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103: Theme 4 - 304 - Respiratory > Principles of Oxygen Therapy and Sleep Apnoea > Flashcards

Principles of Oxygen Therapy and Sleep Apnoea Flashcards

1
Q

When would a Nasal Cannulae be used to deliver oxygen?

A
  • delivering less flow rate
  • delivers 24-40% O2
  • mild hypoxaemia
  • not critically ull
  • flow rate 1-4L/min
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2
Q

What are advantages of a Nasal Cannulae

A
  • able to speak
  • able to eat
  • less claustrophobic
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3
Q

What disadvantages are there to nasal cannulae?

A
  • drying of nasal cavity
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4
Q

When would an uncontrolled mask (hudson mask) be used?

A
  • deliver medium to high flw rate
  • 5-10L/min
  • 30-60% O2 delivered
  • less drying
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5
Q

When would a rebreathe uncontrolled mask be used?

A
  • high oxygen saturation 85-90%
  • high flow rate 12L/min
  • very unwell patients
  • COPD
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6
Q

When would oxygen be given as a treatment?

A
  • acutely hypoxaemic patients
  • reduced oxygen saturations
  • acutely unwell patients that show signs of further deterioration
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7
Q

What are is the target oxygen saturations?

A
  • Young adult: 96%-98%
  • Over 70yrs: 94-98%
  • Those at risk of hypercapnic respiratory failure: 88-92%
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8
Q

What is the treatment for acute breathlessness with hypoxemia?

A
  • Maximal oxygen treatment
  • High flow uncontrolled mask (first-line treatment)
  • Alter flow and delivery device when stable

Target SpO2 = 94-98%

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9
Q

Who is at risk of hypercapnia if given a high dose of oxygen?

A
  • Chronic hypoxic lung disease: COPD, Bronchiectasis/ Cystic fibrosis
  • Chest wall disease: Kyphoscoliosis, Thoracoplasty
  • Neuromuscular disease
  • Obesity-related hypoventilation
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10
Q

What is hypercapnia?

A
  • CO2 retention
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11
Q

What is seen in chronically hypoxaemic patients with COPD who have acute exacerbation?

A
  • They have increasingly worsening breathing

- the exacerbation may be a viral or bacterial infection or an episode of heart failure (inadequate perfusion)

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12
Q

What can untreated hypoxaemic patients develop?

A
  • pulmonary hypertension
  • right ventricular failure
  • right ventricular hypertrophy
  • secondary polycythaemia (raised Haemoglobin)
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13
Q

When would a patient have Long Term Oxygen Therapy (LTOT)?

A
  • some COPD patients
    • pO2 <7.3kPa
      or
    • pO2 7.3<8kPA and, secondary polycythamia, nocturnal hypoxemia, peripheral oedema/ evidence of RV failure. evidence of pulmonary hypertension
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14
Q

What are the benefits of Long term Oxygen Therapy (LTOT)?

A
  • Improved long term survival
  • Prevention of deterioration in pulmonary hypertension cases
  • Reduction of polycythaemia (raised Hb)
  • Improved sleep quality
  • Increased renal blood flow
  • Reduction in cardiac arrhythmias
  • Improved quality of life
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15
Q

What is LTOT

A

Long term oxygen therapy

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16
Q

What is sleep apnoea and obstructive sleep apnoea?

A
  • cessation of airflow for 10 or more seconds

- the collapse of the pharyngeal airway during sleep

17
Q

What are pathophysiological presentation from the pharynx that increases its tendency to collapse

A
  • Decreased upper airway (UA) neuromuscular tone
  • Decreased UA caliber
  • Increased UA resistance
  • INcreased pharyngeal compliance
18
Q

What regions contribute to the pathophysiological presentation to sleep apnoea?

A
  • Nasal pathology: polyps, deviated septum
  • Enlarged Tonsils
  • Abnormal chin: micrognathia, retrognathia
  • The increased soft tissue at the neck: obesity, hypothyroidism
19
Q

What are some clinical features of sleep apnoea

A
  • snoring
  • nocturnal choking
  • unrefreshing/ restless sleep
  • Excessive daytime sleepiness
  • Morning dry mouth
  • Morning headaches
  • Nocturia ( waking up in the night to urinate)
20
Q

What Investigations can be done for sleep apnoea ?

A
  • Nocturnal oximetry
  • Polysomnography (PSG) (sleeping with sensors)
  • Epworth Sleepiness Scale
21
Q

What other pathologies is Sleep Apnoea associated with?

A
  • Hypertension
  • Type 2 diabetes
  • Ischaemic heart disease
  • Heart failure
  • Cerebrovascular disease/stroke
  • Cardiac arrhythmias
  • Death
22
Q

What are some risk factors for Sleep Apnoea

A
  • Males
  • Obesity
  • Neck circumference greater than 43cm
  • Family History of OSAHS
  • Smoking
  • Alcohol
  • Craniofacial abnormalities
  • Pharyngeal abnormalities
  • Sleeping supine
  • Hypothyroidism, Acromegaly, Pregnancy
23
Q

How is Sleep Apnoea diagnosed?

A

Using the Apnoea/hypopnea Index (AHI)
apnoeas+hypopnoeas/ total sleep time in hours

  • Mild: AHI 5-14 per hour (along with symptoms and signs)
  • Moderate: AHI 15-30 per hour
  • Severe: AHI > 30 per hour
24
Q

How can Sleep Apnoea be managed?

A

> Weight loss
- avoid sleeping supine
- avoid alcohol
Treat contributing problems i.e hypothyroidism
Review medications, sedating drugs and drugs causing weight gain
- Mandibular advancement devices
- Continuous Positive Airway Pressure (CPAP)

25
Q

What is CPAP?

A

Continuous Positive Airway Pressure

  • generates airflow –> positive pressure is delivered to the airway via the mask
  • The intraluminal pharyngeal pressure is greater than the surrounding pressure
  • keeping the Pharynx open
26
Q

Who would use CPAP?

A
  • Patients with mild OSAHS and co-morbidities
  • Patients with mild OSAHS and high-risk profession (bus driver)
  • Patients with moderate/ severe OSAHS regardless of symptoms
  • NOT patients with mild OSAHS, with no additional risk factors who aren’t excessively sleepy

103: Theme 4 - 304 - Respiratory (12 decks)

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