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Systems: Resp. WK > 36. Sleep Apnoea > Flashcards

36. Sleep Apnoea Flashcards

1
Q

What is obstructive sleep apnoea syndrome?

A

recurrent episodes of upper airway obstruction leading to apnoea during sleep (cessation of breathing)

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2
Q

What is obstructive sleep apnoea usually associated with? (4)

A
  • heavy snoring
  • typically unfresh sleep
  • daytime somnolence/sleepiness
  • poor daytime concentration
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3
Q

What are common causes of repeated closure of upper airway? (3)

A
  1. muscle relaxation
  2. narrow pharynx
  3. obesity
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4
Q

What does repeated closure of upper airway cause? (3)

A
  1. snoring
  2. oxygen desaturation
  3. apnoeas and hypoapnoeas (cessation of breathing for 10 secs or greater)
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5
Q

What do apnoeas and hypoapnoeas often lead to?

A

frequent microarousals (sleep/wake dynamics, brain moving from light to deep sleep)

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6
Q

What do frequent microarousals lead to?(2)

A
  1. poor concentration

2. daytime hypersomnolence

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7
Q

Why is it important to treat obstructive sleep apnoea syndrome? (4)

A
  • impaired quality of life
  • marital dysharmony
  • increased risk of renal tubular acidosis (RTAs)
  • associated with hypertension (increased chance of stroke and heart disease)
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8
Q

How prevalent is obstructive sleep apnoea in men and women?

A

2% of adult men

1% of adult women

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9
Q

How is obstructive sleep apnoea diagnosed? (3)

A
  1. clinical history and examination
  2. epworth questionnaire (assesses how sleepy the person is)
  3. overnight sleep study
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10
Q

What does the overnight sleep study involve? (3)

A
  1. pulse ixumetry
  2. limites sleep studies
  3. full polysomnography
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11
Q

What is the definition of apnoea?

A

simply cessation of breathing for at least 10 seconds; associated with heavy snoring

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12
Q

What are pharyngeal muscles meant to be like when a person is sleeping?

A

They should be relaxed and collapsed to some degree while sleeping; but during apnoea pharynx can be narrowed as fatty tissues around it makes it more likely to close

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13
Q

What score does polysonography needs to get to be classified as excessive sleepiness?

A

at least 11/24 score

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14
Q

What does pulse oximetry measure?

A

non-invasive method of monitoring oxygen saturation in the body (SO2)

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15
Q

When is polysomnography most often used?

A

When there is doubt about sleep apnoea diagnosis (not necessary to be used in most cases)

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16
Q

What does polysomnography measure? (9)

A
  1. oronasal airflow
  2. thoracoabdominal movement
  3. oximetry
  4. body position
  5. EEG (electroencephalogram; activity of brain monitoring)
  6. audivisual recoding
  7. EOG (electrooculography; activity of corneo-retinal standing)
  8. EMG (electromyography; monitors muscles and nerve cells like motor neurones)
  9. ECG (electrocardiogram; measures heart rhythms and electrical activity)
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17
Q

What SO2 desaturation rate is classified as “normal”?

A

0-5

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18
Q

What SO2 desaturation rate is classified as “mild”?

A

5-15

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19
Q

What SO2 desaturation rate is classified as “moderate”?

A

15-30

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20
Q

What SO2 desaturation rate is classified as “severe”?

A

> 30

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21
Q

What are 3 treatment options for sleep apnoea?

A
  1. identify exacerbating factors ( lifestyle measures)
  2. continous positive airway pressure (CPAP); main treatment
  3. mandibular repositioning splint
22
Q

What are common exacerbating factors that should be addressed when treating sleep apnoea? (3)

A
  1. weight reduction
  2. avoidance of alcohol
  3. diagnose and treat endocrine disorders e.g. hypothyrodism, acromegaly
23
Q

What is CPAP? (continuous positive airway pressure)

A
  • Machine that supplies a constant and steady air pressure on inspiration and expiration.
  • generates with positive pressure using a hose mask and a nose piece
24
Q

How does mandibular repositioning splint work?

