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2. Respiratory Medicine (Lectures) > Sleep Apnoea and Neuromuscular Respiratory Failure > Flashcards

Sleep Apnoea and Neuromuscular Respiratory Failure Flashcards

1
Q

What is obstructive sleep apnoea?

A

Recurrent episodes of upper airway obstruction leading to apnoea during sleep

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2
Q

What is OSA associated with?

A

Heavy snoring
Unrefreshing sleep
Daytime somnolence / sleepiness
Poor daytime concentration
Increased risk of RTAs
HTN
Stroke
Heart disease
Marital disharmony

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3
Q

What is apnoea?

A

The cessation of breathing for at least 10 seconds

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4
Q

What is hypopnoeas?

A

Complete cessation of breathing

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5
Q

What is microarousals?

A

Moving from a deep to a light sleep

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6
Q

Diagnosis of OSA

A

History and exam
Epworth questionnaire
Overnight sleep study
- pulse oximetry
- limited sleep study
- full polysomnography

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7
Q

What does Epworth study look at?

A

Assess how sleep the person is

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8
Q

What Epworth score is considered abnormal?

A

Score of 11 or more

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9
Q

What does pulse oximetry look at?

A

Pulse rate
Oxygen sats

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10
Q

What does the limited sleep study look at?

A

Band round chest
Abdomen and tubes measure nasal air flow

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11
Q

What does full polysomnography look at?

A

Oronasal air flow
Thoracoabdominal movement
Oximetry
Body position
EEG
Audio visual recording
EOG
EMG
ECG

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12
Q

What does EMG look at?

A

Peripheral muscle

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13
Q

What looks at severity of OSA?

A

Desaturation rate / AHI

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14
Q

Treatment of OSA

A

Identify exacerbating factors
- weight reduction
- avoidance of alcohol
- diagnose and treat endocrine disorders (e.g. hypothyroid, acromegaly)
CPAP
Mandibular repositioning splint if cant tolerate CPAP

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15
Q

What does CPAP stand for?

A

Continuous positive airway pressure

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16
Q

Driving and OSA

A

If have excessive daytime somnolence not to drive or restrict driving and inform DVLA
Once satisfactory treated, should be allowed to drive

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17
Q

Is narcolepsy common?

A

No

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18
Q

Who gets narcolepsy?

A

Familial sometimes
HLA associations
Teenagers

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19
Q

Presentation of narcolepsy

A

Cataplexy
Excessive daytime somnolence
Hypnagogic hallucinations
Sleep paralysis

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20
Q

What is cataplexy?

A

Collapse suddenly and they are asleep - vaguely aware of what is going on

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21
Q

What are hypnagogic hallucinations?

A

Frightening visual hallucinations where they go to sleep or when they are coming around from sleep

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22
Q

What is sleep paralysis?

A

Feeling of being unable to move

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23
Q

Treatment of narcolepsy

A

Modafinil
Clomipramide (for cataplexy - an antidepressant)
Sodium oxybate (xyrem)

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24
Q

Features of chronic ventilatory failure

A

Elevated PaCO2 > 6.0kPa
Pa02 < 8kPa
Normal blood pH
Elevated bicarbonate

25
Q

Causes of chronic ventilatory failure

A

Airway disease
- COPD
- Bronchiectasis
- OSA
Chest wall abnormalities
- kyphoscoliosis
Respiratory muscle weakness
- motor neurone disease (ALS)
- muscular dystrophy
Central hypoventilation
- obesity hypoventilation syndrome
- central hypoventilation syndrome (Ondines curse)

26
Q

Presentation of chronic ventilatory failure

A

SOB
Orthopnoea
Ankle swelling
Morning headache
Recurrent chest infections
Disturbed sleep

27
Q

Definition of orthopnoea

A

Breathlessness when lying flat

28
Q

Investigations of neuromuscular disease causing chronic ventilatory failure

A

Lung function
- lying and standing VC
- mouth pressures / SNIP
Assessment of hypoventilation
- early morning ABG
- overnight oximetry
- transcutaneous CO2 monitoring

29
Q

Treatment of chronic ventilatory failure

A

Domicilliary non invasive ventilation (NIV)
Oxygen therapy
(t-IPPV)

30
Q

Infant respiratory pattern

A

Periodic / apneic breathing before 36 weeks PCA
Increased regular respiratory after 36 weeks

31
Q

Sleeping in newborns

A

16 - 18 hours sleep
Sleep wake states alternate in 3 - 4 hour cycles
Then start to adapt to light - dark / social cues

32
Q

Sleeping in 6 month olds

A

14 - 15 hours sleep
2 longer sleep periods at night
1 - 2 daytime naps

33
Q

Sleeping in 2 year olds

A

12 hour sleeps
1 day time nap

34
Q

Pre pubertal childrens sleep

A

Highly efficient sleep
Get into routines

35
Q

Adolescence sleep

A

Increased awakenings
Need more / obtain less

36
Q

Assessment of childrens sleep

A

Polysomnography
Direct behavioural observation
Time lapse video
Movement sensors in cot mattress
Oxygen / CO2 monitoring

37
Q

When is napping and enuresis abnormal?

A

After 3 - 5 years

38
Q

What is enuresis?

A

Wetting the bed

39
Q

What is an abnormal sleep pattern for a 1 year old?

A

8 hours a night and no naps

40
Q

Who is sleep walking normal in?

A

Toddlers

41
Q

Unarousable from sleep children vs adults

A

Children - normal
Adults - abnormal

42
Q

REM sleep child vs adult

A

Children go straight into REM sleep, adults dont

43
Q

Other normal phenomena in children

A

Sleep walking
Sleep terrors
Hypnic jerks

44
Q

Causes of sleeplessness

A

Mainly behavioural problems
Asthma Medication
Neurological disorders

45
Q

What is a hormone used to induce sleep?

A

Melatonin

46
Q

Excessive sleepiness causes

A

Insufficient sleep
OSAS
Narcolepsy

47
Q

What does narcolepsy have a deficiency of?

A

Orexin

48
Q

What is primary snoring?

A

Snoring without
- apnoea
- hypoventilation
- hypoxia
- hypercapnia
- daytime symptoms

49
Q

Prevalence of primary snoring

A

10%

50
Q

What may primary snoring lead to?

A

OSAS

51
Q

What may be a possible treatment for primary snoring?

A

Adenotonsillectomy

52
Q

What does OSAS stand for?

A

Obstructive sleep apnoea syndrome

53
Q

Who is OSAS commonest in and why?

A

Pre school child - adneoids

54
Q

Consequences of OSAS in children

A

FTT
Neurocognitive defects / ADHD
Systemic HTN
Cor pulmonale

55
Q

Are children common mouth breathers?

A

Yes

56
Q

Treatment of OSAS in children

A

Adenotonsillectomy
CPAP
Weight loss
Avoid environmental tobacco smoke

57
Q

Respiratory disorders in children causing sleep problems

A

Chronic neonatal lung disease
- hypoxaemia in REM sleep
- cardiac complications
CF
- less REM / more awakenings
Asthma
- worse at night

58
Q

Neurological disorders causing sleep problems in children

A

CP
- fragmented sleep / delayed onset
Down syndrome
- OSAS
Prader willi syndrome
- excessive daytime sleepiness
Neuromuscular disease (duchennes MD)
- death due to resp failure
- nocturnal desaturtation assosiated with FVC < 1 litre

59
Q

What do patients with neuromuscular disease have increasing QoL / survival with?

A

BiPAP

2. Respiratory Medicine (Lectures) (50 decks)

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