Sleep Apnoea and Neuromuscular Respiratory Failure - Adults

Question 1

What are the symptoms of Obstructive Sleep Apnoea?

Answer 1

Recurrent episodes of upper airways obstruction leading to apnoea during sleep 
Heavy snoring 
Unrefreshing sleep 
Daytime somnolence (sleepiness)
Poor daytime concentration

Question 2

What three factors can leads to repeated closure of the upper airway?

Answer 2

Muscle relaxation
Narrow pharynx
Obesity

Question 3

What can repeated closure of the upper airways lead to?

Answer 3

Oxygen desaturation
Apnoeas
Snoring

Question 4

What causes poor concentration and daytime hypersomnolence?

Answer 4

Apnoeas causing frequent microarousals

Question 5

How does OSAS impact a persons life?

Answer 5

Worse QOL
Marital disharmony
Risk of RTAs
Associated with HPT, increased risk of stroke and heart disease

Question 6

What is apnoea?

Answer 6

Momentary stop in breathing

Question 7

How is OSAS diagnosed?

Answer 7

Clinical history and examination
Epworth questionnaire
Overnight sleep study

Question 8

What are 3 different overnight sleep studies?

Answer 8

Pulse oximetry
Limited sleep study
Full polysomnography

Question 9

What is hypopnoea?

Answer 9

Partial apnoeas, shallow breathing and low respiratory rate

Question 10

What equipment is used in a polysomnography?

Answer 10

EEG - stages sleep through night
EOG - measures eye movement
EMG - measures muscle movement
ECG - heart rate

Question 11

What are the values for desaturation rate?

Answer 11

Normal: 0-5
Mild: 5-15
Moderate: 15-30
Severe: > 30

Question 12

What are exacerbating factors?

Answer 12

Weight reduction
Avoidance of alcohol
Diagnose and treat endocrine disorders i.e. hypothyroidism, acromegaly

Question 13

What are 3 measures of treatment on OSAS?

Answer 13

Identify exacerbating factors
Continuous positive airways pressure (CPAP)
Mandibular repositioning splint

Question 14

What are the clinical features of narcolepsy?

Answer 14

Cataplexy
Daytime somnolence
Hypnagogic hallucinations
Sleep paralysis

Question 15

What are hypnagogic hallucinations?

Answer 15

Visual hallucinations when about to fall asleep or waking up

Question 16

What is the treatment of narcolepsy?

Answer 16

Modafinil
Clomipramine (cataplexy)
Sodium oxybate (xyrem)

Question 17

What is cataplexy?

Answer 17

Strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious.

Question 18

What are the signs of chronic ventilatory failure?

Answer 18

Elevated pCO2 (> 6kPa)
pO2 < 8 kPa
Normal blood pH
Elevated bicarbonate

Question 19

Name 3 airway diseases that cause chronic ventilatory failure

Answer 19

COPD
Bronchiectasis
OSA

Question 20

Name a chest wall abnormality that causes chronic ventilatory failure

Answer 20

Kyphosis

Question 21

Name 2 respiratory muscle weakness which cause chronic ventilatory failure

Answer 21

Motor neurone disease (ALS)

Muscular dystrophy

Question 22

Name 2 central hypoventilation problems that cause chronic ventilatory failure

Answer 22

Obesity hypoventilation syndrome - BMI > 35

Central hypoventilation syndrome

Question 23

What are symptoms of chronic ventilatory failure?

Answer 23

SOB 
Orthopnoea 
Ankle swelling - cor pulmonale symptom
Morning headache 
Recurrent chest infections 
Disturbed sleep

Question 24

What are signs of chronic ventilatory failure?

Answer 24

Reflects underlying disease 
Look for paradoxical abdominal wall motion in suspected neuromuscular disease 
Ankle oedema (hypoxic cor pulmonale)

Question 25

What are investigations for chronic respiratory failure?

Answer 25

Lung function
Assessment of Hypoventilation
(Fluoroscopic screening of diaphragm)

Question 26

What is the treatment for chronic ventilatory failure?

Answer 26

Domicillary non-invasive ventilation (NIV) - applies high inspiratory pressure and low exp pressure
Oxygen failure