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Respiratory > Sleep Apnoea and Narcolepsy > Flashcards

Sleep Apnoea and Narcolepsy Flashcards

1
Q

What is obstructive sleep apnoea syndrome?

A

Recurrent episodes of upper airway obstruction leading to apnoea during sleep and is usually associated with snoring

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2
Q

What are the effects of OSAS on patients?

A

Typically unrefreshing sleep, daytime sleepiness and poor daytime concentration

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3
Q

What does somnolence mean?

A

Sleepiness

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4
Q

Explain the pathophysiology of OSAS?

A

Muscle relaxation, narrow pharynx and obesity can cause repeated closure of upper airway
This causes apnoeas and hypopnoeas which causes frequent microarousals

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5
Q

What is the outcome of repeated closure of upper airway?

A

Snoring
O2 desaturation
Apnoea and hypopnoea

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6
Q

Why is OSAS important?

A

Impaired QoL
Increased risk of road traffic accidents
Risk of hypertension, stroke and heart disease

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7
Q

How is OSAS diagnosed?

A

Clinical history and examination
Epworth questionnaire
Overnight sleep study

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8
Q

Explain the Epworth questionnaire?

A

Patients ranks questions 0-3 from would never doze to high chance of dozing

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9
Q

What is overnight oximetry measuring?

A

O2 saturation and pulse rate

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10
Q

What would oximetry look like if patient has sleep apnoea?

A

Repetitive desaturation
Pulse rate follows saturation

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11
Q

What equipment is in a limited sleep study (embletta)?

A

Thora movement, oximetry and nasal canula

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12
Q

What is central apnoea?

A

Less common
Not due to obstruction
Is lack of respiratory drive from brainstem

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13
Q

What is filled in when carrying out limited sleep study?

A

Sleep study report
Analysed by technician or computer

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14
Q

What is measured in a polysomnography?

A

Oronasal airflow, thorax movement, oximetry, body position, EEG, Audiovisual recording, EOG, EMG an ECG

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15
Q

What is an EEG?

A

Checks brain waves during the night - can tell if patient is actually asleep

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16
Q

What is an EOG?

A

AN electrooculogram measuring eye movement

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17
Q

What is EMG measuring?

A

Peripheral muscle

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18
Q

What is filled out after a polysomnography?

A

PSG report
Contains a hypnogram which shows the stage of sleep

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19
Q

What is the REM stage of sleep?

A

Dreaming stage so get rapid eye movements

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20
Q

What is stage 1-3 of sleep?

A

1and 2 are asleep and 3 is deep

21
Q

What is W stage of sleep?

A

Wakefulness

22
Q

How is OSA severity measured?

A

Desaturation rate/AHI
0-5 is normal
5-15 is mild
15-30 is moderate
>30 is severe

23
Q

What is AHI?

A

Total no. of apnoeas in sleep divided by hours of sleep

24
Q

What is the treatment for sleep apnoea?

A

Identify exacerbating factors
Continuous positive airways pressure (CPAM)
Mandibular repositioning splint

25
Q

What are some exacerbation factors that can cause sleep apnoea?

A

Overweight
Alcohol
Endocrine disorder

26
Q

Explain the mechanism of CPAM treatment?

A

Creates positive pressure so tissues in mouth don’t get stuck together in inspiration

27
Q

How does mandibular repositioning splint help sleep apnoea?

A

Advance lower jaw forward so tongue is forward and creates more space at back of throat

28
Q

Describe driving rules and sleep apnoea?

A

Advice patient to not drive or restrict driving
Inform DVLA
Once satisfactory treated should be allowed to drive

29
Q

What is narcolepsy?

A

Rare long-term brain condition that causes a person to suddenly fall asleep at inappropriate times
Usually presents at younger age then apnoeas

30
Q

What is narcolepsy associated with?

A

Can be familial
Associated with HLA types

31
Q

Explain the clinical features of narcolepsy?

A

Cataplexy, excessive daytime sleepiness, hypnopompic hallucination and sleep paralysis

32
Q

What is cataplexy?

A

Suddenly collapse during day and looks asleep
Person is kind of aware
Sudden muscle weakness

33
Q

What investigations are used to diagnose narcolepsy?

A

Polysomnography
MSLT
Low CSF orexin tested by lumbar puncture

34
Q

Explain MSLT investigation?

A

Multiple sleep latency test
Patient asked to sleep in dark room and time to get to sleep is measured
Under 6 mins is a sign

35
Q

Explain the treatment of narcolepsy?

A

Modafinil
Dexamphetamine
Venlafaxine
Sodium Oxybate

36
Q

Describe chronic ventilatory failure

A

Elevated pCO2 and pO2 is less than 8kPA
Type 2 resp. failure
Normal blood pH
Elevated bicarbonate

37
Q

What are the causes of chronic ventilatory failure?

A

Airway disease, Chest well abnormalities, Respiratory muscle weakness, and central hypoventilation

38
Q

What is airways diseases that cause chronic ventilatory failure?

A

COPD and bronchiectasis

39
Q

What is a chest wall abnormality that cause chronic ventilatory failure?

A

Kyphoscoliosis

40
Q

What are respiratory muscle weakness diseases that cause chronic ventilatory failure?

A

Motor neuron disease (ALS), muscular dystrophy and glycogen storage disease

41
Q

What are central hypoventilation diseases that can cause chronic ventilatory failure?

A

Obesity hypoventilation syndrome and congenital central hypoventilation syndrome

42
Q

What are typical symptoms of chronic ventilatory failure?

A

Breathlessness, orthopnoea, ankle swelling, morning headache, recurrent chest infection and disturbed sleep

43
Q

Explain the term orthopnoea?

A

Breathlessness lying flat
Usually with muscular condition

44
Q

What are some examination findings for chronic ventilatory failure?

A

Reflects underlying disease
Paradoxical abdominal wall motion in suspected neuromuscular disease
Ankle oedema

45
Q

Explain paradoxical abdominal wall motion

A

Weakness of diaphragm
Wont contract properly so diaphragm drawn up
Chest wall then moves down
Opposite to normal

46
Q

What investigations are done to diagnose neuromuscular disease?

A

Lung function
Assessment of hypoventilation
Fluoroscopic screening of diaphragm

47
Q

What happens to FEV1 and FVC, and mouth pressure in neuromuscular disease?

A

FEV1 and FVC is reduced but ratio is higher as restrictive
Mouth pressure on inspiration and expiration is reduced

48
Q

Explain the treatment for chronic ventilatory failure?

A

Domiciliary non invasive ventilation
O2 therapy
Tracheoscopy ventilation - 24hr
Not curable

Respiratory (24 decks)

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