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>10 s) during sleep, followed by arousal from sleep.

Also known as Pickwickian Syndrome

Question 2

Explain the aetiology/risk factors of obstructive sleep apnoea

Answer 2

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

Associated with:
Weight gain
Smoking
Alcohol
Sedative use
Enlarged tonsils and adenoids in children
Macroglossia
Marfan's syndrome
Craniofacial abnormalities

Question 3

Summarise the epidemiology of obstructive sleep apnoea

Answer 3

COMMON
5-20% of men > 35 yrs
2-5% of women > 35 yrs
Prevelance increases with age

Question 4

Recognise the presenting symptoms of obstructive sleep apnoea

Answer 4

Excessive daytime sleepiness
Unrefreshing or restless sleep
Morning headaches
Dry mouth
Difficulty concentration
Irritability and mood changes
Partner reporting snoring, nocturnal apnoeic episodes or nocturnal choking

Question 5

Recognise the signs of obstructive sleep apnoea on physical examination

Answer 5

Large tongue
Enlarged tonsils
Long or thick uvula
Retrognathia (pulled back jaws)
Neck circumference - >42 cm in males, >40 cm in females
Obesity
Hypertension

Question 6

Identify appropriate investigations for obstructive sleep apnoea

Answer 6

Sleep Study - Monitor airflow, respiratory effort, pulse oximetry and heart rate

Bloods - TFTs, ABG