Sleep Apnoea and Neuromuscular Respiratory Disorders

Question 1

What is the respiratory patters of a baby before 36 weeks?

Answer 1

Periodic, breathing for short periods

Question 2

How much sleep should a newborn get?

Answer 2

16 - 18hrs

sleep-wake states alternate in 3-4hr cycles

Question 3

At 6 months how much should a baby sleep?

Answer 3

14 -15hrs
1-2 daytime napps
2 longer sleeping periods

Question 4

At 2 years how much should a child sleep?

Answer 4

12hrs

1 daytime nap

Question 5

When is napping considered abnormal?

Answer 5

Up to around the age of 8 napping is normal

Question 6

How is sleep assessed?

Answer 6

Polysomnography 
Direct behavioural observation 
Movement sensors in cot mattress 
O2/CO2 monitoring
Time-lapse video

Question 7

What sleep would be abnormal for a 1yr old?

Answer 7

Sleeping 8hrs at night with no naps

Question 8

What are normal sleep phenomena?

Answer 8

Sleep walking
Sleep terrors
Hypnic jerks

Question 9

What are the main reasons for sleeplessness in children?

Answer 9

Behavioural problems
Medication
Neurological disorders

Question 10

What are the main reasons for excessive sleepiness in children?

Answer 10

Insufficient sleep
OSAS
Narcolepsy

Question 11

What does Narcolepsy cause?

Answer 11

Cataplexy

Orexin deficiency

Question 12

What is primary snoring?

Answer 12

Snoring without apnoea, hypoventilation, hypoxia, hypercarbia or daytime symptoms

Question 13

What is the prevalence of primary snoring in children?

Answer 13

About 10%

Question 14

What is the prevalence of OSAS in children?

Answer 14

About 2%

Question 15

What are the morbidities of OSAS in children?

Answer 15

Failure to thrive
Neurocognetive defects
Systemic hypertension
Cor pulmonale

Question 16

What are the possible treatment of OSAS in children?

Answer 16

Adenotonsillectomy
CPAP
Weight loss
Avoid tobacco smoke

Question 17

What are some common respiratory disorders in children?

Answer 17

Chronic neonatal lung disease
Cystic Fibrosis
Asthma

Question 18

What neurological disorders in children have an effect on the respiratory system?

Answer 18

Cerebral palsy
Down syndrome
Prader-Willi syndrome

Question 19

What is OSAS?

Answer 19

Obstructive sleep apnoea syndrome is recurrent episodes of upper airway obstruction leading to suspension of breathing during sleep

Question 20

How does OSAS effect patients?

Answer 20

Heavy snoring 
Unrefreshing sleep 
Daytime somnolence 
Poor daytime concentration 
Increased risk of RTA 
Marital disharmony

Question 21

How can the upper airway be closed?

Answer 21

Narrow pharynx
Obesity
Muscle relaxation

Question 22

What is the prevalence of OSAS in adults?

Answer 22

2% men

1% women

Question 23

How is OSAS diagnosed?

Answer 23

Clinical history and examination
Epworth questionare
Overnight sleep study

Question 24

What does an overnight sleep study involve?

Answer 24

Pulso oximetry
Limited sleep studies
Full polysomnography

Question 25

what does oximetry measure?

Answer 25

Oxygen saturation

Question 26

What are the characteristics of a patients overnight oximetry with OSAS?

Answer 26

It varies massively and continuously through the night

Question 27

What is the scale of severity of OSAS?

Answer 27

``` AHI - 0-5 normal 5-15 mild 15-30 moderate >30 severe ```

Question 28

What does AHI show?

Answer 28

The number of apnoea or hypopnea per hour of sleep

Question 29

What is the treatment of OSAS in adults?

Answer 29

Identifying and dealing with exacerbating factors CPAP Mandibular repositioning splint

Question 30

What is the prevalence of narcolepsy?

Answer 30

0.05%

Question 31

When is narcolepsy usually diagnosed?

Answer 31

Teenage years or young adults

Question 32

What are the clinical features of narcolepsy?

Answer 32

Cataplexy Excessive daytime somnolence Hypnagogic hallucinations Sleep paralysis

Question 33

What is the treatment for narcolepsy?

Answer 33

Modafinil Clomipramine Sodium Oxybate

Question 34

What is chronic ventilatory failure?

Answer 34

pCO2 > 6 kPA pO2 < 8 KPA Normal blood pH Elevated bicarbonate

Question 35

What can cause chronic ventilatory failure?

Answer 35

Airway disease Chest wall abnormalities Respiratory muscle weakness Central hypoventilation

Question 36

What are the symptoms of chronic ventilatory failure?

Answer 36

``` Breathlessness Orthopnoea Ankle swelling Morning headache Recurrent chest infection Disturbed sleep ```

Question 37

Why investigations should be done to check for chronic respiratory failure in patients with neuromuscular disease?

Answer 37

``` Lying and standing VC Mouth pressures/ SNIP Early morning ABG Overnight oximetry Transcutaneous CO2 monitoring Fluoroscopic screening of the diaphragm ```

Question 38

What is the treatment for chronic respiratory failure?

Answer 38

Domiciliary non invasive ventilation Oxygen therapy t-IPPV

Question 39

What can down syndrome cause?

Answer 39

OSAS