Sleeping Beauties: Obstructive sleep apnoea and other things that happen at

night

Paul S. Thomas, Professor, Faculty of Medicine,

UNSW,

&

Consultant Physician, Respiratory Medicine, Prince of Wales Hospital, Randwick 2031.

Outline

What is sleep apnoea? -how is it caused, how do we test for it and how to treat it Are there other events that can disrupt sleep? What is involved in testing for these disorders? What is the treatment?

Outline

Normal versus simple snoring versus obstructive

sleep apnoea

Symptoms & Assessment

» Daytime drowsiness

» Unrefreshing sleep

» Snoring

» Morning headache

» Complaints from bed partner or neighbours

– Alcohol

– Sedatives

– Nasal symptoms/ obstruction

– Tonsillitis

– Weight gain

Assessment

– Questionnaires:

Epworth Scale: In this situation what is your chance of falling asleep..?

STOP-BANG

» Berlin

Examination

– Male gender

– Large neck

– Obesity

– Small lower jaw

– Large tonsils

– Narrow throat

– Large tongue- unable to see tonsils

– Hypothyroidism

Investigations

– Sleep study

– Thyroid tests

Sleep study

Sleep study = Polysomnography

EEG/

Brain waves

Eye movements

Heart rhythm

Breaths

Chest and abdominal movements

Oxygen level

Normal sleep with episode of REM sleep

OSA during an episode of REM sleep

Treatments for OSA

• Weight loss?

• Mild: nothing? position?

• Moderate & severe:

– 1. trial of ’CPAP’ (continuous positive airway

pressure)

– 2. Mandibular advancement splint

CPAP

How CPAP works

Mandibular advancement splints (MAS)

• MAS

– Need own dentition in upper and lower jaw

– Splints are moulded to fit over the teeth like

an upper and lower set of dentures or mouth

guard

– The lower jaw is incrementally moved

forwards: this brings the tongue forwards and

reduces the obstruction at the back of the

throat.

• Outcomes

– Perhaps 30-50% of those with moderate-severe OSA use a CPAP device regularly

– Devices have a SD card/upload facility for data analysis (compliance, hours, time used, humidifier setting, leak, estimated sleep apnoea)

Disadvantages: strapped up every night, not enough humidification, cumbersome, not for the claustrophobic

– Variable pressure devices (BiPAP, AutoSet) slightly more comfortable, about twice the price

– Fewer data for MAS

• Jaw joint ache, need to exercise the jaw in the morning

• More discreet

• Other conditions

– Central sleep apnoea

– Restless legs

– Insomnia

– ‘Parasomnias’

– Catplexy

Central sleep apnoea

Central sleep apnoea

Central sleep apnoea

• Can be mixed with OSA

• More commonly associated with other diseases such as

stroke, heart failure (poor blood circulation), drugs

(opiates, anti-depressants), obesity – hypoventilation

• Treat the underlying cause

Restless legs!

Restless legs

Restless legs

Restless legs

• Usually the bed partner complains, not the patient

• Association with iron deficiency

• Familial tendency

• Treat- iron deficiency

• Some respond to anti-Parkinsonian drugs

Insomnia

• In brief, a large topic!

• Difficulty getting off to sleep

• Difficulty in getting back to sleep/ waking up too early

Insomnia

• In brief, a large topic!

• Difficulty getting off to sleep

• Difficulty in getting back to sleep/ waking up too early

• Anxiety, drugs/caffeine, depression, need to pass urine, ex-shift workers

• Keep regular sleeping habits

• Do not read or watch TV in bed

• If you do not get off to sleep get up, do something boring and go back to bed after 20 -30 mins

• Are you still awake?!