Respiratory Aspects of Neurological Disease
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
Respiratory insufficiency may develop insidiously. There may be exertional dyspnoea, but, in neurological disease, symptoms may be present only after the development of nocturnal hypoventilation and sleep apnoea develop. Established nocturnal respiratory insufficiency is chartacterized by insomnia, daytime hypersomnolence and lethargy, morning headaches, reduced mental concentration, depression, anxiety or irritability. The symptoms of obstructive sleep apnoea are similar, but the patient or their partner often complains of snoring, abnormal sleep movements and disturbed sleep with distressing dreams. Patients with progressive diaphragm weakness develop orthopnoea which may be severe, and prevent the patient lying flat. Nocturnal orthopnoea is usually severe and can mimic paroxysmal nocturnal dyspnoea due to heart failure. A careful history is crucial in identifying the cause of generalized weakness or failure to wean in the intensive treatment unit (ITU). Evidence of pre-existing sensory and motor dysfunction should be sought from careful questioning of the patient or the patient’s family. A thorough history of exposure to medications or other toxins should also be taken.
Paediatric anaesthesia
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Obstructive sleep apnoea is characterised by repeated episodes of airway obstruction during sleep – patients may rouse frequently, clearing the airway temporarily before the cycle is repeated. Their sleep is disrupted and they can become significantly hypoxic. They suffer cognitively and can develop behavioural disturbance. Obstructive sleep apnoea can be caused by tonsillar and adenoid hypertrophy in otherwise normal children but is also common in obesity and in conditions such as Down’s syndrome and mucopolysaccharidosis. Overnight pulse oximetry is used as a screening test for those likely to present problems perioperatively but the definitive test is polysomnography. They are at risk following anaesthesia because they are prone to airway obstruction and are very sensitive to opiates.
Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Classically, obstructive sleep apnoea affects overweight, middle-aged men. It is often their partner that is most concerned, as they witness the apnoeic episodes. They often give a long history of snoring, but may complain of feeling increasingly tired, or falling asleep, during the day. Relaxation of the muscles responsible for maintaining the airway during sleep causes occlusion of the airway, resulting in apnoeic episodes. Each time this happens, the patient is woken from sleep due to hypoxia. This may happen hundreds of times per night, but occurs for such a short period of time they are unaware of it. The Epworth Sleepiness Scale is a questionnaire that helps determine the degree of sleepiness during the day, asking the likelihood that the patient would fall asleep in a number of everyday scenarios. Sleep studies are ultimately used to confirm the diagnosis, requiring evidence of at least 15 apnoeic/hypopnoeic episodes per hour of sleep. Simple management strategies include sleeping more upright, losing weight and avoiding alcohol/tobacco. If these fail, CPAP increases the pressure in the pharynx, helping to maintain the airway during sleep. This, however, is poorly tolerated in a number of patients.
Feasibility of conducting type III home sleep apnoea test in children
Published in Acta Oto-Laryngologica, 2021
Tina Kissow Lildal, Jannik Buus Bertelsen, Therese Ovesen
Obstructive sleep apnoea (OSA) is characterized by recurrent events of partial or complete obstruction of the upper airways during sleep. This can lead to hypoxia and sleep fragmentation with detrimental effects on physical and psychological health. Polysomnography (PSG) is the gold standard for diagnosing OSA in children [1]. PSG measures respiratory events and sleep stages allowing objective assessment and quantification of arousals and impaired sleep due to the obstructive respiratory events [2]. However, due to expensive and labour-intensive procedures, PSGs are not accessible in most clinics treating paediatric OSA [3,4]. Therefore, diagnostics are often based solely on the clinical examination and on the medical history despite the low diagnostic validity of this approach [5]. To reduce the discrepancy between gold standard and clinical reality, an alternative objective assessment modality of respiratory events during sleep is highly warranted.
Reducing anger outbursts after a severe TBI: a single-case study
Published in Neuropsychological Rehabilitation, 2019
Lucien Rochat, Rumen Manolov, Tatiana Aboulafia-Brakha, Christina Berner-Burkard, Martial Van der Linden
Three months after the accident, MD was transferred to a neurological rehabilitation centre, where he benefited from several neuropsychological, ergotherapeutic and physiotherapeutic treatments. One year after the TBI, he also received a group intervention based on a CBT approach to decrease aggression and anger outbursts (focusing on anger awareness, self-monitoring, management of emotions in emergency situations, cognitive restructuring and prevention strategies; see Aboulafia-Brakha et al., 2013). The patient and his spouse stated that he benefited from this intervention in that he acquired more introspection into his difficulties. However, one year after the intervention, issues with anger outbursts remained, and MD was motivated to further improve his control of anger. Medical records showed that MD had no history of mental health or neurological difficulties before the TBI. At the time of assessment, a suspicion of obstructive sleep apnoea was mentioned and further diagnosed. A positive airway pressure device was thus introduced two weeks after the end of the first intervention and eight weeks before starting the second intervention (see below).
The acute effect of continuous positive airway pressure titration on blood pressure in awake overweight/obese patients with obstructive sleep apnoea
Published in Blood Pressure, 2018
Culadeeban Ratneswaran, Martino F. Pengo, Sichang Xiao, Yuanming Luo, Gian Paolo Rossi, Michael I. Polkey, John Moxham, Joerg Steier
Obstructive sleep apnoea (OSA) is characterised by intermittent episodes of complete or partial upper airway obstruction that lead to recurrent apnoeas or hypopnoeas during sleep [1]. These respiratory events cause sleep fragmentation and diminished quality of sleep, thus leading to excessive daytime sleepiness [2], cognitive dysfunction [3], as well as to increased risk of road traffic accidents [4]. OSA is associated with significant comorbidities [5], such as cardiovascular disease [6,7] and hypertension [8], stroke [9], coronary heart disease [10], diabetes [11,12] and the metabolic syndrome [13]. Obesity is an important risk factor for the development of OSA and the two conditions share a complex interaction, with poor sleep and sleepiness also facilitating weight gain independent of OSA [14,15]. Obesity [16] and OSA [17] are independently related to increased sympathetic tone, hypertension and associated comorbidities.
Related Knowledge Centers
- Airway Obstruction
- Apnea
- Central Sleep Apnea
- Fatigue
- Hypopnea
- Sleep
- Oxygen Saturation
- Sleep-Related Breathing Disorder
- Snoring
- International Classification of Sleep Disorders