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Sleep apnoea

Liz Bartlett ST3 - 2010. Sleep apnoea. Sleep apnoea. What is it? Who gets it? Risk factors Epworth Sleepiness Score Examination Investigations Treatment Driving. What is it?. Upper airways collapse intermittently and repeatedly during sleep Can be complete or partial collapse

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Sleep apnoea

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  1. Liz Bartlett ST3 - 2010 Sleep apnoea

  2. Sleep apnoea • What is it? • Who gets it? • Risk factors • Epworth Sleepiness Score • Examination • Investigations • Treatment • Driving

  3. What is it? • Upper airways collapse intermittently and repeatedly during sleep • Can be complete or partial collapse • Apnoea = 10 second breathing pause • Occurs repeatedly leading to symptoms

  4. Who gets it? • Men who snore and who are overweight

  5. Having: Large tonsils Hypothyroidism Neuromuscular disease with pharyngeal involvement Risk factors Being: • Middle aged man • Overweight • A snorer • Collar size> 17 inches/43cm • Craniofacial abnorms

  6. Symptoms • Excessive daytime sleepiness • Loud snoring, witnessed apnoeas • Feeling unrefreshed on waking • Poor concentration • Mood swings, depression • Nocturia • Loss of libido

  7. Epworth Sleepiness Score How likely are you to doze off/fall asleep in the following situations, in contrast to feeling just tired? • Sitting and reading • Watching TV • Sitting inactive in a public place e.g. theatre • As a passenger in a car, for an hour without a break • Lying down in the afternoon when circumstances permit • Sitting and talking to someone • Sitting quietly after lunch with no alcohol • In a car, whilst stopped for a few minutes in traffic

  8. Examination • Weight, height – BMI • Neck circumference • Oropharynx • Teeth and tongue • Nasal patency • BP • Evidence of heart failure, endocrine abnorms or neuromuscular discorders

  9. Investigations • Spirometry • Bloods • Sleep studies • Refer to local sleep centre

  10. Treatment • Simple measures • Mandibular advancement splint • Continuous positive airways pressure therapy (CPAP)‏ • Surgery - uvulopalatopharyngoplasty

  11. Driving • Moderate-severe sleep apnoea – increased risk of fatal road accidents • DVLA leaflet • Inform DVLA when diagnosed • HGV + public service drivers

  12. Summary • Sleep apnoea – what it is and who gets it? • Epworth Sleepiness Score • Simple management • Referral and advice on driving • Any questions?

  13. References • BMJ Learning e-module: Sleep apnoea • SIGN guidelines: management of obstructive sleep apnoea in adults • NICE guidelines: CPAP for obstructive sleep apnoea

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