Obstructive sleep apnoea

Question 1

Define obstructive sleep apnoea

Answer 1

A disease characterised by recurrent prolapse of the pharngeal airway and apnoea (cessation of airflow for >10s) during sleep, followed by arousal from sleep. Also known as Pickwickian syndrome

Question 2

Explain the aetiology/risk factors of obstructive sleep apnoea

Answer 2

Occurs due to narrowing of the upper airways because of the collapse of soft tissues of the pharnx

This is due to decreased tone of the pharyngeal dilators during sleep

Associated with:

• Weight gain
• Smoking
• Alcohol
• Sedative use
• Enlarged tonsils and adenoids in children
• Macroglossia
• Marfan’s syndrome
• Craniofacial abnormalities

Question 3

Summary the epidemiology of obstructive sleep apnoea

Answer 3

• Common 5-20% of men >35 years
• 2-5% of women >35 years
• Prevalence increases with age

Question 4

Recognise the presenting symptoms of obstructive sleep apnoea

Answer 4

• Excessive daytime sleepiness
• Unrefreshing or restless sleep
• Morning headaches
• Dry mouth
• Difficulty concentrating
• Irritability and mood changes
• Partner reporting snoring, noctural apnoeic episodes or noctural choking

Question 5

Recognise the signs of obstructive sleep apnoea on physical examination

Answer 5

• Large tongue
• Enlarged tonsils
• Long or thick uvula
• Retrognathia (pulled back jaws)
• Neck circumference
  
  • More than 42cm or 40cm in males and females respectively
• Obesity
• Hypertension

Question 6

Identify appropriate investigations for obstructive sleep apnoea

Answer 6

• Sleep study
• Monitor airflow, respiratory effort, pulse oximetry and heart
• Bloods: TFTs ABG