A

It’s designed to move lower jaw forward creating more space at the back of throat

25
What are the driving regulations for patients with sleep apnoea? (2)
- advise patients with sleep apnoea and excessive daytime somnolence NOT to drive or restrict driving - inform DVLA of their condition
26
When should a patient with sleep apnoea be allowed to drive again?
Once satisfactorily treated
27
What is nercolepsy?
Long-term brain disorder that causes a person to suddenly fall asleep at inappropriate times
28
How prevalent is narcolepsy in a population?
0.05%
29
Is narcolepsy familial?
yes
30
What 2 genes are associated with narcolepsy?
1. HLA-DRB1 *1501 | 2. HLA DQB1* 0602
31
What are clinical features of narcolepsy? (4)
1. cataplexy 2. excessive daytime somnolence/ sleepiness 3. hypnagogic hallucinations 4. sleep paralysis
32
What is cataplexy?
- Sudden and transient episode of muscle weakness typically triggered by strong emotions such as laughing, crying or terror. - Person collapses on the floor possibly asleep but has full awareness (brain unable to regulate sleeping and waking patterns)
33
What chemical is absent in narcolepsy patients?
hypocretin (orexin) which regulates wakefulness
34
What are the treatment options for narcolepsy? (3)
1. modafinil (stimulant for sleepiness) 2. clomipramine (for cataplexy, antidepressant) 3. sodium oxybate (Xyrem)
35
What do patients at extreme end of sleep apnoea often develop?
chronic ventilatory failure
36
What are the statistics for PCO2, PO2, pH and bicarbonate levels in chronic ventilatory failure?
1. elevated pCO2 (>6kPa) 2. pO2<8 kPA 3. normal blood pH 4. elevated bicarbonate
37
Why is pH at a constant level but bicarbonate levels are elevated?
Body will retain bicarbonate in kidneys to buffer excess acid (pH is normal but bicarbonate rises)
38
What are causes (aetiology) for chronic ventilatory failure? (4)
1. airway disease 2. chest wall abnormalities 3. respiratory muscle weakness 4. central hypoventilation
39
What are 3 common airway disease which lead to chronic ventilatory failure?
1. COPD 2. brochiectasis 3. OSA; obstructive sleep apnoea (disorder of upper airway)
40
What is a common chest wall abnormality which leads to chronic ventilatory failure?
kyphoscoliosis (combination of kyphosis and scoliosis)
41
What are common conditions of respiratory muscle weakness leading to chronic ventilatory failure? (2)
1. motor neurone disease (ALS) | 2. muscular dystrophy
42
What are common central hypoventilation syndromes leading to chronic ventilatory failure? (2)
1. obesity hypoventilation syndrome | 2. central hypoventilation syndrome (Ondine's curse)
43
What is the most common cause of central hypoventilation?
Obesity (but congenital conditions and sedative drugs can also cause it)
44
What are typical symptoms of chronic ventilatory failure? (6)
1. breathlessness 2. orthopnoea (dyspnoea when laying flat) 3. ankle swelling (cor pulmonale causes this) 4. morning headache 5. recurrent chest infections 6. disturbed sleep
45
What do examination findings show in chronic ventilatory failure patients?
Reflect underlying disease by looking for: - paradoxical abdominal wall motion in suspected neuromuscular disease (weakness in diaphragm which moves in opposite directions) - ankle oedema (hypoxic cor pulmonale)
46
What are the 4 investigation steps for neuromuscular disease?
1. lung function 2. blood count 3. assessment of hypoventilation 4. fluoroscopic screening of diaphragms
47
What are 2 lung function tests done for neuromuscular disease?
1. lying and standing VC; vital capacity | 2. mouth pressures/SNIP
48
What are 3 assessments of hypoventilation tests done for neuromuscular disease?
1. early morning ABG (arterial blood gas) 2. overnight oximetry 3. transcutaneous CO2 monitoring
49
When should CO2 readings be obtained in neuromuscular disease investigation patient?
Overnight since patient will hypoventilate during REM sleep especially
50
What does a high ratio of FEV: FVC suggest in a pulmonary function test?
restrictive pattern
51
What is the treatment for chronic ventilatory failure? (3)
1. domicillary non-invasive ventilation (NIV) 2. oxygen therapy 3. t-IPPV (tracheostomy ventilation)
52
How does Domicillary non-invasive ventilation work (NIV)?
- like CPAP but more sophisticated - patient wears mask over nose and when breathing in, the machine will sense it and deliver positive pressure to airway - air can be moisturised before breathing in

Systems: Resp. WK (40 decks)

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