Sleeping Beauties: Obstructive sleep apnoea and other things 2019-11-13¢  Sleeping Beauties: Obstructive

  • View
    0

  • Download
    0

Embed Size (px)

Text of Sleeping Beauties: Obstructive sleep apnoea and other things 2019-11-13¢  Sleeping...

  • 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?!