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?!