with neuromuscular disease have increasing QoL / survival with?

Answer 59

BiPAP