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R+S phys > Treatment of Sleep Apnoea > Flashcards

Treatment of Sleep Apnoea Flashcards

1
Q

Why do we treat OSA?

A
  • Relieve Symptoms
  • Prevent Medical Complications like MI’s
  • Improve QoL
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2
Q

When do we treat OSA?

A
  • Only for moderate-severe OSA

- or patients with mild OSA but symptomatic treatment is advised

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3
Q

Benefits of treatment?

A
  • Less sleep fragmentation
  • Less lethargic and more alert
  • Improves Sleep Quality leading to increased energy and decreased sleepiness
  • Motivation to lose weight
  • Reducing BMI
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4
Q

Link with OSA and Hypertension?

A
  • Difficult to establish bc of other factors

- BUT treatment of OSA with CPAP does improve BP

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5
Q

What 4 treatment options are there?

A
  • Behavioural/Conservative measures
  • MRD Mandibular Repositioning Device
  • Surgery
  • CPAP
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6
Q

What are first line treatments for MILD OSA?

A
  • Lifestyle advise
  • Obesity clinic
  • Dietician
  • Weight loss
  • Postion therapy supine position
  • Nasal Spray if obstruction refer to ENT (DEVIATED Septum)
  • Smoking and Alcohol Cessation
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7
Q

What MRD’s?

A
  • Mandibular Repositioning Devices
  • Dental devices which pull lower jaw forward during sleep
  • Similar to a gumshiedl
  • Crowded UA use Mallampati score to assess
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8
Q

What are the 4 classes for Mallampati?

A

Class 1 = full visibility of tonsils, uvula and soft palate

Class 2 = Visibility of Hard and soft palate and base of the uvula

Class 3 = Soft and hard palate and base of the uvula are visible

Class 4 = Only hard Palate visible

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9
Q

Advantages of MRD’s

A
  • Less invasive

- Effecitve for simple snoring or mild OSA

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10
Q

Disadvantages of MRD’s

A
  • Rarely completely treat s moderate OSA
  • Can cause pain
  • Unsuitable for denture patients
  • Not available on the NHS
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11
Q

Surgical options?

A
  • Paeds?
  • Enlarged adenoids or tonsils can cause snoring
  • Can remove these
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12
Q

Surgical options for adults?

A

-Surgery In UA but if more than 1 area is affected surgery may not be effective and OSA will persist

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13
Q

Which adults could benefit from Surgery?

A

Patients with craniofacial abnormalities or obvious UA congestion could benefit

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14
Q

Downsides of having surgery?

A

Surgery is often painful and can reduce ultimate effectiveness of CPAP if surgery fails to solve problem

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15
Q

What is UVPPP?

A

Removal of the excess soft palate tissue

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16
Q

What is LAUP?

A

-Laser sculpt the soft palate

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17
Q

What Nasal surgery is available?

A
  • Straightening of Deviated septum

- Increasing size of nasal passages to improve airflow

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18
Q

What are Nasal turbinates?

A
  • Also known as conga due to shape

- Made up of Columnar ciliated epithelium with vascular erectile glandular tissue

19
Q

What are the 3 pair of nasal turbinates?

A
  • Inferior
  • Middle
  • Superior
20
Q

What do inferior turbinates do?

A
  • Majority of heating, filtering and humidification of air
21
Q

What do Middle turbinates do?

A
  • Protect entrances of sinuses from pressurised air
22
Q

What do Superior turbinates do?

A
  • Protect olfactory bulb
23
Q

What are adenoids AKA?

A

-Pharygeal tonsil

24
Q

Where are adenoids located?

A
  • Roof of Nasopharynx

- Where nasal passage meets oropharynx

25
Q

What can occur to adenoids?

A
  • Enlarge to size of golf balls causing airflow obstruction

- Removed with tonsils

26
Q

What tongue surgery is available?

A
  • Advancement = Geniglossus muscle advanced preventing tongue base falling back
  • Tongue base reduction = removal of tongue mass to widen airway
27
Q

What is lower jaw advancement?

A
  • Retrognathia is when upper/lower jaw is restricted
  • It mobilises upper and lower jaw and stabilise jaw with titanium plates
  • Can change facial appearance
28
Q

What is a tracheostomy?

A
  • Making an opening in trachea bypassing upper airway
  • Not routine
  • Used to ventilate patients in ICU
  • Used when OSA is life threatening and CPAP is unavailable
29
Q

What is CPAP?

A

Continuous Positive Airway Pressure

  • Gold standard for treatment
  • Acts as Pneumatic splint using room air to support airway
30
Q

What are the indications for CPAP?

A
  • Moderate/Severe OSA

- Mild OSA displaying symptoms

31
Q

What are the contraindications for CPAP?

A
  • History of facial oral or skull trauma
  • Severe Epistaxis (nose bleeds)
  • Acute sinustitis
  • Pneumothorax
  • Cardiac arryhtmias (severe)
32
Q

What are the 3 types of CPAP

A
  • Auto titrating CPAP
  • Fixed CPAP
  • Bi-Level
33
Q

What is APAP?

A

Auto-titrating CPAP (APAP)

–> Variable pressure delivery

34
Q

What is Fixed CPAP?

A

Fixed CPAP

–>Pressure set to fixed level for whole night

–>Fixed pressure assessed using prediction formula, manual titration or trial with APAP device

35
Q

What is Bi-Level CPAP?

A

Bi-level

–>2 pressure levels: IPAP and EPAP
Used more in ‘complex OSA’ and respiratory failure

36
Q

What should be included when educating a person about CPAP?

A
  • Information about OSA
  • How CPAP works?
  • Mask fitting
  • Care and Maintenance
  • DVLA regulations
  • Travelling
  • Available resources such as BLF
37
Q

How does Fixed CPAP work?

A
  • Patient would have APAP for a trial period
  • Fixed CPAP is set to a Pressure that prevents events for 95% of the night
  • Calculates pressure using a prediction formula
  • Ramp Setting is for comfort to allow pressure to gradually rise
38
Q

Advantages of Fixed CPAP?

A
  • Machine is cheaper as it isn’t algorithm based
39
Q

Disadvantages of Fixed CPAP?

A
  • Changes in weight
  • Body Position/Alcohol consumption not corrected for
  • Deliver too much Pressure sometimes
40
Q

How does the circuit work?

A
  • Connects patient to CPAP
  • Masks generally nasal or nasal-oral (full face)
  • Must create a seal to ensure pressure is maintained
  • Variety of styles
41
Q

How can we monitor data?

A

Most CPAPs now provide compliance data

-Monitor usage/pressure/AHI

42
Q

List some CPAP side-effects?

A
  • Air Leak
  • Nasal problems
  • Skin Ulceration/Sensitivity
  • Claustrophobia
  • Aerophagy (swallowing air)
  • Noise of CPAP
43
Q

What can help troubleshoot nasal blockage?

A
  • Nasal spray
  • Switch to full face mask
  • Add humidification to CPAP

R+S phys (17 decks)

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