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Week 8 - Respiratory > Obstructive Sleep Apnoea Syndrome > Flashcards

Obstructive Sleep Apnoea Syndrome Flashcards

1
Q

Define obstructive sleep apnoea [3]

A

Recurrent episodes of partial or complete upper (pharyngeal) airway obstruction during sleep, intermittent hypoxia and sleep fragmentation

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2
Q

Define obstructive sleep apnoea syndrome [1]

A

Manifests as excessive daytime sleepiness

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3
Q

Describe the pathophysiology of OSA and its potential complications [11]

A
  1. During sleep, activity of the respiratory muscles is reduced, especially during REM sleep when the diaphragm is virtually the only active muscle.
  2. Apnoea occur when the airway at the back of the throat is sucked closed when breathing in during sleep - the airway collapses, stopping air from travelling to and from your lungs, disturbing your sleep.
  3. Partial narrowing results in snoring, complete occlusion causes apnoea and critical narrowing causes hypopnoea.
  4. This causes arousal from sleep throughout the night, which the patient may not be aware of but it can have several effects:
    • Sleep disruption
      • Sleepiness
      • Reduced quality of life
      • Potential road traffic accidents
    • Blood pressure surge
      • Heart attacks
      • Strokes
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4
Q

What are the typical symptoms of OSA? [12]

A
  1. Snorer
  2. Witnessed apnoea
  3. Disruptive sleep:
    • Nocturia
    • Choking
    • Dry mouth
  4. Sweating
  5. Unrefreshed sleep
  6. Daytime somnolence
  7. Fatigue
  8. Low mood
  9. Poor concentration
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5
Q

What features should you look for during examination of a patient with OSA? [7]

A
  1. Weight
  2. BMI
  3. BP
  4. Neck circumference (> 40cm normal)
  5. Craniofacial appearance (retrognathia, micrognathia)
  6. Tonsils
  7. Nasal patency
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6
Q

Name the 3 questionnaires used to assess excessive daytime sleepiness [3]

A
  1. the Epworth Sleepiness Score
  2. the STOP-BANG Questionnaire
  3. the Berlin Questionnaire
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7
Q

Name the investigations used for OSA [3]

A
  1. limited polysomnography (limited sleep study)
  2. full polysomnography (PSG)
  3. transcutaneous oxygen saturations and carbon dioxide assessment (TOSCA)
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8
Q

What are the features measured in a limited PSG? [5]

A
  1. 5 channel home study
  2. Oxygen Saturations
  3. Heart Rate
  4. Flow
  5. Thoracic and Abdominal effort
  6. Position
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9
Q

What are the features measured in a full PSG? [9]

A
  1. EEG — sleep staging
  2. Video
  3. Audio
  4. Thoracic and abdominal bands
  5. Position
  6. Flow
  7. Oxygen Saturations
  8. Limb leads
  9. Snore
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10
Q

What are the advantages of a full PSG over a limited PSG? [4]

A
  1. Can make sure it’s the correct patient
  2. Accurate assessment of sleep efficiency
  3. Sleep staging via EEG
  4. Parasomnic activity- acting out dreams, sleep talking
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11
Q

Define apnoea [2]

A
  1. the cessation, or near cessation, of airflow
  2. 4% oxygen desaturation, lasting ≥10 secs
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12
Q

Define hypoapnoea [1]

A

a reduction of airflow to a degree insufficient to meet the criteria for an apnoea

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13
Q

Define respiratory effort related apnoea [1]

A

arousals associated with a change in airflow that does not meet the criteria for apnoea or hypopnoea

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14
Q

How is the apnoea-hypopnoea index (AHI) calculated? [1]

A

calculated by adding the number of apnoeas and hypopnoeas and dividing by the total sleep time (in hours)

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15
Q

What AHI scores are diagnostic of OSA? [2]

A
  1. AHI ≥15
  2. AHI 5-15 with compatible symptoms
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16
Q

List the 4 classifications of OSA (normal to severe) based on AHI score [4]

A
  1. Normal = AHI <5
  2. Mild = AHI 5-15
  3. Moderate 16-30
  4. Severe >30
17
Q

Define oxygen desaturation index (ODI)

A

the number of times per hour of sleep that the SpO2 falls ≥4% from baseline

18
Q

What are the 4 interventions that can be used as treatment of OSA? [4]

A
  1. CPAP - Continuous Positive Airways Pressure
  2. Mandibular Advancement Device (MAD)
  3. Maxillary-Mandibular Surgery
  4. Sleep Position Trainers
19
Q

What is continuous positive airways pressure (CPAP) and what does it do? [4]

A
  1. A mask over the nose gently directs air into the throat to keep the airway open
  2. Stops snoring
  3. Stops sleep fragmentation
  4. Improves daytime sleepiness & quality of life
20
Q

When is a mandibular advancement device (MAD) given? [1]

A

Given for mild-moderate OSAS that is unable to tolerate CPAP

21
Q

Who would be eligible for maxillary-mandibular surgery? [3]

A
  1. Problematic patients
  2. Severe retrognathia/micrognathia
22
Q

What are the complications of an untreated OSA? [7]

A
  1. Hypertension
  2. Right heart strain
  3. Cardiovascular disease
  4. Increased risk of CVA
  5. Increased accidents at work/poor concentration
  6. Increased road traffic accidents
  7. 4x more likely to have a RTA

Week 8 - Respiratory (14 decks)

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