Sleep Apnoea / Narcolepsy Flashcards
What is sleep apnoea
Recurrent episodes of upper airway obstruction / collapse of pharynx leading to apnoea (10s cessation of breathing)
What causes OSA
Adults = multi-factorial
Reduced muscle tone in sleep
Alcohol / sedatives = lose muscle tone
Enlarged tonsil / adenoid / obesity = narrow oropharynx / collapse
Nasal obstruction / polyp = greater effort
Inspiration creates a force which collapses airway
In children usually large adenoids / tonsils
What are symptoms of OSA
Apnoea reported by partner Heavy snoring Oxygen desaturation Unrefreshing sleep Arousals Day time sleepiness Poor concentration Morning headache Decreased libido Nocturia
What are consequences
Respiratory acidosis
Pulmonary hypertension
What are RF for OSA
Men Obesity Middle age Alcohol Smoking Hypothyroid Acromegaly DM Down's Large tonsils Marfan's Macroglossia Snoring FH
What causes macroglossia
Acromegaly
Hypothyroid
How do you Dx OSA
History Exam - Measure BMI - Measure neck circumference Flexible nasa-endoscopy to look for structure that may obstruct airflow from nasal cavity to vocal cord Epworth Questionairre >10 Sleep study - 1 night if Epworth >10 or sleepy in dangerous situation Full polysomnogrpahy = gold standard
What does polysomnography look at
Pulse oximetry - O2 sats EEG EMG ECG Oronasal airflow
How do you treat OSA
Weight reduction
Avoid alcohol / smoking
Treat endocrine
Treat nasal obstruction - intranasal steroid or decongestant (short term)
CPAP = 1st line to prevent airway closing
Mandibular repositioning if can’t tolerate
Surgery best in children and can be considered in adults
Inform DVLA
Consequences of OSA
QOL Marital RTA Pulmonary hypertension Type 2 resp failure CVS - IHD / HF Obesity HTN Arrhythmia / AF DM Stroke
Severity
Mild = 5-15 Mod = 15-30 Severe = >30
What is narcolepsy
Cataplexy - collapse when emotional
Excessive sleep in daytime
Hypnagogic hallucination - before falling asleep
Sleep paralysis
How do you treat
Modifil
Clomipramine
Sodium oxybate
