Respiratory: Sleep Apnoea Flashcards
Define what is meant by obstructive sleep apnoea [1]
Obstructive sleep apnoea is caused by complete or partial collapse of the pharyngeal airway during sleep. Apnoeas are episodes where the person stops breathing for up to a few minutes
What are the risk factors for sleep apnoea? [10]
obesity: – narrows upper airway
male sex: longer pharyngeal airway
post-menopause (women)
large neck circumference: increases risk
especially if greater than 16.5 inches
maxillomandibular anomalies (e.g., narrowing, retrognathia, and high, arched palate): micrognathia
increased volume of soft tissues (includes tonsils, adenoids, and tongue)
family history of OSA
chronic snoring
polycystic ovary syndrome (PCOS)
hypothyroidism
Down’s syndrome
increasing age
black, Hispanic, or Asian ethnicity
tobacco smoking
How do patients with sleep apnoea present? [6]
Episodes of apnoea during sleep (reported by a partner)
Snoring
Morning headache
Waking up unrefreshed from sleep
Daytime sleepiness
Concentration problems
Reduced oxygen saturation during sleep
What is the difference between apnoea and hypopnoea? [2]
Apnoea – a complete cessation of airflow for
at least 10 seconds
Hypopnoea – a reduction in airflow to under
50% or by 30% for at least 10 seconds with a desaturation of at least 4%
What is Apnoea and Hypopnoea Index? [1]
What are normal, mild, moderate and severe scores? [4]
AHI – number of apnoeas and hypopnoeas
per hour of the study
- 0 to 5 Within normal limits
- 5 to 15 Mild OSA
- 15 to 30 Moderate OSA
- 30 plus Severe OSA
What is micrognathia? [1]
Why does it increase chance of sleep apnoea? [1]
Micrognathia: condition in which the lower jaw is undersized
Micrognathia increases the risk of obstructive sleep apnea in children because the small size of the jaw narrows the airway and reduces the space needed for breathing
Why does obesity cause sleep apnoea? [1]
Fat deposition in the tissues surrounding the upper airway appears to result in a smaller lumen and increased collapsibility of the upper airway, predisposing to apnea.
Name 4 conditions that cause sleep apnoea due to the abnormal anatomy they cause [4]
- Micrognathia or retrognathia
- Large adenoids and tonsils
- Acromegaly
- Down’s syndrome
Name 4 systemic, associated conditions to sleep apnoea? [4]
Hypothyroidism
Cushing’s syndrome
Type II diabetes
Hypertension
What is the name for the sleep score used for measuring sleep apnoea?
What score is abnormal?
What is the total score
Epworth sleepiness scale
10 / 24 is abnormal
State 7 treatments that could be useful for sleep apnoea [7]
- Weight loss
- Avoiding alcohol and sedatives
- Non-supine sleep
- Tonsillectomy
- Mandibular advancement splints
- Palatal surgery
- Maxillofacial surgery
- Treat medical cause e.g. Cushings
What is this? [1]
When is it indicated? [1]
Mandibular splint
If CPAP not tolerated
What severity of sleep apnoea is CPAP indicated in? [2]
Continuous Positive Airway Pressure (CPAP):
Causes continous air passage to be open
Used for patients with moderate or severe sleep apnoea
Name three conditions that cause macroglossia and therefore sleep apnoea [3]
acromegaly, hypothyroidism, amyloidosis
What is the most common surgery for sleep apnoea? [1]
Surgery is an option but involves significant surgical reconstruction of the soft palate and jaw. The most common procedure is called uvulopalatopharyngoplasty (UPPP).
