Obstructive Sleep Apnoea

Question 1

Define obstructive sleep apnoea

Answer 1

A disease characterised by recurrent prolapse of the pharyngeal airway and apnoea (cessation of airflow for >10s) during sleep, followed by arousal from sleep. AKA Pickwickian Syndrome.

Question 2

Explain aetiology/ risk factors of obstructive sleep apnoea

Answer 2

Occurs due to narrowing of the upper airways bc of the collapse of soft tissue of the pharynx. This is due to decreased tone of the pharyngeal dilators during sleep.

Risk factors:

• Weight gain
• Smoking
• ETOH
• Sedatives
• Enlarged tonsils and adenoids in children
• Macroglossia
• Marfan’s Synd
• Craniofacial Abn
• Idiopathic Pulmonary fibrosis
  *

Question 3

Summarise the epidemiology of obstructive sleep apnoea

Answer 3

COMMON

5-20% of men >35

2-5% of women >35

increases with age

Question 4

Recognise the presenting symptoms of obstructive sleep apnoea

Answer 4

Excessive daytime sleepiness

Irritability and mood changes

Difficulty concentrating

Restless, unrefreshing sleep

Morning headaches

Dry mouth

±snoring, nocturnal apnoeic episodes/ chocking

Question 5

Recognise the signs of obstructive sleep apnoea

Answer 5

Enlarged tonsils

Large tongue

Long/ thick uvula

Retrognathia

Neck circumference >42cm in men and >40 cm in women

Obesity

HTN

Question 6

Identify the appropriate investigations for obstructive sleep apnoea

Answer 6

Polysomnography -sleep study: pulse oximeter, heart rate, chest expansion, EEG, EMG, electro-oculographic recording, respiratory effort, airflow

Apnoea index »15 episodes/hour

ABG, TFTs

Awake fiberoptic endoscopy - look for nasal polyps

Question 7

Generate a management plan for patients with obstructive sleep apnoea

Answer 7

RF management: stop smoking, lose weight

CPAP

Surgery for pharyngeal obstruction: tonsillectomy / uvulopalatpharyngeoplasty

Implantable hypoglossal neurostimulation

Modafinil: wakefulness-promoting drug

Question 8

Identify possible complications of obstructive sleep apnoea

Answer 8

• Pulmonary HTN
• T2RF
• Cor pulmonale
• Cardiovascular disease (hypertension, dysrhythmias, MI, and heart failure, chronic kidney disease)
• Impaired glucose metabolism
• Depression
• RTA
• Cognitive dysfx

Question 9

Summarise the prognosis for patients with obstructive sleep apnoea

Answer 9

Patients efficiently treated may report improvements in alertness and some improvement in quality of life, mood, and cognitive function. Mortality and morbidity from cardiovascular disease is also reduced. Risk of motor vehicle accidents seems to be lower in treated versus untreated patients.