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Respiratory system SA > Sleep Apnoea and Neuromuscular Respiratory Failure > Flashcards

Sleep Apnoea and Neuromuscular Respiratory Failure Flashcards

1
Q

What is the classification of obstructive sleep apnoea

A

where airway is blocked and breathing interrupted for 10 seconds or more
Due to upper airway obstruction

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2
Q

What is the usually symptoms of obstructive sleep apnoea

A

heavy snoring
Typically unrefreshing sleep which leads to:
Daytime somnolence /sleepiness
Poor daytime concentration

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3
Q

What is the aetiology of sleep apnoea

A

Muscle relaxation
Narrow pharynx
Obesity

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4
Q

The repeated obstruction of the upper airways results in what two outcomes

A

Snoring

Oxygen desaturation

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5
Q

What does obstructive sleep apnoea linked to and increases your risk of

A

Hypertension

Increased risk of stroke and heart disease

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6
Q

What is the different methods to diagnose obstructive sleep apnoea

A

Clinical history and examination

Epworth Questionnaire
- questions aimed at determining your sleepiness during the at certain activities

Overnight sleep study

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7
Q

What is examined in overnight sleep study

A

pulse oximetry
limited sleep studies
full polysomnography

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8
Q

When can a full polysomnopgrahy take place

What factors does a polysomnography measure

A

as an inpatient in a hospital

Oximetry - oxygen saturation
Body position
EEG - Audiovisual recording, show they are actually asleep
- EOG - record eye movements
- EMG (peripheral muscle)
- ECG - measure heart
Ornonasal airflow - check to see if obstruction for more than 10 seconds

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9
Q

How do you measure the severity of obstructive sleep apnoea

Therefore What is the classification of sleep apnoeas:

normal
mild
moderate
severe

A

How many desaturations per hour

0-5
5-15
15-30
>30

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10
Q

What is the treatment for obstructive sleep apnoea

A

Identify and moderate exasperating factors

  • weight reduction,
  • avoid alcohol
  • resolve endocrine disorder
  • avoid smoking

CPAP

Mandibular repositioning splint
(creates more space at the back of the throat)

Adenotonsillectomy

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11
Q

What is the definition of the condition Narcolepsy

A

a familial condition (associated with HLA type) characterized by an extreme tendency to fall asleep whenever in relaxing surroundings

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12
Q

What is the clinical features of Narcolepsy

A

Cataplexy - sudden colapse to the floor in sleep
Excessive daytime somnolence
Hypnagogic hallucinations
Sleep paralysis

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13
Q

What is the treatment for narcolepsy

A

Modafinil
Clomipramine (for cataplexy)
Sodium Oxybate (Xyrem)

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14
Q

What is the chemical composition of chronic ventilator failure

A

Elevated pCO2 (> 6.0 kPA)
pO2 < 8 kPA
Normal blood pH
Elevated bicarbonate

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15
Q

Why does the pH remain normal in chronic ventilator and the bicarbonate level increase

A

The CO2 increases shifting the equation to the right, causing an excess of H+ but this is buffered out by bicarbonate

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16
Q

What is the differing aetiologies of chronic ventilator failure

A

Airway diseases
Chest wall abnormalities -kyphoscoliosis

Respiratory muscle weaknesses

  • motor neurone disease (ALS)
  • muscular dystrophy

Central hypoventialtion

  • obesity
  • ondines curse
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17
Q

What is the typical symptoms of chronic ventilator failure

A 
Breathlessness
Orthopnoea - breathlessness lying flat 
Ankle swelling
Morning headache - due to increased CO2
Recurrent chest infections
Disturbed sleep
18
Q

What is a potential cause of orthopnoea - SOB lying down

A

weakness in the diaphragm that is exposed lying down as doesn’t have the help of gravity anymore

19
Q

What clinical finding can indicate underlying neuromuscluar disease in chronic ventilator failure

