Sleep Apnoea and Neuro-Muscular Disorders - Adults

Question 1

What is Obstructive Sleep Apnoea Syndrome? (OSA/OSAS)

Answer 1

AFO leading to apnoea during sleep

Question 2

What is apnoea?

Answer 2

Temporary cessation of breathing during sleep

Question 3

What can OSA effect, what does it increase the risk of?

Answer 3

Impaired quality of life
Marital disharmony
Increased risk of road accidents
Risk of hypertension, stroke, heart disease

Question 4

What is the pathophysiology of OSA?

Answer 4

Muscle relaxation, a narrow pharynx and/or obesity all cause AFO leading to snoring and O2 desaturation

This leads to lots apneas and micro-arousals causing poor conc. and daytime hyper-somnolence

Question 5

What aspects of diagnosis are important in diagnosing OSA?

Answer 5

History
Epworth questionnaire
Overnight sleep studies

Question 6

What is the epworth questionnaire?

Answer 6

Asks patients on a scale of 0-3 how likely they are to doze off in different day to day scenarios

Question 7

What type of overnight sleep studies are there?

Answer 7

Pulse oximentry monitoring

Limited sleep study

Full polysomnography

Question 8

What is the severity grading for OSA?

Answer 8

0-5 = Normal
5-15 = Mild
15-30 = Moderate
30+ = Severe

Question 9

Treatment for OSA?

Answer 9

Treat the cause - weight
Continuous positive airway pressure - CPAP
Mandibular re-positioning splint - like retainers

Question 10

What is warned against if patient has OSA?

Answer 10

Driving

Patient must inform DVLA of the condition

Question 11

What is narcolepsy?

Answer 11

Extreme tendency to fall asleep whenever in relaxing surroundings.

Question 12

How common is narcolepsy?

Answer 12

Rare

Question 13

How do people get narcolepsy?

Answer 13

Generally a familial disease

Question 14

What are the clinical features of narcolepsy?

Answer 14

Cataplexy
Excessive daytime somnolence
Hallucinations before sleep
Sleep paralysis

Question 15

What is cataplexy?

Answer 15

When strong emotion or laughter causes severe muscle weakness and collapse - yet patient remains conscious

Question 16

Treatment for narcolepsy?

Answer 16

Modafinil
Clomipramine - for cataplexy
Sodium Oxybate

Question 17

When is a patient in chronic ventilatory failure?

Answer 17

pCO2 > 6kPa
pO2 < 8kPa
Normal blood pH
Elevated bicarbonate

Question 18

Symptoms of chronic ventilatory failure?

Answer 18

Dyspnoea
Orthopnoea
Disturbed sleep (PND?)
Ankle swelling
Re-currant chest infections

Question 19

What is orthopnea?

Answer 19

Dyspnoea when lying flat

Question 20

Treatment for chronic ventilatory disease

Answer 20

Non-invasive ventilation in the home

O2 therapy