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Respiratory System (CA) > 32. Sleep Apnoea and Neuromuscular Respiratory Disorders > Flashcards

32. Sleep Apnoea and Neuromuscular Respiratory Disorders Flashcards

1
Q

What is Obstructive Sleep Apnoea Syndrome?

A 
Recurrent episodes of upper airway obstruction leading to apnoea during sleep
Usually associated with heavy snoring
Typically unrefreshing sleep
Daytime somnolence /sleepiness
Poor daytime concentration
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2
Q

What three things lead to repeated closure of the upper airway?

A

Muscle relaxation
Narrow Pharynx
Obesity

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3
Q

What can repeated closure of upper airway lead to?

A

Snoring
Oxygen desaturation
Apnoeas and Hypopnoea

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4
Q

What can apnoeas and hypopoeas lead to?

A

Frequent microarousals

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5
Q

What does frequent microarousals cause?

A

Poor concentration

Daytime hypersomnolence

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6
Q

What are some problems associated with OSAS?

A

Impaired quality of life
Marital dysharmony
Increased risk of RTA’s
Associated with hypertension, increased risk of stroke and probably increased risk of heart disease

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7
Q

What is the prevalence of sleep apnoea?

A

2% adult men

1% adult women

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8
Q

How is OSAS diagnosed?

A 
Clinical history and examination
Epworth Questionnaire
Overnight sleep study
- pulse oximetry
- limited sleep studies
- full polysomnography
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9
Q

What is involved in Polysomnography?

A 
Oronasal airflow
Thoracoabdominal movement
Oximetry
Body position
EEG
(Audiovisual recording)
EOG
EMG (peripheral muscle)
ECG
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10
Q

How is OSA Severity measure through desaturation rate/AHI?

A

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

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11
Q

How is OSAS treated?

A

Identify exacerbating factors
weight reduction
avoidance of alcohol
diagnose and treat endocrine disorders e.g. hypothyroidism, acromegaly
Continuous positive airways pressure (CPAP)
Mandibular repositioning splint

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12
Q

What are the effects of OSAS on driving?

A

Advise patients with sleep apnoea and excessive daytime somnolence not to drive or restrict driving and to inform DVLA of their condition

Once satisfactorily treated should be allowed to drive

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13
Q

What are the facts about Narcolepsy?

A

Prevalence 0.05%
Familial
Associated with HLA - DRB11501 and HLA DQB1 0602

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14
Q

What are the clinical features of Narcolepsy?

A

Cataplexy
Excessive daytime somnolence
Hypnagogic hallucinations
Sleep paralysis

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15
Q

How is narcolepsy treated?

A

Modafinil
Clomipramine (for cataplexy)
Sodium Oxybate (Xyrem)

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16
Q

What are the body conditions for Chronic Ventilatory Failure?

A

Elevated pCO2 (> 6.0 kPA)
pO2 < 8 kPA
Normal blood pH
Elevated bicarbonate

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17
Q

What is the aetiology of CVF?

A 
Airways disease
COPD
Bronchiectasis
OSA
Chest wall abnormalities
Kyphoscoliosis
Neuromuscular disease
Muscular dystrophy
Motor neurone disease (ALS)
Central Hypoventilation
Obesity hypoventilation syndrome
Central hypoventilation syndrome (Ondine’s curse)
18
Q

What are the typical symptoms of CVF?

A 
Breathlessness
Orthopnoea
Ankle swelling
Morning headache
Recurrent chest infections
Disturbed sleep
19
Q

What should the examination findings of CVF be?

A 
Reflects underlying disease
Particularly look for paradoxical abdominal wall motion in suspected neuromuscular disease
Ankle oedema (hypoxic cor pulmonale)
20
Q

What are the investigations for neuromuscular disease?

A 
Lung function
- Lying and standing VC
- Mouth pressures / SNIP
Assessment of Hypoventilation
- Early morning ABG
- Overnight oximetry
- transcutaneous CO2 monitoring
(Fluoroscopic screening of diaphragms)
21
Q

What is the treatment for CVF?

