obstructive sleep apnoea

Question 1

definition of obstructive sleep apnoea

Answer 1

Characterized by recurrent collapse of the pharangeal airway and apnoea (defined as cessation of airflow for>10s) during sleep, followed by arousal from sleep.

Also known as Pickwickian syndrome

Question 2

aetiology of obstrictive sleep apnoea

Answer 2

• upper airway narrows because of collapse of the soft tissues of the pharynx when tone in pharangeal dilators decreases during sleep.

Question 3

RF for obstructive sleep apnoea

Answer 3

• Excessive weight gain
• Smoking
• Alcohol
• Sedative use
• Enlarged tonsils/adenoids in children
• Macroglossia
• Marfan’s
• Craniofacial abnormalities

Question 4

epidemiology of obstrictive sleep apnoea

Answer 4

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

Question 5

sx of obstructive sleep apnoea

Answer 5

• typical patient is an obese, middle-aged man who presents because of snoring or daytime somnolence. His partner often describes apnoeic episodes during sleep.
• Excessive daytime sleepiness (at work, driving).
• Unrefreshed/restless sleep
• Morning headaches or dry mouth
• Difficulty concentrating
• Irritability or mood changes
• Partner reported snoring
• Nocturnal apnoeic episodes or nocturnal choking
• Decreased libido
• Nocturia
• Reduced cognitive performance

Question 6

signs of obstructive sleep apnoea

Answer 6

• Large tongue
• Enlarged tonsils
• Long or thick uvula
• Retrognathia (pulled back jaws)
• Neck circumference (>42cm males,>40 cm females) is strongly correlated with presence of disease.
• Obesity and hypertension is common

Question 7

Ix for obstructive sleep apnoea

Answer 7

• Simple studies (eg pulse oximetry, video recordings) may be all that are required for diagnosis.
• Video recording of episodes
• Sleep study
• Blood – TFT, ABG

Question 8

sleep study for obstrictive sleep apnoea

Answer 8

Managed by sleep study centre for polysomnography or diagnostic sleep studies with monitoring of airflow, respiratory effort, pulse oximetry, heart rate, ECG, EMG chest and abdo wall movement.

15 or more episodes of apnoea or hypopnoea during 1h of sleep, on average, = significant sleep apnoea.

Question 9

complications of OSA

Answer 9

• impaired glucose metabolism
• CVD
• depression
• car accidents
• cognitive dysfunction
• increased mortality

Question 9

mx of sleep apnoea

Answer 9

1. CPAP
2. intra-oral mandibular advancement devices
3. upper airway surgery eg tonsillectomy

children
1. adenotonsillectomy
2. CPAP

mx RFs
dont drive, inform DVLA unless dont have excessive sleepiness