Obstructive sleep apnoea

Question 1

What are the predisposing factors?

Answer 1

obesity
macroglossia: acromegaly, hypothyroidism, amyloidosis
large tonsils
Marfan’s syndrome

Question 2

What are the features of Obstructive sleep apnoea?

Answer 2

excessive snoring and may report periods of apnoea.

Question 3

What are the consequences of obstructive sleep apnoea?

Answer 3

daytime somnolence
compensated respiratory acidosis
hypertension

Question 4

What is used to asses the severity obstructive sleep apnoea?

Answer 4

Assessment of sleepiness
Epworth Sleepiness Scale - questionnaire completed by patient +/- partner
Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)

Question 5

What is used to diagnose obstructive sleep apnoea?

Answer 5

sleep studies (polysomnography) - ranging from monitoring of pulse oximetry at night to full polysomnography where a wide variety of physiological factors are measured including EEG, respiratory airflow, thoraco-abdominal movement, snoring and pulse oximetry

Question 6

What is the management for obstructive sleep apnoea?

Answer 6

weight loss
continuous positive airway pressure (CPAP) is first line for moderate or severe OSAHS
intra-oral devices (e.g. mandibular advancement) may be used if CPAP is not tolerated or for patients with mild OSAHS where there is no daytime sleepiness
the DVLA should be informed if OSAHS is causing excessive daytime sleepiness
limited evidence to support use of pharmacological agents