Sleep Apnoea and Neuromuscular Respiratory Failure Flashcards
What is the classification of obstructive sleep apnoea
where airway is blocked and breathing interrupted for 10 seconds or more
Due to upper airway obstruction
What is the usually symptoms of obstructive sleep apnoea
heavy snoring
Typically unrefreshing sleep which leads to:
Daytime somnolence /sleepiness
Poor daytime concentration
What is the aetiology of sleep apnoea
Muscle relaxation
Narrow pharynx
Obesity
The repeated obstruction of the upper airways results in what two outcomes
Snoring
Oxygen desaturation
What does obstructive sleep apnoea linked to and increases your risk of
Hypertension
Increased risk of stroke and heart disease
What is the different methods to diagnose obstructive sleep apnoea
Clinical history and examination
Epworth Questionnaire
- questions aimed at determining your sleepiness during the at certain activities
Overnight sleep study
What is examined in overnight sleep study
pulse oximetry
limited sleep studies
full polysomnography
When can a full polysomnopgrahy take place
What factors does a polysomnography measure
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
How do you measure the severity of obstructive sleep apnoea
Therefore What is the classification of sleep apnoeas:
normal
mild
moderate
severe
How many desaturations per hour
0-5
5-15
15-30
>30
What is the treatment for obstructive sleep apnoea
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
What is the definition of the condition Narcolepsy
a familial condition (associated with HLA type) characterized by an extreme tendency to fall asleep whenever in relaxing surroundings
What is the clinical features of Narcolepsy
Cataplexy - sudden colapse to the floor in sleep
Excessive daytime somnolence
Hypnagogic hallucinations
Sleep paralysis
What is the treatment for narcolepsy
Modafinil
Clomipramine (for cataplexy)
Sodium Oxybate (Xyrem)
What is the chemical composition of chronic ventilator failure
Elevated pCO2 (> 6.0 kPA)
pO2 < 8 kPA
Normal blood pH
Elevated bicarbonate
Why does the pH remain normal in chronic ventilator and the bicarbonate level increase
The CO2 increases shifting the equation to the right, causing an excess of H+ but this is buffered out by bicarbonate
What is the differing aetiologies of chronic ventilator failure
Airway diseases
Chest wall abnormalities -kyphoscoliosis
Respiratory muscle weaknesses
- motor neurone disease (ALS)
- muscular dystrophy
Central hypoventialtion
- obesity
- ondines curse
What is the typical symptoms of chronic ventilator failure
Breathlessness Orthopnoea - breathlessness lying flat Ankle swelling Morning headache - due to increased CO2 Recurrent chest infections Disturbed sleep
What is a potential cause of orthopnoea - SOB lying down
weakness in the diaphragm that is exposed lying down as doesn’t have the help of gravity anymore
What clinical finding can indicate underlying neuromuscluar disease in chronic ventilator failure
for paradoxical abdominal wall motion
Basically,
disordered breathing pattern -as chest moves inward during inhalation instead of moving outward
What can ankle odema indicate when chronic ventilator failure
hypoxic cor pulmonale (enlargement of the right side of the heart)
What investigations take place to investigate underlying neuromuscular disorder
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
If pulmonary function tests show a drop when lying down what does this indicate, and what is the effect on the FEV1/FVC ratio
restrictive pattern indicating a potential neuromuscular disease
Higher FEV1/FVC ratio
What is the treatment for chronic ventilator failure
Non-invasive ventilation (NIV)- machine delivers positive pressure to airway on inspiration and drops pressure on expiration – assists breathing process
Oxygen therapy
Where does the airway obstruction usually occurs in sleep apnoea
usually between posterior pharyngeal wall and tongue
What is the definition of Hypopnea
a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more
How can REM be classified
rapid eye movement, characterized by the active brain waves, flitting motions of the eyes, and weakness of the muscles
What is the sleeping pattern of new borns
– 16-18h asleep
– sleep-wake states in cycles
– then start to adapt to light-dark/social cues
Have more then 50% REM sleep
What reduces during childhood
the REM percentage of your sleep
How can children’s sleeping pattern be assessed
Polysomnography Direct behavioural observation Time-lapse video Movement sensors in cot mattress Oxygen/CO2 monitoring
What is normal characteristics of sleeping in children
Napping up to age 5 REM onset in the first 3 months sleep walking Night terrors Hypnic jerk
What is the characterisation of sleeplessness in children
age 1+
Infants arouse for 1- 5 mins each night resulting in either signalling (crying) or soothing themselves back to sleep
What causes excessive sleepiness in childhood and what can this progress on to
Insufficient sleep
Obstructive sleep apnoea
Progress on to Narcolepsy
What is the cause of primary snoring in childhood
enlarged lymphoid tissue which causes obstruction to the air way
snoring without apnea, hypoventilation, hypoxia, hypercarbia, daytime symptoms
What is the morbidity of obstructive sleep apnoea lead to in children
failure to thrive
neurocognitive defects/adhd
systemic hypertension - cor pulmonale
What is the differences in obstructive sleep apnoea in children compared to adults
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
Obstructive pattern causes what in children compared to adults
children - hypoventilation
adults - apnea
What respiratory disorders affect childood sleeping patterns and how
asthma
cystic fibrosis
- Less REM
- More awakening
chronic neonatal lung disease
-hypoxyaemia in REM sleep
What neurological disorders can affect children sleep
and what medication is given to help
cerebral palsy
Down syndrome
Prader- wili syndrome
Neuromuscular disease duchenes
Melatonin
What is the affect of cerebral palsy on sleep
fragmented sleep/delayed onset
What can down syndrome cause in sleep
Obstructive sleep apnea due to smaller nasal cavities obstructing airways
What can prader will syndrome cause
excessive daytime sleepiness
What can Neuromuscular disease duchenes cause
Death due to respiratory failure as desaturation occurs at night
