Upper airways disease: obstructive sleep apnoea (R1)

Question 1

Definitions: what is obstructive sleep apnoea

Answer 1

Obstructive: there is a blockage to the upper airways during sleep
Apnoea: leads to inadequate/stopped breathing

Question 2

Aetiology: what are 4 causes of upper airway obstruction?

Answer 2

Obesity
Bone abnormalities: recessed jaw, Down syndrome, premolar extraction
Soft tissue abnormalities: enlarged adenoids, tonsils, tongue
Allergies- can lead to nasal obstruction

Question 3

Pathophysiology: describe

Answer 3

Question 4

Complications
- 3 classes of complications?

Answer 4

Neurocognitive sequelae
Cardiovascular sequelae
Metabolic sequelae

Question 5

Complications
- What are the neurocognitive sequelae?

Answer 5

Excessive daytime sleepiness
Cognitive dysfunction - problems with attention/concentration, learning and memory
Mood disorders - depression, anxiety, irritability
Increased risk of MVA’s

Question 6

Complications
- What are the cardiovascular sequelae

Answer 6

Hypertension: due to SNS activation
Arrhythmias: hypoxia irritates heart cells
Increased risk of AMI, heart failure, stroke

Question 7

Complications
- What are the metabolic sequelae?

Answer 7

Oxidative stress
Metabolic syndrome - obesity, diabetes, hyperlipidemia, hypertension

Question 8

History
- Symptoms? (During the night, next morning, neurocognitive sequelae)

Answer 8

Question 9

History
- What score is used to score daytime sleepiness?

Answer 9

The Epworth sleepiness scale

Question 10

Risk factors?

Answer 10

Question 11

Exam
- General inspection
- Vital signs
- Face
- Neck

Answer 11

Question 12

Investigation
- What test is used?

Answer 12

Polysomnography (sleep study)

Question 13

Investigation
- What tests does it do?
- How does it quantify severity of OSA?

Answer 13

Question 14

Management
- What are the broad categories of treatment?

Answer 14

Lifestyle interventions
Non invasive treatments: CPAP, oral appliances
Surgeries
Hypoglossal nerve stimulation

Question 15

Management
- Lifestyle interventions: include

Answer 15

Weight loss
Sleeping on side
Avoid alcohol and sedatives before bed
Stop smoking

Question 16

Non invasive therapy
- Is CPAP first line?
- Is CPAP more effective than oral appliances?
- Why might oral appliances (and surgical treatments) be used?
- What are the two types of oral appliances?

Answer 16

Yes
Yes
If CPAP is not tolerated
Mandibular repositioning device, tongue retracting device (for enlarged tongue)

Question 17

Surgeries
- When are they indciated?
- May include?
- Describe hypoglossal nerve stimulation

Answer 17

When CPAP or oral appliances are not tolerated
Removal of adenoids/tonsils, maxillo-mandibular advancement

Question 18

How would you explain OSA to a patient?

Answer 18

Obstructive: airways become narrowed
Sleep apnoea: leads to you stopping breathing.
Then you wake up gasping for air.
Can happen multiple times during the night.
In the day you can become sleepy. Your concentration, memory, and mood can be affected.