Sleep apnoea and respiratory neuromuscular disorders

Question 1

What is OSAS?

Answer 1

Obstructive sleep apnoea disorder

Condition characterised by recurrent episode of upper airway obstruction leading to temporary cessation of breathing while sleeping

Question 2

What are the effects of sleep apnoea on a sufferer?

Answer 2

Un-refreshing sleep leading to daytime somnolence and poor concentration

Poorer quality of life

Increased risk of RTA’s (crashes)

Increased risk of stroke, heart disease and hypertension

Question 3

What group of people are prone to having sleep apnoea?

Answer 3

The obese

Question 4

What is the prevalence of OSAS amongst men and women?

Answer 4

2% of men

1% of women

Question 5

How is OSAS diagnosed?

Answer 5

Clinical history + examination

Epworth questionnaire

Overnight sleep study

Question 6

What is the Epworth questionnaire?

Answer 6

Questionnaire were patients rate how likely they are to doze off in certain situations out of 0, 1, 2 or 3 (highest)

Question 7

In what 3 ways can a sleep study be carried out?

Answer 7

Overnight oximetry

Limited sleep studies - embletta

Full polysomnography

Question 8

The severity of OSAS is based on the….

Answer 8

Desaturation rate

Question 9

A patient with a desaturation rate of 0-5 is…

Answer 9

Normal

Question 10

A patient with a desaturation rate of 15-30 has …

Answer 10

Moderate OSAS

Question 11

A patient with a desaturation rate of 40 has…

Answer 11

Severe OSAS

>30 is severe

Question 12

A patient with mild OSAS would have a saturation rate of…

Answer 12

5 - 15

Question 13

How is OSAS treated?

Answer 13

Identify and treat exacerbating factors (weight, alcohol, endocrine disorders)

Continuous positive airways pressure (CPAP) machine

Mandibular repositioning splint (looks like a gumshield)

Question 14

Why must the DVLA be informed of someones diagnosis with OSAS?

Answer 14

Severe impairment of ability to drive

Question 15

What is narcolepsy?

Answer 15

Disorder where there is a lack of control of sleeping, and the sufferer may fall asleep at inappropriate times

Question 16

What is the prevalence of narcolepsy?

Answer 16

0.05%

Question 17

Narcolepsy is associated with what genes in the body?

Answer 17

HLA - DRB11501 and HLA DQB1 0602

Question 18

What are the clinical features of narcolepsy?

Answer 18

Daytime somnolence with random, sudden sleeping

Hypnagogic hallucinations

Sleep paralysis

Cataplexy (sometimes)

Question 19

How is narcolepsy treated?

Answer 19

Modafinil (which is good shit)

Clomipramine (for cataplexy)

Sodium oxybate (Xyrem)

Question 20

What are the conditions for a patient to have chronic ventilatory failure?

Answer 20

pCO2 of >6.0 kPa

pO2 <8.0 kPa

Normal blood pH

Elevated blood bicarbonate

Question 21

What conditions might be responsible for chronic ventilatory failure?

Answer 21

Airway diseases - COPD, bronchiectasis, OSA

Chest wall abnormalities - kyphoscoliosis

Respiratory muscle weakness - muscular dystrophy or motor neurone disease (ALS)

Central hypoventilation - obesity hypoventilation syndrome, central hypoventilation syndrome (Ondine’s curse)

Question 22

What are the symptoms of chronic ventilatory failure?

Answer 22

Breathlessness 
Orthopnoea 
Ankle oedema 
Morning headache 
Recurrent chest infections 
Disturbed sleep

Question 23

What is orthopnoea?

Answer 23

Breathlessness when lying flat

Question 24

What is NIV?

Answer 24

(Domicillary) non invasive ventilation

Used for treatment of CVF due to neuromuscular disease

Question 25

t-IPPV is basically what?

Answer 25

Mechanical ventilation machine thingy