Sleep apnoea and neuromuscular respiratory disorders Flashcards
(34 cards)
Define sleep apnoea.
A temporary (10 seconds) cessation of breathing during sleep. Recurrent episodes of upper airway obstruction lead to apnoea.
Describe sleeping patterns in infants.
Natural apnoea before 36 weeks, after this increased regular respiration. Infants then begin going straight into REM sleep and have 50% REM and 50% NREM. Newborns spend 16-18 hours asleep. Sleep-wake states alternate in 3-4 hour cycles, then they start to adapt to light/dark and social cues. 6 month olds spend 14-15 hours asleep. They have 2 longer sleep periods at night and 1-2 daytime naps. 2 year olds spend 12 hours asleep and have 1 daytime nap. After 2 years naps usually disappear.
What happens to sleep patterns throughout life?
REM decreases and NREM increases. Total time asleep also decrease.
When is sleep most efficient?
In pre-pubescent children.
Describe sleep in adolescence.
Increased wakenings. Need more sleep but obtain less.
How can sleep be assessed?
Polysomnography (records brain waves, O2 levels in blood, HR, RR, leg and eye movements); direct behavioral observation; time-lapse video; movement sensors in cot mattress; O2/CO2 monitoring.
When do napping and enuresis become abnormal?
Age 3-5.
Is a 1 year old sleeping 8 hours per night without a nap normal or abnormal?
Abnormal.
When is REM onset of sleep normal?
First 3 months.
Which factors can cause excessive sleepiness?
Insufficient sleep, OSAS (obstructive sleep apnoae syndrome) or narcolepsy (falling asleep at inappropriate times, can be caused by orexin deficiency).
Define cataplexy.
A condition in which strong emotions such as laughter causes the patient to suddenly collapse although they are still conscious.
What is a hypnagogic hallucination?
A vivid/frightening hallucination experienced during the transition from wakefulness to sleep.
Define primary snoring.
Snoring without apnoea, hypoventilation, hypoxia, hypercarbia ( > blood CO2) and day time symptoms.
What is the morbidity associated with OSAS in children?
Failure to thrive, neurocognative effects/ADHD, systemic hypertension and Cor Pulmonale.
Contrast adult and child OSAS.
ADULT: daytime sleepiness, majority obese, no mouth breathing, more males, no enlarged tonsils, apnoea is obstructive pattern. CHILD: minority experience day time sleepiness or are obese, mouth breathing common, equal males and females, enlarged tonsils common, obstructive pattern is to hyperventilate.
What is the treatment for OSAS in children?
Adenotonsillectomy, CPAP (rarely), weight loss and avoid environmental tobacco smoke.
Which respiratory disorders can cause apnoea?
Chronic neonatal lung disease, CF and asthma.
Which neurological disorders can cause apnoea?
Cerebral palsy, Downs, Prader-Willi syndrome and DMD (death due to respiratory failure).
What symptoms will adult OSAS patients have?
Snoring, unrefreshing sleep, daytime sleepiness (hypersomnolence) and poor daytime concentration.
What are the pathophysiological causes of OSAS?
Muscle relaxation, having a narrow pharynx and obesity. Repeated closure of the upper airway causes snoring and O2 desaturation. Result is frequent microarousals so the brain is not properly rested - causes symptoms.
What is the difference between apnoea and hypoapnoea?
Apnoea is a total obstruction and hypoapnoea is not a total obstruction.
Why is OSAS important?
Impaired QOL, matiral dysharmony, > RTA, associations with hypertension, > stroke risk and > heart disease risk.
What is the prevalence of OSAS in adults?
2% men and 1% women.
How is OSAS diagnosed?
Clinical history, examination, Epworth questionnaire (11-24 score is significant) and overnight sleep study pulse oximetry (2 repetitive desaturations is sleep apnoea).
