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: ram.dhillon@rila.co.uk Mobile: 07 958 450 544

BMA House

7th February 2017

The “Dizziness” Symptom

Tripod of BaLAnCE

Tripod of BaLAnCE

Inner ear Visual input

! !Proprioception

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! !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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