Obstructive sleep Apnoea

Question 1

What is Obstructive Sleep Apnoa syndrome?

Answer 1

Repetitive apnoea and symptoms of sleep fragmentation with excessive daytime sleepiness

Question 2

What is the difference between obstructive sleep apnoea syndrome and obstructive sleep apnoea?

Answer 2

Syndrome= with daytime sleepiness, OSA= without daytime sleepiness (just repetitive apnoea at night)

Question 3

What ist the prevalence of Obstructive sleep apnoea?

Answer 3

Prevalence High, many undiagnosed or not treated

• Apnoea Hypopnoea (stop breathing)/ h Index >15= severe (<5 mild)
  
  • 1.6 Million with severe sleep apnoea in UK,
  • 8 million with mild in the UK
• All age groups
  
  • More prone in elderly
  • And obesity

Question 4

Explain the underying mechanism of obstructive sleep apnoea?

Answer 4

• Upper airway collapsing during sleep (due to relaxation of respiratory muscles)
  
  • Partial (hypopnoea)
  • Complete (apnoea)
• Transient arousal from sleep –> restoration of normal airway muscular tone
• Fall back in deeper sleep
• Repeat the cycle

Question 5

What are signs and symptoms of obstructive sleep apnoea?

Answer 5

• Increased daytime sleepiness and/or imparied concentration
• Feeling unrefreshed on waking.
• Witnessed apnoeas or choking noises while sleeping.
• Mood swings, personality changes, or depression.
• Nocturia
• Rarely, nocturnal sweating, reduced libido, and gastro–oesophageal reflux disease

Question 6

Which investigations would you order for a patient with Obstructive sleep apnoea?

Answer 6

• Consider undrelying cause
  
  • e.g. Rule out head/Neck malignancies
• Explore effects of sleepiness on daily life:
  
  • Epworth sleepiness questionnaire
• BP
• BMI
• Neck circumferance
• Investigations if underlying cause is suspected (e.g. Thyroid funtion when hypothyroidism is supsected

Question 7

How does the Epworth sleepiness questionnaire work?

Answer 7

• eight questions, each scored 0–3, which assess the tendency of a person to fall asleep in a variety of situations:How likely are you to doze or fall asleep in the following situations, in contrast to just feeling tired?
  
  • Sitting and reading
  • Watching television
  • Sitting, inactive in a public place (for example at the theatre or in a meeting)
  • As a passenger in a car for an hour without a break
  • Lying down to rest in the afternoon when circumstances permit
  • Sitting and talking to someone
  • Sitting quietly after lunch without alcohol
  • In a car, while stopped for a few minutes in traffic
• Each question is answered choosing from one of the following options:
  
  • Would never doze (0 points)
  • Slight chance of dozing (1 point)
  • Moderate chance of dozing (2 points)
  • High chance of dozing (3 points)
• A total score greater than 10 indicates abnormal daytime sleepiness:
  
  • Mild (11–14)
  • Moderate (15–18)
  • Severe (more than 18)

Question 8

Which signs and symptoms should you asses for someone with obstructive sleep apnoea to rule out head and neck malignancy?

Answer 8

• Unilateral nasal bleeding and/or severe nasal obstruction.
• Change in voice character and/or unexplained hoarseness.
• Dysphagia.
• Unusually rapid onset of symptoms in the absence of marked weight gain

Question 9

What are the aims of managing sleep apnoea?

Question 10

Which patients with sleep apnoea are being treated in the UK?

Question 11

What is the first line-treatment for obstructive sleep apnoea?

Answer 11

• Night CPAP (but mask at night is dealbreaker for about 1/3 of patients)
• • support to patients with CPAP therapy
• Improves BP
• Improves sleepiness