Sleep Apnoea and Neuromuscular Respiratory Failure Flashcards
what is apnoea?
this is the cessation of breathing for 10 seconds
what can cause repeated closure of the upper airway?
muscle relaxation
narrow pharynx
obesity
what is the relevance of sleep apnoea in adults?
> impaired quality of life
marital disharmony
associated with hypertension and an increased risk of stroke
risk to safety (sleepy driving)
how would you diagnose sleep apnoea?
> clinical history and exam
Epworth questionnaire
overnight sleep study
what does the polysomnography measure?
> oronasal airflow > thoracoabdominal movement > oximetry > body position > EEG (establishing that the patient is asleep) > EDG > EMG > ECG
what would be a normal de-saturation rate?
0-5
if a patient has a saturation rate of 5-15 what is their severity?
mild
what desaturation rate would point to moderate sleep apnoea?
15-30
if a patient has a desaturation rate of more than 30 what would their severity be?
severe
name some exacerbating factors that could be managed to reduce sleep apnoea
> weight reduction
avoidance of alcohol within 6 hours of sleeping
diagnosis and treatment of endocrine disorders
what treatment can be given to patients suffering from sleep apnoea?
> management of exacerbating factors
continuous airways pressure
mandibular repositioning splint (increases room in the mouth to reduce snoring
what are the clinical features of narcolepsy?
> cataplexy (falling to the ground)
excessive daytime somnolence
hypnagogic hallucinations
sleep paralysis
what is the treatment of narcolepsy
> modafinil
clomipramine
sodium oxybate
in chronic ventilator failure what would you expect the pCO2 and pO2 to be?
CO2 should be elevated and O2 should be below 8kPa.
what is the aetiology of chronic ventilator failure?
> airway disease (COPD, bronchiectasis)
chest wall abnormalities (kyphoscoliosis)
respiratory muscle weakness (motor neuron disease)
central hypoventilation
what are the symptoms of chronic ventilator failure?
> breathlessness > orthopnoea > ankle swelling > morning headache > recurrent chest infections > disturbed sleep
if you suspected neuromuscular disease what would you look for on examination?
paradoxical abdominal wall motion, have the patient lie flat and look at abdominal wall movement
what investigations would you carry out if you suspected neuromuscular disease?
> lung function: lying and standing VP, mouth pressures.
> assessment of hypoventilation: early morning ABG, overnight oximetry, transcutaneous CO2 monitoring
what is the treatment for chronic ventilator failure?
> domicillary non-invasive ventilation
> oxygen therapy
what is periodic breathing?
in infants there is a cessation in breathing movement, this is normal.
how would you assess a child for sleep disturbances?
>polysomnography > direct behavioural observation > time-lapse video > movement sensors in cot mattress > oxygen/co2 monitering
what is the definition of primary snoring?
snoring without apnoea, hypoventilation. hypoxia, hypercardia and daytime symptoms
what is the morbidity of OSAS?
> failure to thrive
neurocognitive defects
systemic hypertension
cor pulmonale
what is the obstructive pattern of OSAS in children?
hypoventilation
