Flashcards in Sleep Disorders Deck (14):
What are the causes of daytime sleepiness
1. Lifestyle: poor sleep hygiene
2. Sleep breathing disorders
3. Drugs and alcohol
4. Idiopathic hypersomnia
These are considered Tiredness/lethargy, not sleepiness:
• RLS/Periodic limb movement disorder
• Insomnia and circadian disorders
• Postviral (tiredness and fatigue)
How is sleepiness different to tiredness or lethargy?
Sleepiness will fall asleep (e.g. sitting in front of TV)
Tiredness or lethargy will not fall asleep when resting
What scoring system is used to assess sleepiness?
Epworth Sleepiness score
How likely are you to fall asleep in contrast to just feeling tired
What respiratory control changes happen at the onset of sleep?
1. loss of wakefulness drive to breathe and behaviours influences
2. several other resp control mechanisms are down-regulated (respiratory reflexes, chemosensitivity, upper airway and resp pump muscle tone)
3. Chemical control is the major regulator of breathing during sleep
What are the two types of sleep apnoea?
Obstructive and Central
What the cardinal symptoms of obstructive sleep apnoea?
Excessive daytime somnolence
What are some other nocturnal and daytime symptoms?
- Disrupted, restless, unrefreshed sleep
- Nocturnal choking, gasping
- Memory impairment
- Mood disturbance
- Uncontrolled HTN (if marked O2 desaturation)
What are the risk factors of OSA?
- Age (with age the muscles relax more)
- Male gender (males have more collapsable throats)
- Obesity (there is internal fat deposits in the lateral pharyngeal walls, therefore narrow upper airways)
- Alcohol or sedatives (makes upper airway muscle more)
- Upper airway morphology including nasal obstruction (e.g. blocked nose)
What Ix do we use to diagnose sleep apnoea?
Sleep studies: can see when patient is breathing and not breathing
Central v Obstructive Apnoea
The main difference between central and obstructive is that in central there is no effort to breathe as the respiratory centre is not working
In OSA, the chemical feedback induces a will to breathe
How do we diagnose sleep apnoea?
AHI > 5 events per hour (events/total sleep time)
- > apnoea: complete cessation of airflow for 10 seconds or longer regardless of oxygen destauration
- > hyponoea: 30% or more reduction in airflow associated with >/= 3% oxygen desaturation or an alpha wave arousal from sleep (small drops in ventilation)
How do we manage OSA?
When to treat depends on how much the day time sleepiness is bothering the patient.
- Conservative treatments: weight loss, avoid alochol, tobacco and sedatives, body position (lying on the side) treat nasal congestion, treat medical disorders like hypothyroidism)
- CPAP: increases the pressure throughout the respiratory tract (does not breathe for you i.e. not a biPAP or vPAP)
- Oral appliances: if failed CPAP treatment, it pulls the lower throat forward to prevent collapse of upper airway
- Surgery: in adults, surgery does not work well therefore not first line
Two standard treatments for sleep apnoea: WEIGHT LOSS AND CPAP
Ask about sleep apnoea in a pt if the look like
Fat neck, short neck
What is central sleep apnoea?
Apnoeas or hyponoeas caused by a loss of central respiratory drive