Obstructive sleep apnoea Flashcards
1
Q
What is obstructive sleep apnoea?
A
Upper airway obstruction during sleep due to pharyngeal airway collapse > apnoeic episodes > excessive daytime sleepiness
2
Q
Risk factors for OSA
A
- obese
- excessive alcohol
- smoking
- acromegaly
- hypothyroidism
- large tonsils
- Marfan’s syndrome
3
Q
Pathophysiology of OSA
A
- upper airway patency depends on pharngeal dilator muscle activity
- all muscles relax during sleep, including these
- excessive narrowing can be due to: already small pharyngeal size or excessive narrowing occurring with relaxation during sleep
4
Q
Causes of small pharyngeal size
A
- fatty infiltration of pharyngeal tissues + external pressure from increased neck fat
- large tonsils
- craniofacial abnormalities
- extra submucosal tissue e.g. myxoedema
5
Q
Causes of excessive narrowing of airway during sleep
A
- obesity
- increasing age
- muscle relaxants e.g. sedatives, alcohol
- neuromuscular disease with pharyngeal involvement > increased loss of dilator muscle tone e.g. stroke, MND
6
Q
Presentation of OSA
A
- apnoeic episodes (stops breathing in sleep) reported by partner
- snoring
- morning headache
- excessive daytime sleepiness
- concentration problems
- complaints of unrefreshed sleep
7
Q
What scales are used to help in investigations of obstructive sleep apnoea?
A
Epworth sleepiness scale
Berlin scale
8
Q
Diagnosis of obstructive sleep apnoea
A
- overnight oximetry alone
- limited sleep study: oximetry, snoring, body movement, HR, oronasal flow, chest movements, leg movements
- full polysomnography: limited sleep study + EEG + EMG
9
Q
Management of OSA
A
- consider occupation
- patient to notify DVLA
- weight loss
- adjust sleep position
- smoking cessation + reduce alcohol
.
Given based on symptoms/QOL, not severity on investigations - for snorers + mild OSA: mandibular advancement devices | consider pharyngeal surgery as last resort
- for significant OSA: nasal CPAP, consider gastroplasty/bypass
- for severe OSA + CO2 retention: may require NIV prior to CPAP
10
Q
Outline continuous positive airway pressure CPAP
A
- usually given via nasal mask
- upper airway splinted open with ~10cm H2O pressure
- preventing airway collapse, sleep fragmentation + daytime sleepiness
- opens collapses alveoli + improves V/Q matching
11
Q
CPAP vs NIV
A
- CPAP supplies constant positive pressure during inspiration + expiration
- CPAP is NOT a form of ventilatory support
. - NIV does provide ventilatory support with two levels of pressure (IPAP + EPAP)