Sleep apnoea and neuromuscular respiratory failure Flashcards
what is obstructive sleep apnoea syndrome
Recurrent episodes of upper airway obstruction leading to apnoea (temporary cessation of breathing) during sleep - loud snoring
define apnoea
temporary cessation of breathing for at least 10 seconds
what are some daytime effects of sleep apnoea syndrome
Daytime somnolence /sleepiness Poor daytime concentration
which age group commonly have sleep apnoea
elderly
what 3 things combined cause repeated obstruction of the airways in a patient
muscle relaxation narrow pharynx obesity
what other health conditions is OSAS associated with? (3)
hypertension stroke heart disease
public health risk of apnoea?
road traffic accidents
how is OSAS diagnosed? (4)
Clinical history and examination Epworth Questionnaire Overnight sleep study
what things are looked at in a polysomnography sleep study? (3)
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
what is the Epworth sleeping scale?
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
what is an abnormal level on the Epworth chart?
>11
What is recorded in limited sleep studies
pick up strain in chest/ abdomen if they expand/move with bands video recordings pulse oximetry - O2 saturation oronasal flow
what is the gold standard OSAS study
polysomnography
what is used to measure the severity of sleep apnoea
AHI- Apnea–Hypopnea Index
how is OSAS treated/managed?
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
exacerbating factors of OSAS (3)
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.
which is less intrusive? CPAP ro mandibular repositioning splint?
mandibular repositioning splint
what is CPAP?
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
what is mandibular repositioning splint
a mouthguard that brings the tongue forward
what is chronic ventilatory failure?
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
General causes of chronic ventilatory failure? (4)
Airways disease Chest wall abnormalities Respiratory muscle weakness Central hypoventilation syndrome - autonomic nervous system doesn’t control breathing properly
examples of airway diseases that lead to chronic ventilatory failure
COPD bronchiectasis OSA
typical symptoms of chronic ventilatory failure (6)
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
what is orthopnoea
shortness of breath whilst lying flat
