Sleep Studies Flashcards
Symptoms related to tiredness?
- Morning headaches
- low Libido,mood and concentration
- Noctouria
- Sleep onset and walking
- Snoring history
- Marital disharmony
- RTA’s car crash
Physical exam?
- Height
- Weight
- BMI
- Neck circumpherence
- BP
- Cardiothoracic examination
- ENT examination
- Neurological examination
Meds causing fatigue or sleepiness?
- Alcohol
- Opiates
- Beta-blockers
- Antipsychotics
- Anti-histamines
OSAHS
What is an Apnoea
What is a hypopnea
Apnoea = cessation of breathing for at least 10 seconds AND decrease in oxygen saturation <4%
Hypopnea = 50% reduction In tidal volume for at least 10s and decrease in oxygen saturation
What is OSA?
- Cessation of airflow during sleep preventing air entering lungs
- Needs to be longer than 10s to be significant
- Leads to disrupted sleep
How do we assess?
- Subjective sensation
- ESS
- Sleep diary
Risk factors?
- Male
- Elevated BMI
- Smoker
- Alcohol
- Sedatives
- Retrognathia
What occurs in normal individuals?
- On inspiration negative pharyngeal pressure is generated
- Potential for pharyngeal collapse and obstruction
- Despite sleep-induced hypotonia increased contractility of pharyngeal muscles successfully counteracts this
What occurs in sleep apnoea?
Negative pressure generated on inspiration leads to airway collapse
Reasons for referral?
- Snoring –> usually partner complaining
- Excessive daytime somnolence
- Fatigue and tired all the time
- Work-related issues
- FAQ come from ENT/bariatric/cardiology services
Consequences of OSAHS?
Pharyngeal narrowing
–>
Negative Intrathoracic Pressure
–>
Arousal
–>
- Sleep disruption -> Sleepiness and Reduced QoL and RTA’s
OR
- Blood pressure surge -> Stroke-> Heart attacks
Diagnostic criteria for OSAHS
- Based on full poly
- Mild 5-15 events
- Moderate 16-30
- Severe 30+
Conservative measures for OSA
- Weight reduction
- Stop Smoking
- Avoidance of alcohol and sedatives
- Treat nasal symptoms (eg nasal sprays)
Treatment of OSA
- CPAP (5-10cm H2O)
- Gold standard
- Mandibular Advancement Splint (MAS)
- Mild can use CPAP as second line therapy
Surgical treatment?
- Tonsillectomy, polypectomy and septoplasty
- UPPP
- Bariatric Surgery
Define Narcolepsy
-Tetrad of symptoms
–> Excessive daytime somnolence
–> Cataplexy
–> Hypnagogic hallucinations
–> Sleep Paralysis
What are the 3 types of Epidemiology?
- With Cataplexy
- Without Cataplexy (10-50%)
- Due to medical condition (very rare)
Clinical features of Narcolepsy?
- Excessive daytime sleepiness and disturbed night-time sleep
- Cataplexy is a sudden weakening of the muscles triggered by emotions
- Hypnagogic hallucinations
- Insomnia
Two theories of narcolepsy:
- Genetic
- Neurochemical (including orexin)
Genetic link with Narcolepsy?
- Increased risk in first degree relatives
- Rare autosomal dominate inheritance
- 90-100% of patients with narcolepsy and cataplexy have HLA gene
What is HLA?
Human Leukocyte Antigens and they keep the immune system in check
What investigations are there for narcolepsy?
- Polysomnography
- MWT maintenance of wakefulness test
What is the MSLT
Multiple Sleep Latency Test
Normal REM sleep latency is greater than 90mins
but in narcolepsy its 20 minutes
Non pharmacological strategies for narcolepsy?
- exercise to reduce obesity
- Keeping a regular sleep wake cycle
- Supportive social and psychological measures
- timing of mealtimes and avoiding certain foods
- strategic naps
Pharmacological treatment for narcolepsy?
- for Excessive daytime somnolence stimulants can be used such as modafinil
- for cataplexy (REM suppression) SSRIS can be used
Future treatments for Narcolepsy:
- Hypocretin replacement
- TNF replacement
- Gene therapy
