Sleep anoea Flashcards
When should you suspect a diagnosis of OSAS in an adult
Excessive daytime sleepiness, snoring and fatigue
Witnessed breathing pauses(apnoeas), gasping, or choking while sleeping
Unrefreshing sleep, impaired concentration
Unexplained morning headache
Unexplained nocturia
Nocturnal GORD
OSAS associated conditions
Obesity
Depression
Hypertension
Stroke
Risk factors for OSAS
Age Male Obesity Family history Smoking Alcohol Hypothyroidism
What is complete apnoea defined as
Ten-second pause in breathing activity
What is important to examine with regard to the jaw in OSAS
Jaw abnormalities such as micrognathia or retrognathia
What else is important to examine in OSAS
Signs of nasopharyngeal obstruction such as mouth breathing or nasal speech
Signs of COPD, respiratory failure or pulmonary hypertension
Blood pressure, BMI and neck circumference
Examples of screening questionnaires to assess the extent and severity of symptoms in OSAS
STOP-Bang questionnaire
Epworth sleepiness scale
Other conditions which can cause nocturnal choking or gasping besides OSAS
GORD
Nocturnal asthma
Heart failure
Pani cattacks
When should someone be referred urgently to a sleep clinic
Excessive sleepiness impacting on their role as driver or other safety-critical worker
Comorbid condition such as COPD, heart failure/pulmonary hypertension, or respiratory failure
What can be used to investigate OSAS
Polysomnography(PSG) or limited sleep study
Oxygen desaturation index(overnight pulse oximetry)
Specialist treatments for OSAS
CPAP
Intra-oral mandibular advancement devices
Upper airways surgery
Which sleeping position is commonly associated with postural OSAS
Supine posture due to the effect of gravity on tongue and soft palate position
Behavioural interventions for OSAS
Weight loss(rarely curative)
Smoking cessation
Alcohol cessation
Complications of OSAS
Accidents Irritability/depression CVS complications(HTN, CAD, congestive cardiac failure) Risk factor for stroke Risk factor for T2DM
When are people with OSAS allowed to drive
Until satisfactory control of symptoms has been attained
Compliant with treatment(CPAP) where driving is no longer impaired
