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S1.1 Respiratory > Sleep Apnoea and Neuromuscular Respiratory Disorders > Flashcards

Sleep Apnoea and Neuromuscular Respiratory Disorders Flashcards

1
Q

What is obstructive sleep apnoea syndrome?

A

OSAS
Recurrent episodes of upper airway obstruction leading to apnoea during sleep

Usually associated with heavy snoring

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2
Q

What is the pathophysiology of OSAS?

A

Muscle relaxation
Narrow pharynx
Obesity
All leading to repeated closure of upper airways

Leads to snoring, oxygen desaturation

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3
Q

Symptoms/Signs of OSAS?

A

Frequent microarousals
Poor concentration
Daytime hypersomnolence

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4
Q

Prevalence of OSAS?

A

2% adult men

1% adult women

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5
Q

How is OSAS diagnosed?

A 
Clinical history and examination
Epworth questionnaire
Overnight sleep study
- pulse oximetry
- limited sleep studies
- full polysomnography
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6
Q

What is polysomnography?

A

Tests many things in sleep, as inpatient

Oronasal airflow
Thoracoabdominal movement
Oximetry
Body position
EEG - main difference
Audiovisual recording
EOG
EMG
ECG
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7
Q

How is OSAS severity scored?

A

Desaturations per hour

0-5 = normal
5-15 = mild
15-30 = moderate
30+ = severe
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8
Q

How is OSAS treated?

A

Identify exacerbating factors

  • weight
  • alcohol
  • endocrine disorders

CPAP
Mandibular repositioning splint

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9
Q

What are the clinical features of narcolepsy?

A

Cataplexy
Excessive daytime somnolence
Hypnagogic hallucinations
Sleep paralysis

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10
Q

How is narcolepsy treated?

A

Modafinil
Clomipramine for cataplexy
Sodium oxybate (Xyrem)

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11
Q

What is the criteria for chronic ventilatory failure?

A

Elevated pCO2 >6kPa
pO2 <8kPa
Elevated bicarbonate
- normal pH

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12
Q

What can cause chronic ventilatory failure?

A

Airways disease

  • COPD
  • bronchiectasis
  • OSAS

Chest wall abnormalities
- kyphoscoliosis

Respiratory muscle weakness

  • MND
  • Muscular dystrophy

Central hypoventilation

  • obesity
  • central hypoventilation
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13
Q

Typical symptoms of chronic ventilatory failure?

A 
SOB
Orthopnoea
Ankle oedema
Morning headache
Recurrent chest infections
Disturbed sleep
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14
Q

What may examination findings be in chronic ventilatory failure?

A

Reflects underlying disease
Paradoxical abdominal wall motion suggests neuromuscular condition
Ankle oedema may suggest hypoxic cor pulmonale

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15
Q

What investigations might you do in suspected neuromuscular disease in chronic ventilatory failure?

A

Lying and standing VC
Mouth pressures/sniff nasal inhalatory pressure

Assessment of hypoventilation

  • morning arterial blood gases
  • overnight oximetry
  • transcutaneous CO2 monitoring

Fluoroscopic screening of diaphragms
Pulmonary function tests

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16
Q

What is the treatment for chronic ventilatory failure?

A

Domicillary NIV
Oxygen therapy
t-IPPV - tracheosctomy ventilation

S1.1 Respiratory (15 decks)

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