Sleep Apnoea and Neuromuscular Failure Flashcards
What is sleep apnoea?
Recurrent episodes of upper airway obstruction leading to apnoea during sleep
What is sleep apnoea usually associated with?
Heavy snoring
Unrefreshing sleep
Daytime smnolence/sleepiness
Poor daytime concentration
What is A?
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Tensor palatini
What is B?
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Levator palatini
What is C?
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Genioglossus
What is D?
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Epiglottis
What is E?
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Genu of mandible
What is F?
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Geniohyoid
What is G?
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Hyoid bone
What is H?
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Thyrohyoid
What is I?
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Thyroid cartilage
What is J?
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Nasopharynx
What is K?
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Velopharynx
What is L?
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Oropharynx
What is M?
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Hypopharnx
What does OSAS stand for?
Obstructive sleep apnoea
What does obstructive sleep apnoea lead to?
Impaired quality of life
Martial disharmony
Increased risk of road traffic accidents
Associated with hypertension, increased risk of stroke and probably increase risk of heart disease
What is the prevalence of sleep apnoea?
2% of adult men
1% of adult woman
What does the diagnosis of sleep apnoea involve?
Clinical history and examination
Epworth questionaire
Overnight sleep study
What are examples of overnight sleep studies?
Pulse oximetry
Limited sleep studies
Full polysomnography
What is the epworth questionaire?
Different things where you rate your chance of dozing between 0 and 3
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What is this?
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Overnight oximetry
What is polysomnography?
Sleep study used to diagnose sleep disorders, recording brain waves, oxygen level in your blood, heart rate and breathing
What does a polysomnography record?
Brain waves
Oxygen level in your blood
Heart rate
Breathing
What is a sleep stud that diagnoses sleep disorders by recording brain waves, oxygen levels, heart rate and breathing?
Polysomnography
What does PSG stand for?
Polysomnography
What does a polysomnography involve?
Oronasal airflow
Thoracoabdominal movement
Oximetry
Body position
Brain activity (EEG)
Audio-visual recording
Eye movements (EOG)
Skeletal muscle activation (EMG)
Electrocardiogram (ECG)
What is oximetry?
Measures a persons oxygen saturation
What measures a persons oxygen saturation?
Oximetry
What does EEG measure?
Brain activity
What does EOG measure?
Eye movements
What does EMG measure?
Skeletal muscle activation
What does ECG measure?
Heart rhythm and electrical activity
What does the severity of obstructive sleep apnoea (OSA) depend on?
Amount of apnoea per hour
What are the different classes of severity of obstructive sleep apnoea?
Normal (0-5)
Mild (5-15)
Moderate (15-30)
Severe (>30)
What is considered normal severity?
0 - 5 apnoea
What is considered mild severity?
5-15 apnoea
What is considered moderate severity?
15-30 apnoea
What is considered severe severity?
>30 apnoea
What is an apnoea?
Temporary cessation (stopping) of breathing, especially during sleep
What is the temporary cessation of breathing, especially during sleep called?
Apnoea
What is AHI?
Number of apnoea’s recorded during the study per hour of sleep
What does the treatment of sleep apnoea involve?
Identify exacerbating factors
Continous positive airways pressure
Mandibular repositioning splint
What could be exacerbating factors for sleep apnoea?
Weight
Alcohol
Endocrine disorders
What can be said about patients with sleep apnoea and driving?
They should not drive, you should inform the DVLA of their condition
What is narcolepsy?
Sleep disorder characterised by excessive sleepiness, sleep paralysis, hallucinations and in some cases episodes of cataplexy
What is a sleep disorder characterise by excessive sleepiness, sleep paralysis, hallucinations and in some cases episodes of cataplexy?
Narcolepsy
What is cataplexy?
Total or partial loss of muscle control
What is total or partial loss of muscle control called?
Cataplexy
What is the prevalence of narcolepsy?
0.05%
How do people develop narcolepsy?
It is genetic
What genes is narcolepsy associated with?
HLA-DRB1*1501
HLA-DQB1*0602
What are the clinical features of narcolepsy?
Cataplexy
Excessive daytime somnolence
Hypnagogic hallucinations
Sleep paralysis
What is sleep paralysis?
Temporary inability to move or speak when you are falling asleep or waking up
What is the temporary inability to move or speak when you are falling asleep or waking up called?
Sleep paralysis
What is used for the treatment of narcolepsy?
Modafinil
Clomipramine
Sodium oxybate
What is chronic ventilatory failure?
Elevated PCO2 (>6kPa)
PO2 < 8kPa
Normal blood pH
Elevated bicarbonate
What is the aetiology of chronic ventilatory failure?
Airways disease
Chest wall abnormalities
Respiratory muscle weakness
Central hypoventilation
What are examples of airway diseases that can lead to chronic ventilatory failure?
COPD
Bronchiectasis
OSA (obstructive sleep apnoea)
What is an example of a chest wall abnormality that can lead to chronic ventilatory failure?
Kyphoscoliosis
What are examples of respiratory muscle weakness that can lead to chronic ventilatory failure?
Motor neurone disease (ALS)
Muscular dystrophy
What are examples of central hypoventilation problems that can lead to chronic ventilatory failure?
Obesity hypoventilation syndrome
Central hypoventilation syndrome (Ondine’s curse)
What are typical symptoms of chronic ventilatory failure?
Breathlessness
Orthopnoea
Ankle swelling
Morning headache
Recurrent chest infections
Disturbed sleep
What is orthopnoea?
Shortness of breath when lying flat
What is shortness of breath when lying flat called?
Orthopnoea
What are the examination findings of chronic ventilatory failure?
Reflects underlying diease
Particularly look for paradoxical abdominal wall motion in suspected neuromuscular disease
Ankle oedema
What should you particularly look for in the examination for suspected neuromuscular disease?
Paradoxical abdominal wall motion
What investigations are done for neuromuscular disease?
Lung function
Assessment of hypoventilation
Flouroscopic screening of diaphragms
What is used for the assessement of lung function for neuromuscular disease?
Lying and standing vital capacity
Mouth pressures
What is used for the assessment of hypoventilation in neuromuscular disease?
Early morning arterial blood gases
Overnight oximetry
Transcutaneous CO2 monitoring