Upper airways disease: obstructive sleep apnoea (R1) Flashcards
Definitions: what is obstructive sleep apnoea
Obstructive: there is a blockage to the upper airways during sleep
Apnoea: leads to inadequate/stopped breathing
Aetiology: what are 4 causes of upper airway obstruction?
Obesity
Bone abnormalities: recessed jaw, Down syndrome, premolar extraction
Soft tissue abnormalities: enlarged adenoids, tonsils, tongue
Allergies- can lead to nasal obstruction
Pathophysiology: describe
Complications
- 3 classes of complications?
Neurocognitive sequelae
Cardiovascular sequelae
Metabolic sequelae
Complications
- What are the neurocognitive sequelae?
Excessive daytime sleepiness
Cognitive dysfunction - problems with attention/concentration, learning and memory
Mood disorders - depression, anxiety, irritability
Increased risk of MVA’s
Complications
- What are the cardiovascular sequelae
Hypertension: due to SNS activation
Arrhythmias: hypoxia irritates heart cells
Increased risk of AMI, heart failure, stroke
Complications
- What are the metabolic sequelae?
Oxidative stress
Metabolic syndrome - obesity, diabetes, hyperlipidemia, hypertension
History
- Symptoms? (During the night, next morning, neurocognitive sequelae)
History
- What score is used to score daytime sleepiness?
The Epworth sleepiness scale
Risk factors?
Exam
- General inspection
- Vital signs
- Face
- Neck
Investigation
- What test is used?
Polysomnography (sleep study)
Investigation
- What tests does it do?
- How does it quantify severity of OSA?
Management
- What are the broad categories of treatment?
Lifestyle interventions
Non invasive treatments: CPAP, oral appliances
Surgeries
Hypoglossal nerve stimulation
Management
- Lifestyle interventions: include
Weight loss
Sleeping on side
Avoid alcohol and sedatives before bed
Stop smoking
Non invasive therapy
- Is CPAP first line?
- Is CPAP more effective than oral appliances?
- Why might oral appliances (and surgical treatments) be used?
- What are the two types of oral appliances?
Yes
Yes
If CPAP is not tolerated
Mandibular repositioning device, tongue retracting device (for enlarged tongue)
Surgeries
- When are they indciated?
- May include?
- Describe hypoglossal nerve stimulation
When CPAP or oral appliances are not tolerated
Removal of adenoids/tonsils, maxillo-mandibular advancement
How would you explain OSA to a patient?
Obstructive: airways become narrowed
Sleep apnoea: leads to you stopping breathing.
Then you wake up gasping for air.
Can happen multiple times during the night.
In the day you can become sleepy. Your concentration, memory, and mood can be affected.
