OSA

Question 1

what predisposes to obstructive sleep apnoea?

Answer 1

obesity
macroglossia: acromegaly, hypothyroidism, amyloidosis
large tonsils
Marfan’s syndrome

Question 2

what are consequences of OSA?

Answer 2

daytime somnolence
compensated respiratory acidosis
hypertension

Question 3

what is a typical presentation?

Answer 3

The partner often complains of excessive snoring and may report periods of apnoea.

Question 4

how do you assess sleepiness?

Answer 4

Epworth Sleepiness Scale - questionnaire completed by patient +/- partner
Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)

Question 5

what is the diagnostic test?

Answer 5

sleep studies (polysomnography)

Question 6

what is the mx?

Answer 6

weight loss
continuous positive airway pressure (CPAP) is first line for moderate or severe OSAHS
intra-oral devices (e.g. mandibular advancement) may be used if CPAP is not tolerated or for patients with mild OSAHS where there is no daytime sleepiness
the DVLA should be informed if OSAHS is causing excessive daytime sleepiness
limited evidence to support use of pharmacological agents