Sleep Apnoea

Question 1

What is sleep apnoea?

Answer 1

Interupted breathing during sleep

can be daytime or night time

Question 2

What are the features of sleep ap?

Answer 2

Nocturnal: sleeping, chocking, apnoea during sleep, abnormal motor activity, nocturia
daytime: excessive daytim sleepiness, impared concentration, irritabilty, depression, decreased libido
cardiovascualr problems

Question 3

How can you investigate potetnial sleep apnoea?

Answer 3

sleep diary card

Question 4

What investigations can you do?

Answer 4

Epworth sleepiness scale
Home oximetry
Overnight polysomnography

Question 5

WHat would a poitive result on the pulse oximtery indicate?

Answer 5

pt needs treatment

Question 6

What would a negative result on a pulse oximertry indcate?

Answer 6

further investigations

Question 7

what is polysomnogrpahy?

Answer 7

multi parametric test used to study sleep

Question 8

WHat are the components to Polysom?

Answer 8

EEG
Eletrooculogrpahy
Oronasal airflow
ECG
Oximetry
CHest wall movement (plethysmograph)
EMG

Question 9

WHat is the AHI?

Answer 9

apnoea hypopnea index

Question 10

WHat does the AHI index show?

Answer 10

h

Question 11

WHat are the problems with sleep apnoea?

Answer 11

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

Question 12

Who gets Sleep apneoa?q

Answer 12

Males 4% compared to women 2%
middle aged
over wieght
heavy dribnkers
jaw and airways of special shape and size: perecetage predicited neck circumference

Question 13

What featires on a ceph would suggest someone is at greater risk from sleep ap?

Answer 13

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

Question 14

WHat is the treatment for people with Sleep ap?

Answer 14

Conservative:
weightloss ?
CPAP: works almost always but 33% cannot comply
surgical: trachesomty, intransal surgery, max mand advancement, tongue reduction, uvulopalatpharyngeoplasty, bariatric

Question 15

HOw does CPAP work?

Answer 15

cont pos airway pressure

negative pressure in airway causes airway to collapse so by applying pos pressure this splints airway open

Question 16

WHat is the gold standard treatment for sleep ap?

Answer 16

CPAP

Question 17

How is the uvulopalatophayrngeoplasty done and what is it effective at?

Answer 17

with a laser

reducung snoring but not sleep ap

Question 18

WHt are the problems with uvulopaltala… surgery?

Answer 18

risk of morbidity
post op airway constriction
change in voice
relfux
nalsal regurgucatation
dysphagia

Question 19

What intr oral appliacnes can be used?

Answer 19

MAA

Question 20

How well do MAA’s work?

Answer 20

good compliance with a 40=80% success

Question 21

WHat is teh care pathway for sleep ap pateint?

Answer 21

diagnosis of sleep ap
treated with cpap
unable to tolerate cpap
referral to ortho for MMA
review MMA
then referral back to sleepclinci

Question 22

WHat patients do not tolerate MMA’s well?

Answer 22

those with higher MMP
older people
more obese

Question 23

How must you deisgn the MMA?

Answer 23

pateint psotire mandible in the most comfortable protrusive position
minimimal openeing 
robust
minimal bulk
inexpensive

Question 24

What is a risk of MMA?

Answer 24

occlusa changes

diffucult in bruxers and edentulous and those that cannot posture forward enough

Question 25

WHat should GDP be careful about when prescribing anti snoring device>

Answer 25

need to makre sure a proper history is taken as this may mask the problem of sleep ap