Sleep Apnoea

Question 1

Define sleep apnoea

Answer 1

It is a group of disorders where breathing stops for around 10 seconds about 20 times in an hour during sleep. Causes blood deoxygenation

Question 2

Name the 3 types of sleep apnoea

Answer 2

Obstructive, central and mixed

Question 3

Define obstructive sleep apnoea

Answer 3

It is the most common type. Occurs when the upper airway is occluded during sleep

Question 4

What is often the cause of OSA?

Answer 4

The throat relaxes during sleep, causing the tongue and soft palate to block the airway.

Question 5

OSA is more common in which gender?

Answer 5

Men

Question 6

Name some Sx of OSA

Answer 6

Hypersomnia, loud snoring, brief waking during sleep due to breathing interruptions, nocturia, dry mouth, sore throat, ED

Question 7

Define hypersomnia

Answer 7

Excessive daytime sleepiness (note this is not a differentiating Sx for diagnosis)

Question 8

Define nocturia

Answer 8

Waking up during the night needing to urinate

Question 9

Drugs that can be a risk factor for OSA?

Answer 9

Muscle relaxants, sedatives, history of tobacco or alcohol

Question 10

Name some anatomical risk factors for OSA

Answer 10

Large tonsils or adenoids, narrow throat or nasal passage, short neck

Question 11

What is unique about the hypertension caused by sleep apnoea?

Answer 11

It persists throughout the day and is resistant to medication.
Occurs because the body induces vasoconstriction in areas to try increase blood flow to heart and brain

Question 12

Everyone with OSA needs treatment. True or false?

Answer 12

False. Tx only needed when affecting QOL or risking their safety

Question 13

Assessments for sleep apnoea?

Answer 13

Questionnaires, in-lab PSG, portable PSG

Question 14

Define PSG

Answer 14

Polysomnogram. A test using various tests to test for sleep apnoea

Question 15

Name some of the tests used in a PSG

Answer 15

EEG, ECG, pulse oximetry, chest movement, nasal airflow, sound and video recording

Question 16

First line of treatment for OSA?

Answer 16

Eliminate the underlying cause (e.g. obesity, high cholesterol, hypertension, etc) + get an ENT to rule out anatomical causes

Question 17

Explain the use of a CPAP

Answer 17

The pressurised air holds the throat open to improve breathing. Note that it does not breathe for you.

Question 18

Why is patient compliance of a CPAP variable?

Answer 18

Patients find it uncomfortable and it can dry out their mouth and nose

Question 19

Benefits of CPAP?

Answer 19

Reduces number of apnoeas, reduces daytime sleepiness, reduces BP both at night and next day, and can improve cognitive function

Question 20

Does the CPAP reduce the risk of CV events?

Answer 20

No

Question 21

An EPAP has similar effects to CPAP but is a single use instrument. Explain its use.

Answer 21

Expiratory positive airway pressure - attaches to the nose and regulates airways by closing valves when you breath out of your nose to open airways. Doesn’t work if you sleep with mouth open.

Question 22

Other than the CPAP and EPAP, name potential Tx options

Answer 22

Night shift (prevents you from sleeping on back), anti-congestive nasal sprays, surgery, tongue appliance, mandibular splint, etc

Question 23

Explain CSA

Answer 23

Occurs when the CNS impulses to the respiratory muscles fail, which causes periodic loss of respiration

Question 24

Which drug class is associated with CSA?

Answer 24

Narcotics

Question 25

Name respiratory stimulants that can be used for CSA

Answer 25

Acetazolamide, theophylline, caffiene citrate

Question 26

Can the CPAP be used for CSA?

Answer 26

Yes

Question 27

Compare CPAP and BPAP

Answer 27

Cpap = continuous. Bpap = bi-level.

BPAP has different pressure settings for inspiration vs expiration. Works better for hypoventilation related CSA

Question 28

Main treatment for OSA, CSA, MSA?

Answer 28

Treat underlying condition + lifestyle changes