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Obstructive sleep apnoea (OSA) (Differentials (Drugs Sedatives, B…
Obstructive sleep
apnoea (OSA)
Definition
Syndrome of irregular breathing at night
and excessive daytime sleepiness
Epidemiology
All age groups affected
1-2% children, 3% adults
Pathophysiology
Mechanism
Upper airway collapse during night, causing irregular breathing
Partial (hypopnoea) or complete (apnoea) collapse of the airway
Loss of airway results in transient arounsal from deep to lighter sleep, restoring normal airway muscle tone
Cycle repeats during the night, causing fragmented sleep pattern
Outcome
Results in reduced sleep quality, excessive daytime sleepiness, and reduced alertness/concentration
Risk factors
Adults
Male gender
Obesity
FH
Smoking
Alcohol
Hypothyroidism
Acromegaly
Children
Adenotonsillar hypertrophy
Obesity
Congenital disorders (Down's, neuromuscular dis, craniofacial dis)
Clinical
presentation
Children
Snoring and pauses in breathing
Restlessness and sudden arousal from sleep
Irritability, poor concentration, fatigue
Mouth breathing
Adults
Snoring
Excessive daytime sleepiness
Witnessed apnoeas/cholking during sleep
Reduced concentration
Unrefreshing sleep
Morning headache
Mood swings
Diagnosis
Examination
ENT
BMI, small jaw, large tonsils,
nasal blockage (polyps, septal deviation)
Investigations
Bedside
Obs (BP)
Height/weight (BMI)
Collar size
Epworth Sleep Questionnaire
Bloods
FBC, U+E, LFT, TFTs (thyroid)
Special tests
Polysomnography: O2 sats, mouth airflow, ECG, EMG chest/abdo) - DIAGNOSTIC
History
PMH
Growth and development
Vaccinations
Known medical conditions
DH
Meds, allergies
POH
Bloods, scans, growth, gestation,
delivery, weight, complications
FH
Snoring, OSA, resp disease
PC/HPC
Snoring, witnessed apnoeas,
unrefreshing sleep, daytime sleepiness
Red flags - voice change, swallowing,
epistaxis, etc.
SH
Occupation, school/nursery,
driving, lifestyle
Differentials
Drugs
Sedatives, B-blockers, SSRIs
Degenerative
MND, PD
Idiopathic
Sleep deprivation e.g. shift work
Functional
Narcolepsy
Depression
Panic attacks, night terrors
Vascular
HF (pulmonary oedema)
Autoimmune/immune
Asthma
Metabolic
GORD
Complications
Adults
Stroke
HTN
Type II resp failure
Children
Behavioural problems
Irritability, poor concentration
Poor school performance
Prognosis
Adults
CPAP at night reduces HTN
Children
Improved severity and QoL
after adenotonsillectomy
Management
Conservative
Information, advice, support
Refer to sleep centre/ENT (confirm diagnosis)
Lifestyle (sleep on side, weight loss, smoking cessation, alcohol)
Medical
CPAP
Indication: mod-severe OSA
MOA: positive pressure via nasal mask
keeps airway open during inspiration
SEs: nasal dryness, bleeding, irritation
Intra-oral devices
Indication: mild OSA
E.g. mandibular advancement device
Surgical
Adenotonsillectomy
Indication: child with adenotonsillar hypertrophy
MOA: remove URT obstruction, aiding breathing