obstructive sleep apnoea

Question 1

define obstructive sleep apnoea

Answer 1

coexistence of excessive daytime sleepiness with irregular breathing at night

Question 2

what happens in obstructive sleep apnoea (OSA)

Answer 2

complete obstruction of the airway which requires the patient to wake up to alter their position in order to open up the airway again. Repeated apnoea in a night leads to a poor night’s sleep and strain on the cardiovascular system

Question 3

commonest cause of OSA in children and adults

Answer 3

children - adenotonsillar hypertrophy

adult - obesity

Question 4

risk factors of OSA in adults

Answer 4

Male sex (the male to female ratio is 2–3:1).
Obesity.
Neck circumference greater than 43 cm.
Family history of OSAS.
Smoking.
Alcohol intake before bed.
Sleeping supine.
Hypothyroidism.
Craniofacial abnormalities.
Acromegaly

Question 5

risk factors of OSA in children

Answer 5

Adenotonsillar hypertrophy.
Obesity.
Congenital conditions (such as Down’s syndrome, neuromuscular disease, craniofacial abnormalities, achondroplasia, and Prader–Willi syndrome).

Question 6

complications of OSA in children

Answer 6

Behavioural problems, irritability, poor concentration, and poor school performance.
Faltering growth (in severe cases).

Question 7

complications of OSA in adults

Answer 7

HTN
Stroke
RTA

Question 8

when to suspect OSA in adults

Answer 8

Excessive daytime sleepiness and snoring and/or impaired concentration.

Witnessed apnoeas or choking noises while sleeping.

Feeling unrefreshed on waking.

Mood swings, personality changes, or depression.

Nocturia.

Rarely, nocturnal sweating, reduced libido, and gastro–oesophageal reflux disease (GORD).

Question 9

when to suspect OSA in children

Answer 9

Snoring and pauses in breathing, which may be followed by a gasp or snort.

Restlessness and sudden arousals from sleep, laboured breathing, unusual sleep posture (for example head bent backwards), and bedwetting.

Daytime symptoms such as changes in behaviour (for example irritability), poor concentration, decreased performance at school, tiredness and sleepiness, failure to gain weight or grow, and mouth breathing.

Question 10

how to assess OSA patient

Answer 10

ask if they feel sleepy in the morning

Examine for
Enlarged tonsils.
Small jaw.
Nasal blockage (for example due to polyps or a deviated nasal septum).
Signs of chronic obstructive pulmonary disease, respiratory failure, or cor pulmonale

Question 11

what questionnaire is there for OSA

Answer 11

Epworth

Question 12

DD for daytime sleepiness

Answer 12

sleep disturbance - pain/anxiety

sleep deprivation or inadequate sleep opportunity

narcolepsy

depression

restless legs syndrome

drugs - B-blcokers, selective serotonin reuptake inhibitors

hypothyroidism

neuro disorders - MND, Parkinsons

Question 13

DD for nocturnal choking or gasping

Answer 13

GORD
Nocturnal asthma
heart failure
panic attacks and night terrors

Question 14

name of sleep studies

Answer 14

polysomnography or limited sleep study

confirm the diagnosis

Question 15

secondary care treatment options for adults

Answer 15

1st line - CPAP

Intra-oral devices - who snore or have mild OSAS with normal daytime alertness. Intra-oral devices can also be used as an alternative for people unable to tolerate CPAP

Question 16

secondary care treatment options for children

Answer 16

adenotonsillectomy.

contradicted - CPAP