Week 3 - Sleep Apnoea & Chronic Fatigue Syndrome

Question 1

What is sleep apnoea?

Answer 1

• Sleep disorder.
• Episodes of pause (apnoea) or shallow breathing (hypopnea) attacks during sleep.
• > 5 episodes per hour is diagnostic.

Question 2

Identify the 3 major types of sleep apnoea.

Answer 2

1. Central (CSA - 0.5%):
   • Respiratory centre neural failure (rare).
2. Obstructive (OSA - 85%):
   • Physical block in air flow (flaccid soft palate - soft pallate falling back obstructing the airway - commonest).
   • OSA very common (approx. 15% of population).
3. Mixed (15%):
   • Mix of both central and obstructive.

Question 3

What are the risk factors for obstructive sleep apnoea?

Answer 3

• Male.
• Later age.
• Obesity.
• Large neck.
• Enlarged tonsils.
• Tongue (thick or swollen).
• Allergy.
• Sinusitis.
• URTI.
• Nasal septum deviation.
• Pharyngeal tumours.

Question 4

Identify the symptoms of obstructive sleep apnoea.

Answer 4

• Due to increased CO2, hypoxia, cardiorespiratory stress - common in OSA patients:

• Snoring.
• Daytime sleepiness.
• Fatigue.
• Steatosis.
• NASH (associated with OSA).
• Metabolic syndrome.
• Hypertension.

Question 5

Outline the diagnosis of sleep apnoea.

Answer 5

• Overnight polysomnography - sleep study (records breathing and O2 levels).

Question 6

Describe therapy for sleep apnoea.

Answer 6

• CPAP - continuous positive airway pressure devices to hold soft palate (artificial respiration using pumps).
• Surgeru (turn) etc.

Question 7

What is chronic fatigue syndrome?

Answer 7

• AKA Myalgic Encephalomyelitis.

* Neurological multisystem disease of excess exhaustion. Deterioration of health in a previously healthy person.

Question 8

Outline the aetiology of chronic fatigue syndrome.

Answer 8

• Unknown aetiology - viral? immune? pollution?

* Theories are viral infection, immune dysfunction, environmental pollution, heavy metal poisoning.

Question 9

Describe the epidemiology of chronic fatigue syndrome.

Answer 9

• Common.
• Any age (from young children to later age).
• Females more common.

Question 10

What are the symptoms of chronic fatigue syndrome?

Answer 10

• Chronic fatigue (>6 months) - suddenly or gradually develop fatigue.
• Post exercise fatigue (work produces more fatigue).
• Sleep dysfunction.
• Non specific myalgic pain.
• Neurological - confusion, disorientation, sensory disturbances, ataxia, muscle weakness, photophobia, emotional, anxiety etc.
• Autonomic and neuroendocrine manifestations - sweating, low body temperature, cold extremities, cold/heat intolerance. Weight change. Anorexia.

Question 11

Outline the diagnosis and prognosis of chronic fatigue syndrome.

Answer 11

• Diagnosis - by exclusion (of other primary causes).

* Prognosis - poor, <10% return to normal health. Better in children and youth.

Question 12

What are the differential diagnoses for chronic fatigue syndrome?

Answer 12

• Endocrine - hypo/hyperthyroidism, Cushing’s/Addison’s.
• RESP - COPD.
• CVS - heart failure.
• Anaemia.
• Diabetes mellitus.
• Depression.