Sleep Related Breathing Disorders

Question 1

What does OSAS stand for

Answer 1

Obstructive sleep apnoea syndrome

Question 2

What are some of the consequences of OSAS

Answer 2

Quality of life
daytime sleepiness
poor concentraiton
decreased cognitive function

Question 3

OSAS is a risk factor for what 3 conditions

Answer 3

Cardiovascular disease

Stoke and hypertension

Question 4

What might sleep aggrevate

Answer 4

Pre-existing respiratory disease and specific breathing disorders may arise during sleep

Question 5

Where is the respiratory centre

Answer 5

In the medulla

Question 6

Why does the respiratory centre become less responsive to chemical and mechanical stimuli during sleep

Answer 6

Because it receives less stimulation from higher cortical centres

Question 7

What is really important in diseases associated with hypercapnic respiratory failure (COPD, neuromuscular disease and thoracic cage disorders)

Answer 7

The sleep related oxygen desaturation

Question 8

What is the treatment for sleep related breathing disorders

Answer 8

To manage the underlying respiratory disease

Avoid aggravating factors (alcohol or sedative medication)

Question 9

Is oxygen always beneficial and why?

Answer 9

It may alleviate oxygen desaturation but it may provoke further hypoventilation and carbon dioxide retention

Question 10

How is long term ventilatory support given

Answer 10

As domiciliary nocturnal non invasive positive pressure ventilation

Question 11

What triggers the ventilator to deliver additional tidal volume under positive pressure

Answer 11

The spontaneous respiratory efforts of the patient

Question 12

What can control of nocturnal desaturation by NIPPV improve

Answer 12

Quality of sleep, nocturnal symtoms
Daytime symptoms
Gas exchange

Question 13

What is a main cause of ventilatory failure

Answer 13

Kyphoscoliosis

Question 14

What is OSAS

Answer 14

A condition of sleep related pharyngeal collapse in which recurrent episodes of upper airways occlusion occur during sleep causing diminution or cessation of airflow in the pharynx provoling arousals and sleep fragmentation resulting in daytime sleepiness

Question 15

What plays an important role in maintaining the patency of the upper airway

Answer 15

The oropharyngeal dilator muscles

Question 16

What plays an important role in maintaining patency of the upper airways

Answer 16

The oropharyngeal dilator muscles

Question 17

What happens to the muscle tone during deep sleep

Answer 17

There is reduced muscle tone

Question 18

What can result in narrowing of the upper airways

Answer 18

Fat deposition in the neck from obesity
bone morphology
soft tissue deposition (hypothyroidism
Enlargement of tonsils or adenoids in children

Question 19

What can result in narrowing of the upper airways

Answer 19

Fat deposition in the neck from obesity
bone morphology
soft tissue deposition (hypothyroidism
Enlargement of tonsils or adenoids in children

Question 20

How is apnoea terminated

Answer 20

By a brief arousal from sleep

Question 21

What are some daytime symptoms of OSAS

Answer 21

Excessive sleepiness
Poor concentration
irritability 
morning headaches 
loss of libido

Question 22

What type of scale is useful in assessing the likelihood of falling asleep in various situations

Answer 22

The Epworth sleepiness scale

Question 23

Who do patients with OSAS have to advise

Answer 23

Driving licence authority

Question 24

What might the bed partner report

Answer 24

Loud snoring

Witnessed apnoeas and restless sleep

Question 25

What does examination focus on

Answer 25

Obesity Increased neck circumference anatomical abnormalities reducing pharyngeal calibre nasal obstruction (polyps and deviated septum)

Question 26

What are some of the CV complications of OSAS

Answer 26

``` Hypertension MI Stoke Cardiac arrhythmias Structural cardiac changes Cardiac failure ```

Question 27

What is OSAS often associated with

Answer 27

Hormonal changes - reduced testoesterone and growth hormone levels

Question 28

What does CPAP stand for

Answer 28

Continous positive airway pressure

Question 29

What does definitive assessment of OSAS require

Answer 29

Polysomnography

Question 30

What all is measured during a polysomnography

Answer 30

``` EEG - the stage of sleep EOG - Detects rapid eye movement Thermistor - airflow at the nose and mouth and ribcage and abdominal Oximetry - oxygen desaturation ECG - heart rate ```

Question 31

When is OSAS usually diagnosed

Answer 31

When there are more than 15 apnoeas or hypopnoeas per hour, each lasting 10 second

Question 32

What is an important treatment for patients who are overweight

Answer 32

Weight loss

Question 33

What sleeping position should be discouraged

Answer 33

Sleeping on the back

Question 34

What is now the first choice treatment for OSAS

Answer 34

Nasal CPAP applied via a tight fitting nasal mask

Question 35

How does the CPAP work

Answer 35

It acts by splinting the pharyngeal airway open, counteracting the tendency to collapse

Question 36

What pharmacological treatments are effective in OSAS

Answer 36

Moafinil Protroptylline Progesterone Acetazolamide

Question 37

What does uvulopalatopharyngoplasty involve

Answer 37

The surgical excision of redundant tissue of the soft palate, vuvla and pharyngeal walls

Question 38

What is the purpose of uvulopalatopharyngoplasty

Answer 38

To increase the calibre of the pharyngeal airway

Question 39

What happens in central sleep apnoea

Answer 39

Cessation of airflow at the nose and mouth which is associated with a lack of respiratory muscle activity

Question 40

What happens in central sleep apnoea

Answer 40

Cessation of airflow at the nose and mouth which is associated with a lack of respiratory muscle activity