Sleep Apnoea and Neuromuscular Respiratory Failure Flashcards
What is obstructive sleep apnoea?
Recurrent episodes of upper airway obstruction leading to apnoea during sleep
What is OSA associated with?
Heavy snoring Unrefreshing sleep Daytime somnolence / sleepiness Poor daytime concentration Increased risk of RTAs HTN Stroke Heart disease Marital disharmony
What is apnoea?
The cessation of breathing for at least 10 seconds
What is hypopnoeas?
Complete cessation of breathing
What is microarousals?
Moving from a deep to a light sleep
Diagnosis of OSA
History and exam Epworth questionnaire Overnight sleep study - pulse oximetry - limited sleep study - full polysomnography
What does Epworth study look at?
Assess how sleep the person is
What Epworth score is considered abnormal?
Score of 11 or more
What does pulse oximetry look at?
Pulse rate
Oxygen sats
What does the limited sleep study look at?
Band round chest
Abdomen and tubes measure nasal air flow
What does full polysomnography look at?
Oronasal air flow Thoracoabdominal movement Oximetry Body position EEG Audio visual recording EOG EMG ECG
What does EMG look at?
Peripheral muscle
What looks at severity of OSA?
Desaturation rate / AHI
Treatment of OSA
Identify exacerbating factors
- weight reduction
- avoidance of alcohol
- diagnose and treat endocrine disorders (e.g. hypothyroid, acromegaly)
CPAP
Mandibular repositioning splint if cant tolerate CPAP
What does CPAP stand for?
Continuous positive airway pressure
Driving and OSA
If have excessive daytime somnolence not to drive or restrict driving and inform DVLA
Once satisfactory treated, should be allowed to drive
Is narcolepsy common?
No
Who gets narcolepsy?
Familial sometimes
HLA associations
Teenagers
Presentation of narcolepsy
Cataplexy
Excessive daytime somnolence
Hypnagogic hallucinations
Sleep paralysis
What is cataplexy?
Collapse suddenly and they are asleep - vaguely aware of what is going on
What are hypnagogic hallucinations?
Frightening visual hallucinations where they go to sleep or when they are coming around from sleep
What is sleep paralysis?
Feeling of being unable to move
Treatment of narcolepsy
Modafinil
Clomipramide (for cataplexy - an antidepressant)
Sodium oxybate (xyrem)
Features of chronic ventilatory failure
Elevated PaCO2 > 6.0kPa
Pa02 < 8kPa
Normal blood pH
Elevated bicarbonate
Causes of chronic ventilatory failure
Airway disease - COPD - Bronchiectasis - OSA Chest wall abnormalities - kyphoscoliosis Respiratory muscle weakness - motor neurone disease (ALS) - muscular dystrophy Central hypoventilation - obesity hypoventilation syndrome - central hypoventilation syndrome (Ondines curse)
Presentation of chronic ventilatory failure
SOB Orthopnoea Ankle swelling Morning headache Recurrent chest infections Disturbed sleep
Definition of orthopnoea
Breathlessness when lying flat
Investigations of neuromuscular disease causing chronic ventilatory failure
Lung function - lying and standing VC - mouth pressures / SNIP Assessment of hypoventilation - early morning ABG - overnight oximetry - transcutaneous CO2 monitoring
Treatment of chronic ventilatory failure
Domicilliary non invasive ventilation (NIV)
Oxygen therapy
(t-IPPV)
Infant respiratory pattern
Periodic / apneic breathing before 36 weeks PCA
Increased regular respiratory after 36 weeks
Sleeping in newborns
16 - 18 hours sleep
Sleep wake states alternate in 3 - 4 hour cycles
Then start to adapt to light - dark / social cues
Sleeping in 6 month olds
14 - 15 hours sleep
2 longer sleep periods at night
1 - 2 daytime naps
Sleeping in 2 year olds
12 hour sleeps
1 day time nap
Pre pubertal childrens sleep
Highly efficient sleep
Get into routines
Adolescence sleep
Increased awakenings
Need more / obtain less
Assessment of childrens sleep
Polysomnography Direct behavioural observation Time lapse video Movement sensors in cot mattress Oxygen / CO2 monitoring
When is napping and enuresis abnormal?
After 3 - 5 years
What is enuresis?
Wetting the bed
What is an abnormal sleep pattern for a 1 year old?
8 hours a night and no naps
Who is sleep walking normal in?
Toddlers
Unarousable from sleep children vs adults
Children - normal
Adults - abnormal
REM sleep child vs adult
Children go straight into REM sleep, adults dont
Other normal phenomena in children
Sleep walking
Sleep terrors
Hypnic jerks
Causes of sleeplessness
Mainly behavioural problems
Asthma Medication
Neurological disorders
What is a hormone used to induce sleep?
Melatonin
Excessive sleepiness causes
Insufficient sleep
OSAS
Narcolepsy
What does narcolepsy have a deficiency of?
Orexin
What is primary snoring?
Snoring without
- apnoea
- hypoventilation
- hypoxia
- hypercapnia
- daytime symptoms
Prevalence of primary snoring
10%
What may primary snoring lead to?
OSAS
What may be a possible treatment for primary snoring?
Adenotonsillectomy
What does OSAS stand for?
Obstructive sleep apnoea syndrome
Who is OSAS commonest in and why?
Pre school child - adneoids
Consequences of OSAS in children
FTT
Neurocognitive defects / ADHD
Systemic HTN
Cor pulmonale
Are children common mouth breathers?
Yes
Treatment of OSAS in children
Adenotonsillectomy
CPAP
Weight loss
Avoid environmental tobacco smoke
Respiratory disorders in children causing sleep problems
Chronic neonatal lung disease - hypoxaemia in REM sleep - cardiac complications CF - less REM / more awakenings Asthma - worse at night
Neurological disorders causing sleep problems in children
CP - fragmented sleep / delayed onset Down syndrome - OSAS Prader willi syndrome - excessive daytime sleepiness Neuromuscular disease (duchennes MD) - death due to resp failure - nocturnal desaturtation assosiated with FVC < 1 litre
What do patients with neuromuscular disease have increasing QoL / survival with?
BiPAP
