Dizziness & Snoring (easily handled) Professor Ram...
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Dizziness & Snoring (easily handled) Professor Ram Dhillon London North West London Hospitals, London, UK Director of Medical Education, Rila Institute, London, UK Middlesex University, London, UK Advisor on Obstructive Sleep Apnoea: Department of Health, UK, Email: [email protected] Mobile: 07 958 450 544 BMA House 7 th February 2017
Transcript of Dizziness & Snoring (easily handled) Professor Ram...
Dizziness & Snoring (easily handled)
Professor Ram Dhillon
London North West London Hospitals, London, UK Director of Medical Education, Rila Institute, London, UK Middlesex University, London, UK Advisor on Obstructive Sleep Apnoea: Department of Health, UK,
Email: [email protected] Mobile: 07 958 450 544
BMA House
7th February 2017
The “Dizziness” Symptom
Tripod of BaLAnCE
Tripod of BaLAnCE
Inner ear Visual input
! !Proprioception
"""
! !ALL NEUROLOGICAL CONNECTIONS
Only ??% dizziness ever gets a diagnosis!!!!!!
Some Definitions Dizziness? …………………………………………………… Vertigo? ……………………………………………………….
Some Definitions Dizziness? A term used to describe everything from feeling faint or lightheaded to feeling weak or unsteady. Vertigo? Dizziness that creates the sense that you or your surroundings are spinning or moving is called vertigo.
Lossofconsciousness
Case Scenario 1 65 yr old Female Dizzy on turning in bed, bending down, cleaning shelves Lasts few seconds Rotatory sensation No hearing loss, no tinnitus, no other symptoms. Diagnosis?
BPPV : Key clinical examination: ?.................................. Treatment: ?.................................. Self treatment exercises: ?.................................
BPPV : Key clinical examination: Dix and Hallpike manœuvre Treatment: Epley manoeuvre Self treatment exercises: Brandt Daroff
BPPV Menieres AcuteVestFailure
HearingLoss
Ver7go(dura7on
3Keydiagnosespresen7ngwithVer7go
BPPV Menieres AcuteVestFailure
HearingLoss N Y N
Ver7go(dura7on Seconds/Minutes Hours/Allday Days
3Keydiagnosespresen7ngwithVer7go
What is Snoring? Where does it arise? What are the implications (2)?
What is Snoring? Snorting/rattling Where does it arise? Pharynx (ENT) What are the implications (2)? Partial narrowing/OSA
Is the snoring associated with OSA? Epworth Sleepiness Score: 11 STOP BANG (Score out of 8) S: T: O: P: B: BMI A: Age N: Neck G: Gender: Low, Intermediate or High risk of OSA?? If YES to 0 – 2? then ?? risk of Obstructive Sleep Apnoea If YES to 3 – 4? then at ??????? risk of having sleep apnoea If YES to 5 – 8? then at ??? risk of having sleep apnoea
Is the snoring associated with OSA? Epworth Sleepiness Score: 11 STOP BANG (Score out of 8) S: Snoring T: Tiredness O: Obstruction of breathing observed P: Blood pressure B: BMI=/>35 A: Age: 50 N: Neck circumference:16.5” G: Gender: Male If YES to 0 – 2? then low risk of Obstructive Sleep Apnoea If YES to 3 – 4? then at intermediate risk of having sleep apnoea If YES to 5 – 8? then at high risk of having sleep apnoea
What are the 3 Stages of sleep & percentage of each? 1. L 2. D 3. R Why is R?? sleep so key? Define the AHI (Apnoea/Hypopnoea Index/score)?:
Sleep Study
Sleepcycledura7on?: Howmanycycles/night?
What are the 3 Stages of sleep & percentage of each? 1. Light: 50% 2. Deep: 25% 3. REM: 25% Why is REM sleep so key? Mood, memory, sharpness, cognition Define the AHI (Apnoea/Hypopnoea Index/score)?: No air flow for at least 10 seconds (Apnoea event) PLUS Airflow reduced to 50% of normal (Hypopnoea event)
Sleep Study
Sleepcycledura7on?:90minutesHowmanycycles/night?X3
Sleep Study
P
R S
pRDI 66.09 pAHI 66.09 ODI 59.76
Respiratory Indices Chart
522 522 472 Total Events
Wake
Sleep
Sleep/wake states
REM Deep
Light
Sleep stages
Why Treat OSA? Socio-economic: 1. 2. 3. 4. 5. Medical: 1. 2. 3. 4. 5.
Why Treat OSA? Socio-economic: - Interpersonal - Antisocial - Loss of libido/impotence - Cognitive - Economic productivity Medical: - **OBESITY (STPs!!)
- Road Traffic Accidents (RTAs)
- **CARDIOVASCULAR (BP++, HF, MI, Dys) (STPs!!)
- **DIABETES (Insulin, type 2) (STPs!!!)
- Stroke
07/02/2017
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GeneralObstrucCveSleepApnoeaNarcolepsyParkinson’sEpilepsy
07/02/2017
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