Sleep Apnoea and Neuromuscular Respiratory Disorders Flashcards

1
Q

What does OSAS stand for?

A

Obstructive sleep apnoea syndrome

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2
Q

What causes OSAS

A

Respiratory movement of the chest wall generates negative pressure which draws upper airway tissue inwards, obstructing airway

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3
Q

What is primary snoring?

A

Snoring without:

  • apnea
  • hypercapnia
  • hypoventilation
  • hypoxia
  • daytime symptoms
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4
Q

What can primary snoring progress to?

A

OSAS

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5
Q

When is OSAS most common?

A

Pre-school child

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6
Q

What is the prevalence of OSAS?

A

2%

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7
Q

What are the associated morbidities with sleep apnoea?

A

Failure to thrive

Neurocognitive defects/adhd

Systemic hypertension

Cor Pulmonale

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8
Q

What is the difference between Adult versus Childhood OSAS?

A
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9
Q

What is the treatment for OSAS?

A
  • Adenotonsillectomy
  • weight reduction
  • avoid alcohol
  • diagnose/treat endocrine disease (hypothyroidism, acromegaly)
  • CPAP
  • mandibular repositioning splint
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10
Q

What are the respiratory disorders associated with sleep apnoea?

A

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

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11
Q

What neuorlogical disorders are associated with sleep disorders?

A

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

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12
Q

What are the three types of sleep apnoea?

A

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

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13
Q

Which type of sleep apnea is most common in infants and premature babies?

A

Central sleep apnea

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14
Q

Who often has mixed apnea?

A

Smaller premature babies

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15
Q

Who is most likely to have OSA?

A

Adults and children age 1 year and older

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16
Q

Why do children with Down Syndrome have a higher incidence of sleep apnea?

A

Condition affects the upper airway

17
Q

In babies, what are the common causes of sleep apnea?

A

Immaturity of the brain stem - regulates breathing

Upper airway Obstruction

18
Q

What is meant by periodic breathing?

A

Irregular breathing pattern

19
Q

What is the presentation of sleep apnea?

A
  • Unrefreshing sleep
  • Daytime somnolence/sleepiness
  • Poor daytime concentration
20
Q

What is the test often used to diagnose sleep apnea?

A

Polysomnogram

21
Q

What does polysomnogram consist of?

A

sleep study + EEG, EOG, EMG, ECG)

22
Q

What is sleeplessness caused by?

A

Behavioural problems

Medication

Neurological Disorders (melatonin)

23
Q

What is the scoring for the severity of sleep apnoea

A

0-5 - Normal

5-15 Mild

15-30 Moderate

>30 Severe

24
Q

Define narcolepsy

A

Rare, long term brain condition that causes patient to fall asleep at inappropriate times

25
Q

What is often a common feature of patients suffering from narcolepsy?

A

Cataplexy - strong emotion or laughter causes person to have sudden physical collapse but remaining conscious

26
Q

What are the risk factors for narcolepsy

A

Familial

(associated with HLA-DRB1*1501/HLADQB1*0602)

27
Q

What are the clinical features of narcolepsy

A
  • Cataplexy
  • Excessive daytime somnolence
  • Hypnagogic / hynopompic hallucinations
  • Sleep paralysis
28
Q

What are the investigations for narcolepsy

A

Polysomnography

Multiple sleep latency test

  • Sleep onset at REM > 1 (SOREM >1)
  • Fall asleep in < 8 min

Low CSF orexin (neuropeptide)

29
Q

What is the management for narcolepsy

A
  • Modafinil
  • Dexamphetamine
  • Venlafaxine (for cataplexy)
  • Sodium Oxybate (Xyrem)