Sleep Apnoea and Neuromuscular Respiratory Failure - Adults Flashcards Preview

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Flashcards in Sleep Apnoea and Neuromuscular Respiratory Failure - Adults Deck (26)
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1
Q

What are the symptoms of Obstructive Sleep Apnoea?

A
Recurrent episodes of upper airways obstruction leading to apnoea during sleep 
Heavy snoring 
Unrefreshing sleep 
Daytime somnolence (sleepiness)
Poor daytime concentration
2
Q

What three factors can leads to repeated closure of the upper airway?

A

Muscle relaxation
Narrow pharynx
Obesity

3
Q

What can repeated closure of the upper airways lead to?

A

Oxygen desaturation
Apnoeas
Snoring

4
Q

What causes poor concentration and daytime hypersomnolence?

A

Apnoeas causing frequent microarousals

5
Q

How does OSAS impact a persons life?

A

Worse QOL
Marital disharmony
Risk of RTAs
Associated with HPT, increased risk of stroke and heart disease

6
Q

What is apnoea?

A

Momentary stop in breathing

7
Q

How is OSAS diagnosed?

A

Clinical history and examination
Epworth questionnaire
Overnight sleep study

8
Q

What are 3 different overnight sleep studies?

A

Pulse oximetry
Limited sleep study
Full polysomnography

9
Q

What is hypopnoea?

A

Partial apnoeas, shallow breathing and low respiratory rate

10
Q

What equipment is used in a polysomnography?

A

EEG - stages sleep through night
EOG - measures eye movement
EMG - measures muscle movement
ECG - heart rate

11
Q

What are the values for desaturation rate?

A

Normal: 0-5
Mild: 5-15
Moderate: 15-30
Severe: > 30

12
Q

What are exacerbating factors?

A

Weight reduction
Avoidance of alcohol
Diagnose and treat endocrine disorders i.e. hypothyroidism, acromegaly

13
Q

What are 3 measures of treatment on OSAS?

A

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

14
Q

What are the clinical features of narcolepsy?

A

Cataplexy
Daytime somnolence
Hypnagogic hallucinations
Sleep paralysis

15
Q

What are hypnagogic hallucinations?

A

Visual hallucinations when about to fall asleep or waking up

16
Q

What is the treatment of narcolepsy?

A

Modafinil
Clomipramine (cataplexy)
Sodium oxybate (xyrem)

17
Q

What is cataplexy?

A

Strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious.

18
Q

What are the signs of chronic ventilatory failure?

A

Elevated pCO2 (> 6kPa)
pO2 < 8 kPa
Normal blood pH
Elevated bicarbonate

19
Q

Name 3 airway diseases that cause chronic ventilatory failure

A

COPD
Bronchiectasis
OSA

20
Q

Name a chest wall abnormality that causes chronic ventilatory failure

A

Kyphosis

21
Q

Name 2 respiratory muscle weakness which cause chronic ventilatory failure

A

Motor neurone disease (ALS)

Muscular dystrophy

22
Q

Name 2 central hypoventilation problems that cause chronic ventilatory failure

A

Obesity hypoventilation syndrome - BMI > 35

Central hypoventilation syndrome

23
Q

What are symptoms of chronic ventilatory failure?

A
SOB 
Orthopnoea 
Ankle swelling - cor pulmonale symptom
Morning headache 
Recurrent chest infections 
Disturbed sleep
24
Q

What are signs of chronic ventilatory failure?

A
Reflects underlying disease 
Look for paradoxical abdominal wall motion in suspected neuromuscular disease 
Ankle oedema (hypoxic cor pulmonale)
25
Q

What are investigations for chronic respiratory failure?

A

Lung function
Assessment of Hypoventilation
(Fluoroscopic screening of diaphragm)

26
Q

What is the treatment for chronic ventilatory failure?

A

Domicillary non-invasive ventilation (NIV) - applies high inspiratory pressure and low exp pressure
Oxygen failure