A

Domicillary Non Invasive Ventilation (NIV)
Oxygen therapy
(t-IPPV)

22
Q

What is the respiratory patterns in infants?

A

periodic/apneic before 36 weeks PCA

increased regular resp after 36 weeks

23
Q

What is common sleeping patterns in Newborns?

A

16-18h asleep
sleep-wake states alternate in 3-4 h cycles
then start to adapt to light-dark/social cues

24
Q

What is REM?

A

Rapid Eye Movement sleep

25
Q

What percentage of a babies sleep is REM?

A

50% REM

26
Q

What is common sleeping patterns for infants of 6 months?

A

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

27
Q

What is common in an infants 2nd year

A

12h asleep

1 daytime nap

28
Q

What happens to the balance of REM and NREM sleep?

A

REM sleep decreases

29
Q

What is common sleeping patterns in Prepubertal children?

A

highly efficient sleep

30
Q

What is common sleeping patterns in Adolecense?

A

increased awakenings

need more/obtain less

31
Q

How are sleeping patterns assessed?

A 
Polysomnography
Direct behavioural observation
Time-lapse video
Movement sensors in cot mattress
Oxygen/CO2 monitoring
32
Q

What is normal and what is abnormal?

A

Abnormal:
Napping and enuresis after 3-5y
1y old sleeping 8h at night and not napping
Unmedicated adult unrousable from sleep

Normal:
Sleep walking in toddlers

33
Q

What are normal phenomena?

A 
Sleep walking
- middle childhood
Sleep terrors
- “look of fear”
Hypnic jerks
34
Q

What are the facts about sleeplessness?

A 
Mainly behavioural problems
- Infants 1+ arousal for 1-5 mins each night
- “self-soothers”
- “signalers”
Medication
Neurological disorders
- melatonin
35
Q

What are the facts about excessive sleepiness?

A 
Insufficient sleep
OSAS
Narcolepsy
- often not diagnosed in childhood
- cataplexy
- orexin deficiency
36
Q

What is primary snoring?

A 
Definition:
- snoring without apnea, hypoventilation, hypoxia, hypercarbia, daytime symptoms
Prevalence ~10%
? Progresses to OSAS
? Adenotonsillectomy
37
Q

What is OSAS?

A 
Commonest pre-school child (adenoids)
Prevalence ~2%
Morbidity
- failure to thrive
- neurocognitive defects/adhd
- systemic hypertension
- cor pulmonale
38
Q

What are the differences between adult and childhood OSAS?

A

Daytime Sleepiness
Adult - Main Symptom
Child - Minority

Obesity
Adult - Majority
Child - Minority

Mouth breathing
Adult - No
Child - Common

Gender
Adult - M:F = 2:1
Child - M:F = 1:1

Enlarged tonsils
Adult - Uncommon
Child - Common

Obstructive pattern
Adult - Apnea
Child - Hypoventilate

39
Q

How is OSAS treated in children?

A

Adenotonsillectomy
(CPAP)
Weight loss
Avoid environmental tobacco smoke

40
Q

What are other respiratory disorders in children?

A 
Chronic neonatal lung disease
- hypoxaemia in REM sleep (similar COPD)
- cardiac complications
Cystic fibrosis
- FEV1 30-60% associated with lowered SaO2 (~8%)
- less REM/more awakenings
Asthma
41
Q

What are some neurologic disorders associated with children?

A 
Cerebral palsy
- fragmented sleep/delayed onset
- melatonin
Down syndrome
- OSAS
Prader-Willi syndrome
- excessive daytime sleepiness
Neuromuscular disease (Duchenne’s MD)
- death due to respiratory failure
- nocturnal desaturation associated with FVC <1litre
- increasing quality of life/survival with BiPAP

Respiratory System (CA) (32 decks)

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