Sleep Apnoea Flashcards
What is sleep apnoea?
Interupted breathing during sleep
can be daytime or night time
What are the features of sleep ap?
Nocturnal: sleeping, chocking, apnoea during sleep, abnormal motor activity, nocturia
daytime: excessive daytim sleepiness, impared concentration, irritabilty, depression, decreased libido
cardiovascualr problems
How can you investigate potetnial sleep apnoea?
sleep diary card
What investigations can you do?
Epworth sleepiness scale
Home oximetry
Overnight polysomnography
WHat would a poitive result on the pulse oximtery indicate?
pt needs treatment
What would a negative result on a pulse oximertry indcate?
further investigations
what is polysomnogrpahy?
multi parametric test used to study sleep
WHat are the components to Polysom?
EEG Eletrooculogrpahy Oronasal airflow ECG Oximetry CHest wall movement (plethysmograph) EMG
WHat is the AHI?
apnoea hypopnea index
WHat does the AHI index show?
h
WHat are the problems with sleep apnoea?
risk of car acident
cardivascualr disease: hypertension, IHD, arrythmia, stroke
psychiatric illness: suicide rate 14 times higher in men ages 30-59 with snoiring and daytie sleepness but not snoring alone
Who gets Sleep apneoa?q
Males 4% compared to women 2% middle aged over wieght heavy dribnkers jaw and airways of special shape and size: perecetage predicited neck circumference
What featires on a ceph would suggest someone is at greater risk from sleep ap?
small manidble increased lower facia height thicker soft palate enlarged tongue decreased posterior airway space inferior posituoned hyoid bone increased over jet increased MMAmore anterior hyoid bone
WHat is the treatment for people with Sleep ap?
Conservative:
weightloss ?
CPAP: works almost always but 33% cannot comply
surgical: trachesomty, intransal surgery, max mand advancement, tongue reduction, uvulopalatpharyngeoplasty, bariatric
HOw does CPAP work?
cont pos airway pressure
negative pressure in airway causes airway to collapse so by applying pos pressure this splints airway open
WHat is the gold standard treatment for sleep ap?
CPAP
How is the uvulopalatophayrngeoplasty done and what is it effective at?
with a laser
reducung snoring but not sleep ap
WHt are the problems with uvulopaltala… surgery?
risk of morbidity post op airway constriction change in voice relfux nalsal regurgucatation dysphagia
What intr oral appliacnes can be used?
MAA
How well do MAA’s work?
good compliance with a 40=80% success
WHat is teh care pathway for sleep ap pateint?
diagnosis of sleep ap treated with cpap unable to tolerate cpap referral to ortho for MMA review MMA then referral back to sleepclinci
WHat patients do not tolerate MMA’s well?
those with higher MMP
older people
more obese
How must you deisgn the MMA?
pateint psotire mandible in the most comfortable protrusive position minimimal openeing robust minimal bulk inexpensive
What is a risk of MMA?
occlusa changes
diffucult in bruxers and edentulous and those that cannot posture forward enough
WHat should GDP be careful about when prescribing anti snoring device>
need to makre sure a proper history is taken as this may mask the problem of sleep ap
