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1ST YEAR SYSTEMS: Respiratory > Sleep apnoea and neuromuscular respiratory failure > Flashcards

Sleep apnoea and neuromuscular respiratory failure Flashcards

1
Q

what is obstructive sleep apnoea syndrome

A

Recurrent episodes of upper airway obstruction leading to apnoea (temporary cessation of breathing) during sleep - loud snoring

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2
Q

define apnoea

A

temporary cessation of breathing for at least 10 seconds

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3
Q

what are some daytime effects of sleep apnoea syndrome

A

Daytime somnolence /sleepiness Poor daytime concentration

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4
Q

which age group commonly have sleep apnoea

A

elderly

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5
Q

what 3 things combined cause repeated obstruction of the airways in a patient

A

muscle relaxation narrow pharynx obesity

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6
Q

what other health conditions is OSAS associated with? (3)

A

hypertension stroke heart disease

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7
Q

public health risk of apnoea?

A

road traffic accidents

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8
Q

how is OSAS diagnosed? (4)

A

Clinical history and examination Epworth Questionnaire Overnight sleep study

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9
Q

what things are looked at in a polysomnography sleep study? (3)

A

pulse oximetry - O2 saturation oronasal flow ECG Electromyography (EMG) chest - diagnostic procedure to assess muscle and the nerve cell function abdominal wall movement during sleep

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10
Q

what is the Epworth sleeping scale?

A

a scale where patients have to grade how likely they are to fall asleep in certain situations from 0= would never doze to 3= high chance of dozing

There are 8 situations. Some for example are:-

  • Sitting and reading
  • Watching TV
  • sitting inactive in a public place ie cinema
  • In a car while stopped for a few minutes in the traffic
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11
Q

what is an abnormal level on the Epworth chart?

A

>11

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12
Q

What is recorded in limited sleep studies

A

pick up strain in chest/ abdomen if they expand/move with bands video recordings pulse oximetry - O2 saturation oronasal flow

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13
Q

what is the gold standard OSAS study

A

polysomnography

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14
Q

what is used to measure the severity of sleep apnoea

A

AHI- Apnea–Hypopnea Index

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15
Q

how is OSAS treated/managed?

A

Mandibular repositioning splint - device worn in the mouth Continuous positive airways pressure (CPAP) - ie O2 via a nasal mask - recommended for moderate to severe sleep apnoea Identify exacerbating factors - weight, smoking, alcohol

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16
Q

exacerbating factors of OSAS (3)

A

weight gain/obesity alcohol endocrine disorders e.g. hypothyroidism - enlargement of the tongue or disruption of the muscles that control the upper airway. acromegaly - overreaction of pituitary gland - osseous and soft-tissue changes surrounding the upper airway - narrowing and subsequent collapse during sleep.

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17
Q

which is less intrusive? CPAP ro mandibular repositioning splint?

A

mandibular repositioning splint

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18
Q

what is CPAP?

A

a mask worn at night which is connected to a machine that blows air into the throat and this creates low pressure that keeps smooth muscle apart to prevent obstruction

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19
Q

what is mandibular repositioning splint

A

a mouthguard that brings the tongue forward

20
Q

what is chronic ventilatory failure?

A

not enough oxygen passes from your lungs into your blood condition is associated with hypercapnia and low O2 for it to be chronic need to have normal blood pH and elevated bicarbonate

21
Q

General causes of chronic ventilatory failure? (4)

A

Airways disease Chest wall abnormalities Respiratory muscle weakness Central hypoventilation syndrome - autonomic nervous system doesn’t control breathing properly

22
Q

examples of airway diseases that lead to chronic ventilatory failure

A

COPD bronchiectasis OSA

23
Q

typical symptoms of chronic ventilatory failure (6)

A

Breathlessness Orthopnoea ankle swelling - due to complications with chronic condition like pulmonary hypertension or cor pulmonale Morning headache - rise in CO2 - widening of blood vessels in the brain - more pressure in CSF Recurrent chest infections Disturbed sleep

24
Q

what is orthopnoea

A

shortness of breath whilst lying flat

25
Q

what 2 things should you really look out for in examination: chronic ventilatory failure

A

paradoxical abdominal wall motion in suspected neuromuscular disease - bilateral diaphragmatic paralysis causes abdominal wall to move inwards instead of out on inspiration Ankle oedema - sign of pulmonary hypertension or cor pulmonale

26
Q

how do we investigate neuromuscular disease? (2)

A

lung function assessment of hypoventilation

27
Q

treatment of neuromuscular disease? (2)

A

Non Invasive Ventilation (NIV) - mask on the face (different to CPAP) Oxygen therapy

28
Q

narrow pharynx can be due to?

A

genetic inheritance

29
Q

what does repeated closure of upper airway cause?

A

snoring oxygen desaturation apnoea and hypopnoeas

30
Q

what is a hypopnoea

A

only partial blockage of the airway

31
Q

what is snoring caused by at a physiological level?

A

tissues vibrating together

32
Q

what is microarousal?

A

when your brain senses that you’re not breathing so it goes from a deep to light sleep and sometimes you even wake up

33
Q

approx prevelence of sleep apnoea in adult men and women?

A

men- 2% women- 1%

34
Q

what is pulse oximetery

A

monitoring the oxygen saturation of a patient’s blood and changes in blood volume in the skin whilst they sleep

35
Q

what does a full polysomnography test include?

A

recorded in hospital: - brain waves - oxygen level in your blood - heart rate and breathing - eye and leg movements

36
Q

limited sleep studies

A

home tests limited scope can include abdominal/thoracic bands to see movement/expansion nasal flow

37
Q

Electromyography (EMG) shows?

A

skeletal muscle movement

38
Q

what is narcolepsy

A

falling asleep uncontrollably in any situation very rare, can be familial

39
Q

clinical features of narcolepsy

A

cataplexy- collapsing after strong emotion or laughter excessive daytime somnolence - need/ desire to sleep sleep hallucinations or paralysis

40
Q

how is chronic respiratory failure linked with neuromuscular disease?

A

Brain sends signals to the respiratory muscles so if there is interference with this then it can cause respiratory muscle weakness and therefore insufficient ventilation or nocturnal hypoventilation

41
Q

how is blood pH normal but with elevated bicarbonate in chronic ventilatory failure?

A

the kidney’s usually get rid of bicarbonate but in chronic V.F the kidneys retain it as a way of balancing the elevated PCO2 levels that occur.

42
Q

acute ventilatory failure

A

rapid onset pH decreases because the kidney’s haven’t had time to react and retain bicarbonate

43
Q

what is the desaturation rate for mild OSA

A

5-15 desaturations per hour ie no. of times per hour of sleep that the blood’s O2 level drops by a certain degree from baseline

44
Q

what is the desaturation rate for normal OSA

A

0-5 per hour no. of times per hour of sleep that the blood’s O2 level drops by a certain degree from baseline

45
Q

what is the desaturation rate for moderate OSA

A

15-30 per hour no. of times per hour of sleep that the blood’s O2 level drops by a certain degree from baseline

46
Q

what is the desaturation rate for severe OSA

A

>30 per hour no. of times per hour of sleep that the blood’s O2 level drops by a certain degree from baseline

47
Q

what is the link with neuromuscular disease and sleep apnoea?

A

Specific characteristics of neuromuscular disorders, such as pharyngeal neuropathy or weakness, macroglossia (enlarged tongue) or low lung volumes, predispose patients to the development of obstructive events ie OSAS

1ST YEAR SYSTEMS: Respiratory (38 decks)

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