A

for paradoxical abdominal wall motion
Basically,
disordered breathing pattern -as chest moves inward during inhalation instead of moving outward

20
Q

What can ankle odema indicate when chronic ventilator failure

A

hypoxic cor pulmonale (enlargement of the right side of the heart)

21
Q

What investigations take place to investigate underlying neuromuscular disorder

A

Lung function : Pulmonary function variations from lying down and standing up

Assessment of Hypoventilation - overnight oximetry, CO2 monitoring
Fluoroscopic screening of diaphragms - how well they are working

22
Q

If pulmonary function tests show a drop when lying down what does this indicate, and what is the effect on the FEV1/FVC ratio

A

restrictive pattern indicating a potential neuromuscular disease

Higher FEV1/FVC ratio

23
Q

What is the treatment for chronic ventilator failure

A

Non-invasive ventilation (NIV)- machine delivers positive pressure to airway on inspiration and drops pressure on expiration – assists breathing process

Oxygen therapy

24
Q

Where does the airway obstruction usually occurs in sleep apnoea

A

usually between posterior pharyngeal wall and tongue

25
Q

What is the definition of Hypopnea

A

a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more

26
Q

How can REM be classified

A

rapid eye movement, characterized by the active brain waves, flitting motions of the eyes, and weakness of the muscles

27
Q

What is the sleeping pattern of new borns

A

– 16-18h asleep
– sleep-wake states in cycles
– then start to adapt to light-dark/social cues
Have more then 50% REM sleep

28
Q

What reduces during childhood

A

the REM percentage of your sleep

29
Q

How can children’s sleeping pattern be assessed

A 
Polysomnography
Direct behavioural observation
Time-lapse video
Movement sensors in cot mattress
Oxygen/CO2 monitoring
30
Q

What is normal characteristics of sleeping in children

A 
Napping up to age 5 
REM onset in the first 3 months 
sleep walking 
Night terrors 
Hypnic jerk
31
Q

What is the characterisation of sleeplessness in children

A

age 1+

Infants arouse for 1- 5 mins each night resulting in either signalling (crying) or soothing themselves back to sleep

32
Q

What causes excessive sleepiness in childhood and what can this progress on to

A

Insufficient sleep
Obstructive sleep apnoea

Progress on to Narcolepsy

33
Q

What is the cause of primary snoring in childhood

A

enlarged lymphoid tissue which causes obstruction to the air way

snoring without apnea, hypoventilation, hypoxia, hypercarbia, daytime symptoms

34
Q

What is the morbidity of obstructive sleep apnoea lead to in children

A

failure to thrive
neurocognitive defects/adhd
systemic hypertension - cor pulmonale

35
Q

What is the differences in obstructive sleep apnoea in children compared to adults

A

Daytime sleepniess main symptom in adults not children
Obesity is a factor in adults not children
Children prone to mouth breathing, adults aren’t
Enlarged tonsils common in children not adults

36
Q

Obstructive pattern causes what in children compared to adults

A

children - hypoventilation

adults - apnea

37
Q

What respiratory disorders affect childood sleeping patterns and how

A

asthma

cystic fibrosis

  • Less REM
  • More awakening

chronic neonatal lung disease
-hypoxyaemia in REM sleep

38
Q

What neurological disorders can affect children sleep

and what medication is given to help

A

cerebral palsy
Down syndrome
Prader- wili syndrome
Neuromuscular disease duchenes

Melatonin

39
Q

What is the affect of cerebral palsy on sleep

A

fragmented sleep/delayed onset

40
Q

What can down syndrome cause in sleep

A

Obstructive sleep apnea due to smaller nasal cavities obstructing airways

41
Q

What can prader will syndrome cause

A

excessive daytime sleepiness

42
Q

What can Neuromuscular disease duchenes cause

A

Death due to respiratory failure as desaturation occurs at night

Respiratory system SA (37 decks)

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