Sleep Apnoea and Neuromuscular Respiratory Failure

Question 1

What is the presentation of sleep apnoea?

Answer 1

Sleep apnoea is characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. Common symptoms include loud snoring, choking or gasping during sleep, excessive daytime sleepiness, fatigue, and difficulty concentrating.

Question 2

Conditions commonly associated with sleep apnoea include:

Answer 2

Obesity (increases risk due to fat deposition around the airway).

Hypertension (sleep apnoea can contribute to high blood pressure).

Heart failure (sleep apnoea exacerbates cardiovascular conditions).

Stroke and Type 2 diabetes.

Chronic obstructive pulmonary disease (COPD).

Question 3

What are the consequences of untreated sleep apnoea?

Answer 3

Untreated sleep apnoea can lead to serious consequences such as:

• Cardiovascular problems (e.g., high blood pressure, heart attack, arrhythmias).
• Stroke.
• Daytime fatigue and impaired cognitive function (increased risk of accidents).
• Metabolic disturbances (e.g., insulin resistance, obesity).
• Increased mortality if left untreated over time.

Question 4

What are the management options for sleep apnoea?

Answer 4

Management options include:

• Continuous Positive Airway Pressure (CPAP) therapy (most common treatment).
• Lifestyle modifications (weight loss, avoiding alcohol and sedatives, sleeping on one’s side).
• Oral appliances (mandibular advancement devices) to reposition the jaw.
• Surgical options (e.g., tonsillectomy, uvulopalatopharyngoplasty) in severe cases.

Question 5

What are other conditions causing excessive daytime sleepiness?

Answer 5

Other conditions that cause excessive daytime sleepiness include:

• Narcolepsy (a neurological disorder causing sudden sleep attacks).
• Restless leg syndrome (an urge to move legs, leading to poor sleep quality).
• Idiopathic hypersomnia (excessive sleepiness without a clear cause).
• Depression (can lead to fatigue and sleep disturbances).
• Sleep deprivation due to lifestyle or other medical conditions.

Question 6

What neurological conditions are associated with respiratory muscle weakness?

Answer 6

Neurological conditions associated with respiratory muscle weakness include:

• Amyotrophic lateral sclerosis (ALS).
• Guillain-Barré syndrome.
• Muscular dystrophies (e.g., Duchenne muscular dystrophy).
• Spinal cord injuries (especially at higher levels).
• Multiple sclerosis (can affect respiratory muscles if the upper motor neurons are involved).

Question 7

What are the presenting symptoms and signs of respiratory muscle weakness?

Answer 7

Symptoms of respiratory muscle weakness include:

Shortness of breath (especially with exertion).
Orthopnea (difficulty breathing when lying flat).
Fatigue.
Hypoventilation (shallow breathing).
Weak cough (inability to clear secretions effectively).

Signs include:

Decreased breath sounds.
Decreased diaphragmatic movement.
Weak or absent gag reflex.
Elevated CO2 levels in blood gases.

Question 8

What investigations are used for respiratory muscle weakness?

Answer 8

Investigations include:

Pulmonary function tests (to assess lung volumes and capacities).
Blood gases (to assess oxygen and CO2 levels).
Electromyography (EMG) (to assess muscle function).
Chest X-ray or CT scan (to rule out other causes of respiratory distress).
MRI of the spinal cord or brain (if a neurological cause is suspected).

Question 9

What is the management of respiratory muscle weakness?

Answer 9

Management includes:

Non-invasive ventilation (NIV), such as BiPAP or CPAP, to support breathing.
Oxygen therapy for hypoxemia.
Physical therapy to strengthen remaining respiratory muscles.
Pharmacological treatments (e.g., corticosteroids for inflammatory conditions like myasthenia gravis).
Surgical interventions (e.g., diaphragm pacing in certain conditions).
Tracheostomy or mechanical ventilation in advanced cases where non-invasive methods fail.