Respiratory: Sleep Disordered Breathing

Question 1

During REM sleep does the control of breathing become more stable or unstable?

Answer 1

Unstable - relaxation of voluntary muscles in upper airway and chest, so airway collapse is more likely

Question 2

Sleep disordered breathing occurs due to what?

Answer 2

Airway obstruction or central hypoventilation or combination

Question 3

What symptoms are associated?

Answer 3

Loud snoring
Witnessed pauses in breathing - apnoea
Restlessness
Disturbed sleep

Question 4

Are symptoms alone a sensitive or specific marker of actual difficulties?

Answer 4

No

Question 5

What does obstructive sleep apnoea lead to?

Answer 5

Excessive daytime sleepiness or hyperactivity
Learning and behaviour problems
Faltering growth
Severe cases: pulmonary hypertension

Question 6

In children, what is OSA usually secondary to ?

Answer 6

Airway obstruction due to adenotonsillar hypertrophy

Question 7

What are some predisposing causes of sleep disordered breathing?

Answer 7

Neuromuscular disease e.g Duchenne MD
Craniofacial abnormalities
Dystonia of upper airway muscles e.g in cerebral palsy, severe obesity
Children with Down syndrome have anatomical upper airway restriction and hypotonia, so particularly at risk

Question 8

What is the most basic assessment?

Answer 8

Overnight pulse oximetry
- enables frequency and severity of desaturation to be quantified
Normal oximetry does not exclude condition, but means severe physical consequences unlikely

Question 9

What investigation is required in more complex cases?

Answer 9

Polysomnography - monitoring HR, RR, airflow, CO2, video recording
Provides more info about gas exchange
Can distinguish between central and obstructive events

Question 10

How can it be managed?

Answer 10

If due to adenotonsillar hypertrophy - tonsillectomy

CPAP or BiPAP to maintain upper airway at night