respiratory: OSA Flashcards
When should we consider OSA?
- If patient has 2 or more of:
- snoring
- witnessed apnoeas
- unrefreshing sleep
- unexplained excessive sleepiness, tiredness/fatigue
- nocturia
- choking during sleep
- insomnia, sleep fragmentation
- cognitive dysfunction/memory impairment
- waking headaches
which 2 rating scales can be used if there is concern for OSA?
- Epworth Sleepiness Scale
- STOP-Bang questionnaire
Use ESS in first assessment (only assesses for sleepiness)
Also consider STOP-Bang (good screening tool, as not all with OSA have sleepiness)
What is the scoring for sleepiness in ESS?
- 0-5 - lower normal daytime sleepiness
- 6-10 - higher normal daytime sleepiness
- 11-12 mild excessive daytime sleepiness
- 13-15 moderate excessive daytime sleepiness
- 16-24 severe excessive daytime sleepiness
What is the DVLA guidance for suspected OSA?
group 1 and 2
- anyone with excessive sleepiness (whether due to suspected OSA or another condition) - must NOT drive
- with suspected OSA - they can resume driving when symptom control has been obtained - the DVLA must be informed if this is not achieved within 3 months
- so they must stop driving immediately, but do not yet need to inform the DVLA (have 3 months to do this)
If they are not happy - inform them you have to document this advice in his notes, and that driving home against this advice will likely invalidate their insurance.
Who should be referred to sleep clinic for urgent (within 4 weeks) assessment with suspected OSA?
- severe hypercapnia PaCO2 >7.0 when awake
- hypoxaemia, O2 sats <94% on air
- they have an occupation where they must drive
- a job where vigilance is critical for safety
- pregnant
- comorbidity: COPD, poorly controlled CVS disease, HF, AF, angina, HTN, pul HTN.
- pre-op for major surgery
- non-arteritic anterior ischaemic optic neuropathy
when should people with suspected OSA be referred (non-urgent referral)?
- suspected moderate or severe OSA
- Suspected mild OSA impacting QoL
Mild OSA may be managed by lifestyle change alone- what advice is given?
- weight loss, exercise, dietary advice
- stopping smoking
- reducing alcohol
- avoiding sleeping on back, sleep on side instead. Positioning devices.
CPAP can be offered to which OSA patients?
- all who are symptomatic
- first line treatment for moderate-severe OSA
CPAP increases pressure in the air passages to hold them open, so breathing is normal and sleep not interrupted. Controls the condition but is not a cure.
Who are intra-oral advancement devices suitable for?
- those who snore
- those with mild OSA with normal daytime alertness
- those unable to tolerate CPAP/don’t respond to CPAP
If OSA is confirmed by specialist as MILD - what is the driving advice? (Group 1 car and motorcycle and Group 2 bus and lorry)
If they have excessive sleepiness:
* They must not drive.
* Driving may resume only after satisfactory symptom control.
* If symptom control cannot be achieved in 3 months, the person must notify the Driving and Vehicle Licensing Agency (DVLA).
If OSA is confirmed by specialist as MODERATE or SEVERE - what is the driving advice?
(Group 1 car and motorcycle and Group 2 bus and lorry)
If they have excessive sleepiness:
* They must not drive and must notify the DVLA.
* Subsequent licensing will require control of the condition; improved sleepiness; treatment adherence. DVLA will need medical confirmation, and the driver must confirm review to be undertaken every 3 years at the minimum.
* GROUP 2 need review EVERY YEAR minimum
If a patient has suspected or confirmed OSA but does not have excessive sleepiness, what is the driving advice?
- they may continue to drive and do not need to notify the DVLA
What is obesity hypoventilation syndrome?
- obesity (BMI 30 or more)
- Raised CO2 level when awake
- breathing abnormalities when asleep (apnoea, hypopnoeas, hypoventilation)
