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Year 3 > Obstructive sleep apnoea (RESP) > Flashcards

Obstructive sleep apnoea (RESP) Flashcards

1
Q

Define OSA.

A

Sleep-related breathing disorder characterised by episodes of complete or partial upper airway obstruction during sleep

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2
Q

What is the pathophysiology of OSA?

A

Sleep –> decreased muscle tone –> upper airway collapse –> apnoea (intermittent hypoxia) –> arousal (fragmented sleep, sleepiness and cognitive dysfunction) –> airway reopens

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3
Q

What groups does OSA happen most in? (3)

A
  • M>F
  • prevalence increases with age
  • classically in overweight middle-aged men
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4
Q

How is OSA classified?

A
  • mild (5-15 events/hr)
  • moderate (15-30 events/hr)
  • severe (>30 events/hr)
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5
Q

What are some causes of OSA? (6)

A
  • obesity
  • acromegaly (causes macroglossia)
  • hypothyroidism (causes macroglossia)
  • large tonsils
  • alcohol
  • smoking
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5
Q

What are the clinical features of OSA? (5)

A
  • excessive daytime sleepiness - measured with Epworth sleepiness scale (14 is moderate, 18 severe)
  • unrefreshing or restless sleep
  • episodes of apnoea and gasping
  • chronic loud snoring
  • signs of complications - impaired cognitive function, depression, decreased libido, hypertension with increased pulse pressure
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6
Q

How is excessive daytime sleepiness measured in OSA?

A

Epworth sleepiness scale (14 is moderate sleepiness, 18 is severe sleepiness)

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7
Q

What are some signs of complications that OSA can present with? (4)

A
  • impaired cognitive function
  • depression
  • decreased libido
  • hypertension with increased pulse pressure
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8
Q

What might be seen on examination in OSA? (7)

A
  • macroglossia - large tongue
  • enlarged tonsils
  • long/thick uvula
  • maxillomandibular anomalies e.g. retrognathia (pulled back jaw)
  • neck circumference (>42cm male, >40cm female)
  • obesity
  • hypertension
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9
Q

What are the risk factors for OSA? (14)

A
  • increased age
  • male
  • obesity, weight gain –> more soft tissue in neck
  • surgical swelling
  • smoking
  • alcohol
  • hypothyroidism
  • sedative use
  • enlarged tonsils and adenoids in children
  • macroglossia
  • Marfan’s syndrome
  • post-menopause
  • craniofacial abnormalities
  • Fx, GORD, Down’s, tooth extractions, motor vehicle accidents
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10
Q

What are the 1st-line investigations for OSA? (3)

A
  • polysomnography (PSG)
  • portable multichannel sleep tests
  • awake fibreoptic endoscopy - excludes hypertrophic lingual tonsils, nasal polyps or tumours
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11
Q

What is the definitive (gold-standard) test for OSA?

A

Polysomnography (PSG)

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12
Q

What does polysomnography show us in OSA?

A
  • monitor airflow, respiratory effort, pulse oximetry and HR, and snoring and movement
  • occurrence of 15+ episodes of apnoea/hypopnoea during 1h of sleep indicates significant sleep apnoea:
    • snoring
    • upper air resistance syndrome
    • mild OSA (5-15 events/hr)
    • moderate OSA (15-30 events/hr)
    • severe OSA (>30 events/hr)
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13
Q

What Apnoea-Hypopnoea Index (AHI) do we need on polysomnography to diagnose OSA?

A
  • 15+ episodes/hour
  • OR 5+ with symptoms or comorbidities
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14
Q

How do we assess risk of OSA?

A

STOP-BANG score (>3 = do polysomnography)

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15
Q

What are some differential diagnoses for OSA? (4)

A
  • central sleep apnoea, Cheyne-stokes respiration (recurrent episodes of apnoea with absence of respiratory effort)
  • narcolepsy (higher Epworth Sleepiness scale scores, cataplexy, hypnagogic hallucinations, sleep paralysis)
  • insufficient sleep/inadequate sleep hygiene
  • hypothyroidism
16
Q

What is the diagnostic criteria for OSA?

A
  • Apnoea-Hypopnoea Index (AHI) or Respiratory Event Index (REI)
  • occurrence of 15+ episodes of apnoea/hypopnoea during 1h of sleep indicates significant sleep apnoea:
    • snoring
    • upper air resistance syndrome
    • mild OSA (5-15 events/hr)
    • moderate OSA (15-30 events/hr)
    • severe OSA (>30 events/hr)
17
Q

What risk factor needs to be addressed for OSA management?

A

Weight loss

18
Q

What are some general OSA treatments for all AHI/REI scores? (3)

A
  • with concurrent obesity - weight loss & bariatric surgery
  • with persistent hypersomnolence - modafinil/armodafinil/solriamfetol (promotes wakefulness)
  • with positional component - positional therapy (non-supine sleep position)
19
Q

What is 1st (and 2nd line) for OSA with AHI/REI>30 per hour?

A
  • 1st line: continuous positive airway pressure (CPAP)
  • 2nd line: oral appliance therapy
  • 2nd line: implantable hypoglossal neurostimulation
  • 2nd line: upper airway surgery
20
Q

What is 1st (and 2nd line) for OSA with AHI/REI 5-30 per hour?

A
  • 1st line: CPAP or oral appliance therapy
  • 2nd line: implantable hypoglossal neurostimulation or upper airway surgery
21
Q

What is 1st line for OSA with discrete anatomical lesions?

A

Upper airway surgery

22
Q

How can we improve CPAP adherence in OSA?

A

Nasal surgery, intranasal corticosteroid application and non-benzodiazepine soporifics

23
Q

In general, what is 1st line for OSA?

A

Continuous positive airway pressure (CPAP) at night

24
Q

In OSA, what do we tend to use if CPAP not tolerated?

A

Intra-oral devices e.g. mandibular advancement

25
Q

In OSA, what do we give if co-existing respiratory failure?

A

BiPAP (vs CPAP)

26
Q

Who needs to be informed about certain patients with OSA?

A

DVLA if OSA is causing excessive daytime sleepiness

27
Q

What are some complications of OSA? (6)

A
  • impaired glucose metabolism (due to sleep deprivation)
  • cardiovascular disease (MI, dysrhythmias, stroke, hypertension)
  • depression
  • motor vehicle accidents
  • cognitive dysfunction
  • increased mortality
28
Q

Describe the prognosis of OSA.

A

Patients efficiently treated may report improvements in alertness and some improvement in QoL, mood and cognitive function

Year 3 (148 decks)

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