Week 3 - COMPLEX CASE

Question 1

What is apnoea and sleep apnoea?

Answer 1

apnoea = lack of breathing

sleep apnoea = lack of breathing during sleep

Question 2

What is diagnostic for sleep apnoea?

Answer 2

• sleep disorder
• pause (apnoea) or shallow breathing (hypopnoea) attacks during sleep

*>5/hour = DIAGNOSTIC

Question 3

How do pts wake if they suffer from sleep apnoea?

Answer 3

• apnoea/hypopnoea
• increase CO2
• resp. drive stimulated and pt. wakes up to start breathing again
• pt. falls back asleep

Question 4

What are the 3 types of sleep apnoea and which is the commonest?

Answer 4

1. Central (0.5%) –> resp. centre neural failure
2. Obstructive (85%) –> physical block in air flow (flaccid soft palate) –> COMMONEST**
3. Mixed (15%) –> mix of both CSA + OSA

Question 5

What are the risk factores for OSA?

Answer 5

• male
• elderly
• obesity
• large neck
• enlarged tonsils
• increased tongue size
• allergy
• sinusitis
• URTI
• nasal septum deviation
• pharyngeal tumours

Question 6

What is the commonest Sx. of OSA?

Answer 6

Snoring

Question 7

What are the Sx. of OSA?

Answer 7

• snoring
• daytime sleepiness
• fatigue
• steatosis
• NASH
• metabolic syndrome*
• HTN*

*increase CO2/hypoxia can cause cardiorespiratory distress

Question 8

How do we diagnose OSA and what is the Tx.?

Answer 8

Dx: -overnight polysomnography (sleep study)
Tx: -CPAP (Continuous Positive Airway Pressure)

Question 9

How does CPAP work?

Answer 9

• artificial respiration using pumps

- devices to hold the soft palate in place

Question 10

What is chronic fatigue syndrome AKA?

Answer 10

myalgic encephalomyelitis

Question 11

What is chronic fatigue syndrome?

Answer 11

• neurological multisystem disease of excess exhaustion

- deterioration of health in a previously healthy person

Question 12

What is the etiology and epidemiology of chronic fatigue syndrome?

Answer 12

Etiology:

• unknown
• viral? / immune dysfunction? / pollution?

Epidemiology?

• common
• ANY age
• more common in females

Question 13

What are the Sx. of chronic fatigue syndrome?

Answer 13

-chronic fatigue (>6mths)
-increased post-exercise fatigue
-sleep dysfunction
-non specific myalgic pain
Neurological:
-confusion/disorientation
-sensory disturbances
-ataxia, muscle weakness
-photophobia
-emotional, anxiety, etc

Question 14

What are the autonomic and neuroendocrine manifestations of chronic fatigue syndrome?

Answer 14

• sweating
• decreased body temp
• cold extremities
• cold/heat intolerance
• weight change
• anorexia

Question 15

What is the Dx. and prognosis for chronic fatigue syndrome?

Answer 15

Dx. usually by exclusion
Prognosis:
-poor :(
-<10% return to normal health
-better in children + youth

Question 16

What are the differentials for chronic fatigue syndrome?

Answer 16

Endocrine:

• hyper/hypothyroidism
• cushings/addisons

Resp:
-COPD

CVS:
-heart failure

Anemia
Severe DM
Depression