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ALL / Respiratory Medicine
Obstructive sleep apnoea/hypopnoea syndrome
Obstructive sleep apnoea/hypopnoea syndrome
Predisposing factors- obesity
- macroglossia: acromegaly, hypothyroidism, amyloidosis
- large tonsils
- Marfan's syndrome
The partner often complains of excessive snoring and may report periods of apnoea.
Consequence
- daytime somnolence
- compensated respiratory acidosis
- hypertension
Assessment of sleepiness
- Epworth Sleepiness Scale - questionnaire completed by patient +/- partner
- Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)
Diagnostic tests
- sleep studies (polysomnography) - ranging from monitoring of pulse oximetry at night to full polysomnography where a wide variety of physiological factors are measured including EEG, respiratory airflow, thoraco-abdominal movement, snoring and pulse oximetry
Management
- weight loss
- continuous positive airway pressure (CPAP) is first line for moderate or severe OSAHS
- intra-oral devices (e.g. mandibular advancement) may be used if CPAP is not tolerated or for patients with mild OSAHS where there is no daytime sleepiness
- the DVLA should be informed if OSAHS is causing excessive daytime sleepiness
- limited evidence to support use of pharmacological agents
+PassMedicine Notes
Predisposing factors
- obesity
- macroglossia: acromegaly, hypothyroidism, amyloidosis
- large tonsils
- Marfan's syndrome
The partner often complains of excessive snoring and may report periods of apnoea.
Consequence- daytime somnolence
- compensated respiratory acidosis
- hypertension
- Epworth Sleepiness Scale - questionnaire completed by patient +/- partner
- Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)
- sleep studies (polysomnography) - ranging from monitoring of pulse oximetry at night to full polysomnography where a wide variety of physiological factors are measured including EEG, respiratory airflow, thoraco-abdominal movement, snoring and pulse oximetry
- weight loss
- continuous positive airway pressure (CPAP) is first line for moderate or severe OSAHS
- intra-oral devices (e.g. mandibular advancement) may be used if CPAP is not tolerated or for patients with mild OSAHS where there is no daytime sleepiness
- the DVLA should be informed if OSAHS is causing excessive daytime sleepiness
- limited evidence to support use of pharmacological agents
