Sleep Apnoea / Narcolepsy Flashcards
What is sleep apnoea? [2]
- Recurrent episodes of upper airway obstruction / collapse of pharynx
- leading to apnoea (10s cessation of breathing)
Risk factors [2]
Associated disease [4]
- Obese, middle age male
- Smoking, excessive alcohol consumption
Associated disease
- HTN, CVD
- Metabolic syndrome
- DM, asthma
- Marfan’s, macroglossia
What are symptoms of OSA [8]
Witnessed apnoea Heavy snoring Sleep - unrefreshing, restless Day time sleepiness Poor concentration Morning headache Decreased libido Nocturia
Signs of OSA [4]
Obesity, fat deposition anterolat to upper airway
Neck circumference >48cm
Cranio-facial pharyngeal abnormalities
Nasal polyps, rhinitis, nose deformity
Pathophysiology
Reduced muscle tone in sleep
Alcohol / sedatives = lose muscle tone
Enlarged tonsil / obesity = narrow
Nasal obstruction = greater effort
Inspiration creates a force which collapses airway
What causes macroglossia [2]
What are some craniofacial/pharyngeal abnormalities that are associated with OSA? [4]
Acromegaly
Hypothyroid
Retrognathia, micrognathia
Enlarged tonsils
Macroglossia
Thickening/lengthening of soft palate or uvula
Diagnosis of OSA [4]
Clinical dx
Epworth Sleepiness score
Pulse oximetry
Polysomnogrpahy
What does the polysomnography measure?
Name 4 components
Diagnostic criteria for OSA [2]
The polysomnography measures number of apnoeic episodes ie 10s pause in breathing
EEG
Oronasal airflow
ECG
Oximetry
- > 5 apnoea, hypo-apnea or arousals per hour in association with:
- symptoms of sleep disordered breathing
Name 4 lifestyle modifications
What are first line treatments [2]
Weight loss
Smoking cessation
Alcohol and sedative drug avoidance in evening
Inform DVLA
Nasal CPAP is gold standard
Pneumatic splint
Consequences of OSA [6]
QOL, marital RTA HTN Pulmonary hypertension Type 2 resp failure Stroke, Heart disease
Severity (according to polysomnography AHI)
What is AHI?
Mild = 5-15 Mod = 15-30 Severe = >30
AHI is aponea, hypo-apnea index
Key features of narcolepsy
Cataplexy
Excessive sleep in daytime
Hypnagogic hallucination - before falling asleep
Sleep paralysis
How do you treat [3]
Modifil
Clomipramine
Sodium oxybate
2nd line treatments [2]
BiPAP
Higher pressure during ventilation and lower pressure during expiration
Mandibular advanced splints
Narcolepsy aetiology and pathophysiology [3]
- Familial HLA-DRBQ
- Mutations lead to loss of hypothalamic hypocretin-containing neurons
- via autoimmune destruction
SE of modafinil [4]
Anxiety, depression, euphoria
Dry mouth
Dyskinesia
Elevated ALP
Investigations Narcolepsy
Polysomnography
Multiple sleep latency testing
What is cataplexy [2]
Temporary loss of muscle control resulting in weakness and possible collapse
Due to strong emotions including laughter and anger
Obesity hypoventilation syndrome (Pickwick syndrome) definition [3]
- Longer and continuous episodes of hypoventilation overnight
- with(out) upper airway obstruction
- AND daytime hypercapnia
Pickwick syndrome
Aetiology
Symptoms
Ax: obesity, drugs exacerbate eg anti-histamines, sedatives Symptoms: - Sleep apnea - Chronic mouth breathing - Morning headaches - Decreased ET
Pickwick syndrome signs [6]
- Obesity
- Thoracic kyphosis
- Leg oedema
- Upper airway obstruction
- Cor pulmonale
- Acquired pectus excavatum from respiratory muscle overuse
Pickwick syndrome investigations [8]
- daytime ABG
- overnight polysomnography
- nocturnal oximetry
- CXR
- Echo (RVH)
- ECG (RBBB)
- spirometry (restrictive pattern)
- FBC, TFTs
Diagnostic criteria Pickwick syndrome [4]
- BMI >30
- Daytime PaCO2 >45mmHg
- Associated sleep breathing disorder
- Absence of other known causes of hypoventilation
Pickwick syndrome mx
Complications [3]
Mx: weight loss Complications: - CHF - Cor pulmonale - Angina
