Lectures

Question 1

What is sleep apnoea?

Answer 1

When a person stops breathing for up to 10 seconds while sleeping.

Question 2

What is narcolepsy?

Answer 2

sleep disorder which affects the brains’ ability to regulate the normal sleep-wake cycle. This can lead to symptoms such as disturbed night-time sleep and excessive sleepiness throughout the day.

Question 3

What is cataplexy?

Answer 3

Cataplexy- lose muscle tone and collapse, usually during emotional states

Question 4

What are the symptoms of sleep apnoea?

Answer 4

¥ Daytime somnolence /sleepiness
¥ Poor daytime concentration
¥ Waking up during the night

The patient tends to wake up frequently during the night due to not being able to breath which results in an unrefreshing sleep.

Question 5

State three reasons why sleep apnoea may occur

Answer 5

¥ Muscle relaxation
¥ Narrowing of the pharynx
¥ Obesity

Question 6

State some life style consequences which could occur with sleep apnoea.

Answer 6

¥ Impaired quality of life – constantly feeling tired
¥ Marital disharmony
¥ Increased risk of RTA’s
¥ Associated with hypertension, increased risk of stroke and probably increased risk of heart disease.

Question 7

State some common consequences of sleep apnoea for children.

Answer 7

o failure to thrive
o neurocognitive defects/adhd
o systemic hypertension
o cor pulmonale

Question 8

What treatment can be done to help with sleep apnoea?

Answer 8

Simple life style changes such as; alcohol, exercise, diet, weight reduction

Continuous positive airways pressure (CPAP)

Adenotonsillectomy

Mandibular repositioning splint

Question 9

Name five tests that can be done to help confirm the diagnosis of sleep apnoea.

Answer 9

¥	Clinical history and examination
¥	Epworth Questionnaire – filled in by patient and partner independently. 11/24 usually indicates apnoea. 
¥	Time lapse video
¥	Oxygen/CO2 monitoring 
¥	Overnight sleep study

Question 10

what is the prevalence of sleep apnoea in the public?

Answer 10

2% of men and 1% of women

Question 11

state the symptoms of narcolespy.

Answer 11

¥ Cataplexy- lose muscle tone and collapse, usually during emotional states
¥ Excessive daytime somnolence
¥ Hypnagogic hallucinations
¥ Sleep paralysis

Question 12

Does narcolepsy tend to run in families?

Answer 12

yes

Question 13

What drugs can be used to treat narcolepsy

Answer 13

¥ Modafinil
¥ Clomipramine (for cataplexy)
¥ Sodium Oxybate (Xyrem)

Question 14

Chronic ventilatory failure: what are the levels of PO2 and PCO2 like in the blood?

Answer 14

¥ Elevated pCO2 (> 6.0 kPA)

¥ pO2

Question 15

Can you state the symptoms associated with chronic ventilation failure

Answer 15

• Breathlessness
• Orthopnoea- SOB lying flat
• Ankle swelling
• Morning headache- retension of CO2 during the night
• Recurrent chest infections
• Disturbed sleep

Question 16

What are some of the causes of chronic ventilation failure?

Answer 16

• Airways disease
• COPD
• bronchiectasis
• OSA - obstructive sleep apnoea
• Chest wall abnormalities
• Kyphoscoliosis
• Respiratory muscle weakness
• motor neurone disease (ALS)
• muscular dystrophy
• Central hypoventilation
• obesity hypoventilation syndrome
• central hypoventilation syndrome (Ondine’s curse)

Question 17

State an examination finding with the condition chronic ventilatory failure.

Answer 17

paradoxical abdominal wall motion - diaphragm is weak and cannot relax properly so there is a dip in the abdomen. 
Ankle oedema (hypoxic cor pulmonale)
Lying and standing vital capacity

Question 18

With chronic ventilatory failure, will the spirometry show obstructive or restrictive patterns?

Answer 18

restrictive

Question 19

What is the treatment for chronic ventilatory failure?

Answer 19

♣ Domicillary Non Invasive Ventilation (NIV)

♣ Oxygen therapy

Question 20

State three normal sleeping phenomena

Answer 20

o Sleep walking - middle childhood
o Sleep terrors - “look of fear”
o Hypnic jerks

Question 21

what is primary snoring ?

Answer 21

Snoring without apnea (stop breathing), hypoventilation, hypoxia, hypercarbia, daytime symptoms

Question 22

what is the prevalence of primary snoring?

Answer 22

~10%

Question 23

Name some Neurological conditions associated with respiratory muscle weakness.

Answer 23

Cerebral palsy

• fragmented sleep/delayed onset
• Treatment - melatonin

Down syndrome
- OSAS

Prader-Willi syndrome
- excessive daytime sleepiness

Neuromuscular disease (Duchenne’s MD)