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respiratory > Sleep Apnoea / Narcolepsy > Flashcards

Sleep Apnoea / Narcolepsy Flashcards

1
Q

What is sleep apnoea? [2]

A
  • Recurrent episodes of upper airway obstruction / collapse of pharynx
  • leading to apnoea (10s cessation of breathing)
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2
Q

Risk factors [2]

Associated disease [4]

A
  • Obese, middle age male
  • Smoking, excessive alcohol consumption

Associated disease

  • HTN, CVD
  • Metabolic syndrome
  • DM, asthma
  • Marfan’s, macroglossia
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3
Q

What are symptoms of OSA [8]

A 
Witnessed apnoea
Heavy snoring 
Sleep - unrefreshing, restless
Day time sleepiness 
Poor concentration
Morning headache
Decreased libido
Nocturia
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4
Q

Signs of OSA [4]

A

Obesity, fat deposition anterolat to upper airway
Neck circumference >48cm
Cranio-facial pharyngeal abnormalities
Nasal polyps, rhinitis, nose deformity

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5
Q

Pathophysiology

A

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

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6
Q

What causes macroglossia [2]

What are some craniofacial/pharyngeal abnormalities that are associated with OSA? [4]

A

Acromegaly
Hypothyroid

Retrognathia, micrognathia
Enlarged tonsils
Macroglossia
Thickening/lengthening of soft palate or uvula

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7
Q

Diagnosis of OSA [4]

A

Clinical dx
Epworth Sleepiness score
Pulse oximetry
Polysomnogrpahy

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8
Q

What does the polysomnography measure?
Name 4 components
Diagnostic criteria for OSA [2]

A

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
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9
Q

Name 4 lifestyle modifications

What are first line treatments [2]

A

Weight loss
Smoking cessation
Alcohol and sedative drug avoidance in evening
Inform DVLA

Nasal CPAP is gold standard
Pneumatic splint

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10
Q

Consequences of OSA [6]

A 
QOL, marital 
RTA
HTN
Pulmonary hypertension
Type 2 resp failure
Stroke, Heart disease
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11
Q

Severity (according to polysomnography AHI)

What is AHI?

A 
Mild = 5-15
Mod = 15-30
Severe = >30

AHI is aponea, hypo-apnea index

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12
Q

Key features of narcolepsy

A

Cataplexy
Excessive sleep in daytime
Hypnagogic hallucination - before falling asleep
Sleep paralysis

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13
Q

How do you treat [3]

A

Modifil
Clomipramine
Sodium oxybate

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14
Q

2nd line treatments [2]

A

BiPAP
Higher pressure during ventilation and lower pressure during expiration

Mandibular advanced splints

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15
Q

Narcolepsy aetiology and pathophysiology [3]

A
  • Familial HLA-DRBQ
  • Mutations lead to loss of hypothalamic hypocretin-containing neurons
  • via autoimmune destruction
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16
Q

SE of modafinil [4]

A

Anxiety, depression, euphoria
Dry mouth
Dyskinesia
Elevated ALP

17
Q

Investigations Narcolepsy

A

Polysomnography

Multiple sleep latency testing

18
Q

What is cataplexy [2]

A

Temporary loss of muscle control resulting in weakness and possible collapse
Due to strong emotions including laughter and anger

19
Q

Obesity hypoventilation syndrome (Pickwick syndrome) definition [3]

A
  • Longer and continuous episodes of hypoventilation overnight
  • with(out) upper airway obstruction
  • AND daytime hypercapnia
20
Q

Pickwick syndrome
Aetiology
Symptoms

A 
Ax: obesity, drugs exacerbate eg anti-histamines, sedatives
Symptoms:
- Sleep apnea
- Chronic mouth breathing
- Morning headaches
- Decreased ET
21
Q

Pickwick syndrome signs [6]

A
  • Obesity
  • Thoracic kyphosis
  • Leg oedema
  • Upper airway obstruction
  • Cor pulmonale
  • Acquired pectus excavatum from respiratory muscle overuse
22
Q

Pickwick syndrome investigations [8]

A
  • daytime ABG
  • overnight polysomnography
  • nocturnal oximetry
  • CXR
  • Echo (RVH)
  • ECG (RBBB)
  • spirometry (restrictive pattern)
  • FBC, TFTs
23
Q

Diagnostic criteria Pickwick syndrome [4]

A
  1. BMI >30
  2. Daytime PaCO2 >45mmHg
  3. Associated sleep breathing disorder
  4. Absence of other known causes of hypoventilation
24
Q

Pickwick syndrome mx

Complications [3]

A 
Mx: weight loss
Complications:
- CHF
- Cor pulmonale
- Angina

respiratory (14 decks)

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