Sleep Apnoea and Neuromuscular Respiratory Disorders Flashcards
What does OSAS stand for?
Obstructive sleep apnoea syndrome
What causes OSAS
Respiratory movement of the chest wall generates negative pressure
Draws upper airway tissue inwards, obstructing airway
What is primary snoring?
Snoring without:
- apnea
- hypercapnia
- hypoventilation
- hypoxia
- daytime symptoms
What can primary snoring progress to?
OSAS
When is OSAS most common?
Pre-school child
What is the prevalence of OSAS?
2%
What are the associated morbidities with sleep apnoea?
Failure to thrive
Neurocognitive defects/adhd
Systemic hypertension
Cor Pulmonale
What is the difference between Adult versus Childhood OSAS?
What is the treatment for OSAS?
- Adenotonsillectomy
- weight reduction
- avoid alcohol
- diagnose/treat endocrine disease (hypothyroidism, acromegaly)
- CPAP
- mandibular repositioning splint
What are the respiratory disorders associated with sleep apnoea?
Chronic neonatal lung disease
–hypoxaemia in REM sleep (similar COPD)
–cardiac complications
Cystic Fibrosis
–FEV1 30-60% associated with decrease SaO2 (~8%)
–less REM/more awakenings
Asthma
What neuorlogical disorders are associated with sleep disorders?
Cerebral palsy
–fragmented sleep/delayed onset
–melatonin
Down Syndrome
–OSAS
Prader-Willi Syndrome
–excessive daytime sleepiness
•Neuromuscular disease (Duchenne’s MD)
–death due to respiratory failure
–nocturnal desaturation associated with FVC <1litre
–increasing quality of life/survival with BiPAP
What are the three types of sleep apnoea?
Obstructive sleep apnoea - caused by blockage in the upper airway
Central sleep apnea - brain fails to signal muscles to breathe
Mixed apnoea - combination of above
Which type of sleep apnea is most common in infants and premature babies?
Central sleep apnea
Who often has mixed apnea?
Smaller premature babies
Who is most likely to have OSA?
Adults and children age 1 year and older
Why do children with Down Syndrome have a higher incidence of sleep apnea?
Condition affects the upper airway
In babies, what are the common causes of sleep apnea?
Immaturity of the brain stem - regulates breathing
Upper airway Obstruction
What is meant by periodic breathing?
Irregular breathing pattern
What is the presentation of sleep apnea?
- Unrefreshing sleep
- Daytime somnolence/sleepiness
- Poor daytime concentration
What is the test often used to diagnose sleep apnea?
Polysomnogram
What does polysomnogram consist of?
sleep study + EEG, EOG, EMG, ECG)
What is sleeplessness caused by?
Behavioural problems
Medication
Neurological Disorders (melatonin)
What is the scoring for the severity of sleep apnoea
0-5 - Normal
5-15 Mild
15-30 Moderate
>30 Severe
Define narcolepsy
Rare, long term brain condition that causes patient to fall asleep at inappropriate times
What is often a common feature of patients suffering from narcolepsy?
Cataplexy - strong emotion or laughter causes person to have sudden physical collapse but remaining conscious
What are the risk factors for narcolepsy
Familial
(associated with HLA-DRB1*1501/HLADQB1*0602)
What are the clinical features of narcolepsy
- Cataplexy
- Excessive daytime somnolence
- Hypnagogic / hynopompic hallucinations
- Sleep paralysis
What are the investigations for narcolepsy
Polysomnography
Multiple sleep latency test
- Sleep onset at REM > 1 (SOREM >1)
- Fall asleep in < 8 min
Low CSF orexin (neuropeptide)
What is the management for narcolepsy
- Modafinil
- Dexamphetamine
- Venlafaxine (for cataplexy)
- Sodium Oxybate (Xyrem)
