Sleep/Ventilation Flashcards
(23 cards)
What is the magic number for ODI?
5-15 mild
15-30 is moderate
>30 is severe
What are the DVLA rules?
excessive sleepiness w mild OSA
should not drive- should be controlled over a 3/12 period or inform DVLA
suspected OSA
Group 1 and 2-can not drive. unitl symptoms under control for >3months
mod/severe OSA
Group 1- inform DVLA and can not drive until control, adherence and improvment with medical confirmation every 3 years
Group 2- inform DVLA and can not drive until control, adherence and improvment with medical confirmation every year
which gene is associated with narcolepsy?
HLA-DQB1*06:02
What are the criteria for narcolepsy type 1 (with hypocretin def)?
- daily daytime lapses of sleep >3months
- sleep latency <8mins and 2+SO REMs
CSF hypcretin <1/3 normal value or <110
What are the criteria for narcolepsy type 2 (without hypocretin def)?
must meet 5 criteria:
1. daily daytime lapses of sleep >3months
2. sleep latency <8mins and 2+SO REMs
3. cataplexy is absent
4. normal or no result of CSF hypocretin
5. hypersomnolence not better explained by other causes
What other conditions are associated with narcolepsy type 2?
Neuro:
parkinsons, MS, MD
infiltrative disorders:
sarcoid, tumours involving the hypothalamus
autoimmune/paraneoplasia:
anti-Ma-2 and antiaquaporin-4
prader willi
trauma
what is the pathophysiology of REM behavioural disorder?
not fully understood
brainstem areas affecting REM sleep
locus subcoeruleus
How do you diagnose for RBD?
RBD1Q, RBDSQ
Gold standard: polysomnography
prevalance of RBD?
rare
usually over 50, under reported/diagnosed in women
genetic factor of RBD?
GBA1 mutation
What is the prevalance of Narcolepsy?
1 in 2000 in UK, in Japan it is 1 in 600
Peaks at 15 and again in late 30s
Main clinical features of narcolepsy?
breakdown of boundary between REM and NREM sleep
- daytime sleepiness (15m-1h) which are refreshing
- start dreaming in early sleep (almost straight from being awake)
- sleep paralysis
- cataplexy
Is there a test for narcolepsy?
Can test CSF hypocreitin- deficiency
HLA DQB1 0602 almost 98% diagnostic
What additional tests should patients with severe OSA have?
assessment for Airways disease: LFTs and blood gas
If CO2 >7 with non obstructive pattern consider NIV
If CO2 <7 with non obstructive pattern treat with CPAP
If COPD and CO2 >6 for NIV
What are the key pathophysiological causes of OSA?
https://www.jacc.org/doi/epdf/10.1016/j.jacc.2021.05.048
variable combination of:
- an anatomically compromised or collapsible upper airway
- inadequate upper airway dilator muscles (genioglossus) responsiveness during sleep
- low respiratory arousal threshold
- a high “loop gain” with an oversensitive ventilatory control system
What affect does CPAP have on AF?
CPAP therapy can reduce AF recurrence after DCCV and ablation (42% in meta-analysis)
What is the relationship between OSA and CV risk?
two fold increase
interestingly patients with severe OSA are more likley to have nocturnal MIs
what are the interventions for insomnias?
conservative:
- identify extrinsic factors
- relaxation
- anxiety management
- CBT
pharm:
- melatonin
- clonazepam
- antidepressants
what are the interventions for non-REM disorders
conservative:
- identify extrinsic factors
- relaxation
- anxiety management
- CBT
pharm:
- melatonin
- clonazepam
- antidepressants
SRED - topiramate
PLMS/RLS- gabapentin/pregabalin/dopamine agonists and anti-epileptics
NIV criteria for MD?
FVC <50%
MIP <60
daytime sats<95%
daytime PaCO2 >6
sleep disordered breathing
When weaning invasive ventilation what happens to the risk of mortality per day?
increases by 1% per day
What is your mortality if you wean successively off invasive ventilation by days?
day 0-1 5.8%
day 2-6 16.5%
day 7+ 29.8%
What needs to be done to set the conditions for weaning IV?
ABG: if HCO3 >40 pCOs to aim between 7-7.5 and maintain pO2 7.5-8
5 min self-ventilation trial:
- check insp muscle func
- check exp muscle func (cough and secretion clearance)
- lower airway secretion load
- upper airway secretion load (bulbar palsy)
- WOB during cuff down trial
- change extended tube lengths to short length (cuation in obese)
