Obstructive Sleep Apnoea
- An apnoea is a pause in breathing of at least 10 seconds and can be more prevalent during sleep
- Sleep apnoea can be divided into central (rare) and obstructive (common) which we deal with here
- Commoner obstructive form there is usually recurrent occlusion at pharyngeal level during sleep
- This is possibly due to negative pressure generated through inhalation
- Smoking is a risk factor
- Typically obese males with large collar sizes who snore loudly
- Worse after sedation or alcohol.
- Excessive day time somnolence - Fatigue, Poor concentration
- Weariness is main complaint
- Heavy Snoring at night with periods of witnessed apnoea
- Morning headaches and Non satisfying sleep
- Partner describes periods of apnoea during sleep
- OSA is associated with increased risk of single vehicle Road traffic Collisions
- Increased systemic hypertension
- Mild pulmonary hypertension
- Associated with MI and Arrhythmias and Stroke.
- Sleep lab studies show profound drops in PO2 and measure O2 Saturation,EEG, EMG oronasal airflow and respiratory effort and snoring
- There are usually > 15 apnoea's (10 seconds or more) per hour)
- With severe sleep apnoea there is an apnoea episode per minute
- Epworth sleepiness scale is useful
- Avoid alcohol, smoking cessation, avoid sedatives
- Aim for weight loss
- Some may need Treatment with CPAP which reduces self reported car accidents
- A disorder of the sleep/wake cycle with rapid entry to REM sleep
- Affected individuals usually are positive for DQB10602 and DRB11
- Reduced hypocretin in the brains of those affected.
- Sudden falling asleep inappropriately due to excessive daytime sleepiness often with a REM sleep disorder
- Narcolepsy is associated with cataplexy - Sudden loss of muscle tone and collapse induced by emotional experiences, Hypnagogic hallucinations, Sleep paralysis and Automatic behaviour.
- Diagnosis by polysomnogram and the multiple sleep latency test (MSLT)
- Narcolepsy may require modafinil a central alpha agonist and Cataplexy may respond to antidepressants such as clomipramine
- Short naps may also help.