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)