What is apnoea and sleep apnoea?
apnoea = lack of breathing
sleep apnoea = lack of breathing during sleep
What is diagnostic for sleep apnoea?
- sleep disorder
- pause (apnoea) or shallow breathing (hypopnoea) attacks during sleep
*>5/hour = DIAGNOSTIC
How do pts wake if they suffer from sleep apnoea?
- apnoea/hypopnoea
- increase CO2
- resp. drive stimulated and pt. wakes up to start breathing again
- pt. falls back asleep
What are the 3 types of sleep apnoea and which is the commonest?
- Central (0.5%) –> resp. centre neural failure
- Obstructive (85%) –> physical block in air flow (flaccid soft palate) –> COMMONEST**
- Mixed (15%) –> mix of both CSA + OSA
What are the risk factores for OSA?
- male
- elderly
- obesity
- large neck
- enlarged tonsils
- increased tongue size
- allergy
- sinusitis
- URTI
- nasal septum deviation
- pharyngeal tumours
What is the commonest Sx. of OSA?
Snoring
What are the Sx. of OSA?
- snoring
- daytime sleepiness
- fatigue
- steatosis
- NASH
- metabolic syndrome*
- HTN*
*increase CO2/hypoxia can cause cardiorespiratory distress
How do we diagnose OSA and what is the Tx.?
Dx: -overnight polysomnography (sleep study)
Tx: -CPAP (Continuous Positive Airway Pressure)
How does CPAP work?
- artificial respiration using pumps
- devices to hold the soft palate in place
What is chronic fatigue syndrome AKA?
myalgic encephalomyelitis
What is chronic fatigue syndrome?
- neurological multisystem disease of excess exhaustion
- deterioration of health in a previously healthy person
What is the etiology and epidemiology of chronic fatigue syndrome?
Etiology:
- unknown
- viral? / immune dysfunction? / pollution?
Epidemiology?
- common
- ANY age
- more common in females
What are the Sx. of chronic fatigue syndrome?
-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
What are the autonomic and neuroendocrine manifestations of chronic fatigue syndrome?
- sweating
- decreased body temp
- cold extremities
- cold/heat intolerance
- weight change
- anorexia
What is the Dx. and prognosis for chronic fatigue syndrome?
Dx. usually by exclusion Prognosis: -poor :( -<10% return to normal health -better in children + youth
What are the differentials for chronic fatigue syndrome?
Endocrine:
- hyper/hypothyroidism
- cushings/addisons
Resp:
-COPD
CVS:
-heart failure
Anemia
Severe DM
Depression
