Obstructive Sleep Apnoea Flashcards
How long do they not breathe for before it is classed as apnoea?
Why do patients have bad sleep?
10 seconds without breathing
Frequent waking - it is usually forgotten by the patient but they are tired
What is the main cause?
It is common in those who are obese. Over what circumference is classed as a large neck?
What may cause it in children?
Pharyngeal obstruction
> 40 cm
Enlarged tonsils
S+S:
What would a partner notice?
Why do they get morning headaches?
Why do they gt daytime sleepiness and difficulty concentrating?
Why do they get hypertension?
Why do they get reduced libido?
Why do they get nocturia?
What are the 3 Sās of OSA?
Snoring
Gasping
Choking during sleep
As O2 levels drop, CO2 goes up, which causes the blood vessels in and around the brain to dilate. This dilation of the blood vessels in the brain causes the pain we identity as a headache.
Apnoeic episodes lead to sympathetic nervous system spikes - Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system.
The inability to breathe properly during sleep ā produce lower levels of testosterone, resulting in decreased libido and sexual activity
The heart excretes a hormone called ANP (Atrial natriuretic peptide) that tells the body to get rid of sodium and water, resulting in nocturia. - READ UP ON
Snoring
Sleepiness
Sleep apnoea episodes
Risk factors:
What is the main risk factor?
What 3 substances taken orally could increase your risk by lowering your GCS?
What 2 endo conditions increases risk?
What anatomical factors could cause OSA?
What soft tissue structures may be enlarged causing?
Being Male and Increased AGE as well!!!
OBESITY!!!!
Use of alcohol, sedatives, muscle relaxants
Hypothyroidism
Acromegaly
Small lower jaw
Overbite
Enlagred tongue - macroglossia
Tonsiller hypertrophy
Enlarged adenoids
Long soft palate
Investigations:
Initial examination:
- What is the ESS and what is it used to measure?
- What may be measured physically?
- Metabolic tests? - 2
- What bedside inv needs to be done because of their hypoxaemia and hypercapnia?
- What can chronic hyperaemia lead to, requiring a FBC?
What 2 things may be done during sleep for a simple diagnosis?
What is the Mallampati score?
What is the gold standard for diagnosis?
Polycythaemia
Epworth Sleepiness Scale - >10 requires referral to sleep service
Neck circumference BMI Nasal patency Tongue size Oropharynx for large tonsils
BP - looking for systemic HTN
Glucose
ABG
SATS
Video recordings
Relationship of tongue size to pharyngeal size
Overnight sleep studies/Polysomnography
Investigations - Polysomnography (PSG):
What physiological measures does it measure during sleep?
What is the apnoea-hypopnoea index (API)?
How do you know it is central or obstructive?
SATS Airflow at the nose and mouth ECG EMG Chest and abdo movements
The number of apnoeas or hypopnoeas in 1 hr
Mild - 5-15
Moderate - 15-30
Severe -»_space;30
OA - Absence of airflow despite persistent ventilatory effort
CA - Absence of airflow due to lack of ventilatory effort
Management - Lifestyle:
What is advised to all patients?
Sleep hygiene
- What sedatives should be avoided in the evening?
- How are they advised to lie down?
Who needs to be notified if they have daytime sleepiness?
On their side - not on back
LOSE WEIGHT - may indlcude bariatric surgery
Alcohol
DVLA
Management - CPAP:
What does it stand for?
What type of mask can it be administered with? - 2
Continuous positive airway pressure
Nasal or facial mask
Management - Other options:
Mandibular advancement devices - what is it?
What is done for large tonsils?
Removal of obstructing structure can be done (eg. Adenoids) or opening of the airway. READ THE PRESENTATION FROM SLIDE 40
It is worn like a mouth guard.
It holds the airways open.
Tonsillectomy
Complications:
Complications of sleepiness?
Why do they get pul HTN?
Car crashes!!! X7
Work accidents
Due to hypercapnia - leads to vasoconstriction
Others are:
HTN Myocardial infarction Heart failure Stroke Sudden death
OSA and Hypertension:
What 2 changes leads to this?
What detects these changes?
What does the night time HTN lead to?
Repetitive hypoxemia and hypercapnia
Chemoreceptors - activates sympathetics
Chronic HTN
