Sleep Apnoea and Neuromuscular Respiratory Failure

Question 1

Features of Sleep Apnoea (5)

Answer 1

Heavy snoring
Unrefreshing sleep
Daytime somnolence
Poor daytime concentration
Obstruction between the pharyngeal wall and soft palette

Question 2

Pathophysiology (5)

Answer 2

Muscle relaxation
Narrow pharynx
Obesity
Snoring
Oxygen desaturation

Question 3

Definition of Apnoea

Answer 3

Complete obstruction

Question 4

Definition of Hypopneas

Answer 4

Partial obstruction

Question 5

Importance of treating OSAS

Answer 5

Impaired quality of life
Marital disharmony
Increased risk of road traffic accident
Hypertension
Increased risk of stroke and heart disease

Question 6

Diagnosis

Answer 6

Clinical history and examination
Epworth questionnaire
Overnight sleep study
Polysomnography

Question 7

What is a Epworth questionnaire

Answer 7

a questionnaire with a scale marked out of 24 where patients grade themselves how likely they are to fall asleep in 8 situation

Question 8

What is carried out in an overnight sleep study

Answer 8

Pulse oximetry- monitors oxygen saturation of a patient’s blood
Limited sleep studies
Full polysomnography

Question 9

What is a polysomnography

Answer 9

Gold standard
Records brain waves overnight
Apnoea index
Oronasal airflow

Question 10

What is the Apnoea index

Answer 10

Apnoea + Hypopnea events / Hours of sleep

Question 11

Other investigations for Sleep Apnoea

Answer 11

Thoracoabdominal movement
ECG
Audio-visual recording
EOG
EMG
ECG

Question 12

Normal Apnoea index

Answer 12

0-5

Question 13

Mild Apnoea index

Answer 13

5-15

Question 14

Moderate Apnoea index

Answer 14

15-30

Question 15

Severe Apnoea index

Answer 15

> 30

Question 16

Treatment (5)

Answer 16

Weight reduction
Avoidance of alcohol
Diagnose and treat endocrine disorders e.g. hyperthyroidism acromegaly
Continuous positive airways pressure
Mandibular repositioning splint

Question 17

What is Narcolepsy

Answer 17

A sleep disorder characterised by excessive sleepiness, sleep paralysis, hallucinations and in some cases cataplexy

Question 18

What is the genetics of narcolepsy

Answer 18

Familial

Associated with HLA- DRB11501 and HLADQB10602

Question 19

Clinical features of narcolepsy

Answer 19

Cataplexy
Excessive daytime somnolence
Hypnagogic hallucinations
Sleep Paralysis

Question 20

Treatment of Narcolepsy

Answer 20

Modafinil- promote wakefulness
Clomipramine (for cataplexy)
Sodium Oxybate (Xyrem)

Question 21

Features of Chronic Ventilatory Failure

Answer 21

Elevated PCO2
Low PO2
Normal blood PH
Elevated bicarbonate

Question 22

Why is bicarbonate elevated and Co2 high in CVF

Answer 22

Bicarbonate is release to buffer the excess CO2 which reduced the respiratory drive and leads to respiratory hypoventilation

Question 23

Aetiology of CVF

Answer 23

COPD
Bronchiectasis
OSA
Kyphoscoliosis
Motor neurone disease (ALS)
Muscular dystrophy
Obesity hypoventilation syndrome
Ondine's curse

Question 24

Symptoms of CVF

Answer 24

SOB
Orthopnea
Ankle swelling
Morning headache
Recurrent chest infections
Disturbed sleep

Question 25

Examination finding of CVF

Answer 25

Reflects underlying disease
Ankle Oedema (cor pulmonale)

Question 26

Treatment of CVF

Answer 26

Domiciliary non-invasive ventilation
Oxygen therapy (24-28%)
Tracheotomized Intermittent Positive Pressure Ventilation