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Week 8 - Respiratory > Obstructive sleep apnoea > Flashcards

Obstructive sleep apnoea Flashcards

1
Q

What is the definition of obstructive sleep apnoea?

A

Recurrent episodes of partial or complete upper (pharyngeal) airway obstruction during sleep, intermittent hypoxia and sleep fragmentation

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2
Q

How does obstructive sleep apnoea syndrome manifest?

A

As excessive daytime sleepiness

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3
Q

Explain the mechanism of obstructive sleep apnoea

A
  • Pharyngeal narrowing
  • Negative thoracic pressure
  • Arousal from sleep
  • Blood pressure surge (heart attack and stroke risk) and sleep disruption (sleepiness, reduced quality of life and risk of RTAs)
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4
Q

Describe the epidemiology of sleep apnoea

A
  • Men 2-3 >premenopausal women
  • Average age of incidence 40-50 years
  • Incidence is increasing with the obesity epidemic
  • COPD overlap is estimated in 1% of adults
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5
Q

What are the symptoms of obstructive sleep apnoea?

A
  • snorer
  • witnessed apnoeas
  • Disruptive sleep - nocturne/choking/dry mouth/ sweating
  • Unrefreshed sleep
  • Daytime somnolence
  • Fatigue/low mood/poor concentration
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6
Q

What clinical examinations should be carried out in someone with a suspected sleep apnoea?

A
  • Weight
  • BMI
  • BP
  • Neck circumference
  • Craniofacial appearance (retrognathia, micrognathia)
  • Tonsils
  • Nasal patency
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7
Q

What can be used to asses daytime sleepiness?

A
  • Epworth sleepiness score
  • The STOP-BANG questionnaire
  • The Berlin questionnaire
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8
Q

What are the available investigations for sleep apnoea?

A
  • Limited polysomnography
  • Full polysomnography
  • Transcutaneous oxygen saturations and carbon dioxide assessment
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9
Q

What is measured in a limited polysomnography?

A
  • Oxygen saturations
  • heart rate
  • Flow
  • Thoracic and abdominal effort
  • Position
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10
Q

What are the investigations of a full polysomnogrpahy?

A
  • EEG - sleep staging
  • Video
  • Audio
  • Thoracic and abdominal bands
  • Position
  • Flow
  • Oxygen saturations
  • Limb leads
  • Snore
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11
Q

What are the advantages of a full polysomnography over a limited polysomnography?

A
  • Correct patient
  • Accurate sleep assessment of sleep efficiency
  • Sleep staging via EEG
  • Parasomnic activity- acting out dreams, sleep talking
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12
Q

What is apnoea in regards to the results of sleep studies?

A
  • The cessation, or near cessation, of airflow

* 4% oxygen desaturation, lasting >/10 seconds

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13
Q

What is hypopnea in regards to the results of a sleep study?

A

•Reduction of airflow to a degree insufficient to meet the criteria for an apnoea

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14
Q

What are respiratory effort related arousals?

A

Arousals associated with a change in airflow that does not meet the criteria for apnoea or hypopnoea

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15
Q

How is the apnoea-hypopnea index calculated?

A

Adding the number of apnoeas and hypopnoeas and dividing by the total sleep time (in hours)

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16
Q

What is the oxygen desaturation index?

A

The number of times per hour of sleep that the SpO2 falls >/4% from the baseline e

17
Q

What apnoea-hypopnea score is diagnostic of obstructive sleep apnoea?

A

> /15 or >5 with compatible symptoms

18
Q

What is a severe sleep apnoea as classified by AHI?

A

> 30

19
Q

What would you see in a sleep study result in someone with a central apnoea?

A
  • Cessation of airflow
  • No abdominal movement
  • No thoracic movement
20
Q

What underlying conditions could worsen sleep apnoea?

A
  • Tonsils
  • Hypothyroidism
  • Nasal obstruction
  • Obesity
  • Alcohol
21
Q

What does CPAP do?

A
  • Splints the airway open
  • Stops snoring
  • Stops sleep fragmentation
22
Q

What compliance is required for CPAP to be effective?

A

> 4 hours for >70% of days

23
Q

What is the treatment of OSAS in someone who can not tolerate the CPAP machine?

A
  • Mandibular advancement device

* It moves the lower jaw forwards

24
Q

What is a sleep position trainer?

A
  • Only suitable for supine OSA
  • Vibrates when patient is lying on their back
  • Takes weeks to change the sleeping position
25
Q

What are the risks of an untreated OSAS?

A
  • Hypertension
  • Right heart strain
  • Cardiovascular disease
  • Increased risk of CVA
  • Increased accidents at work/poor concentration
  • More likely to have a road traffic accident

Week 8 - Respiratory (12 decks)

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