Obstructive sleep apnoea-hypopnoea syndrome.

Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a common disorder characterised by repetitive episodes of the complete or partial collapse of the pharyngeal airway during sleep. This results in cessation (apnoea) or reduction (hypopnoea) of airflow, leading to oxygen desaturation and sleep fragmentation. An individual's disposition to develop OSAHS depends on the collapsibility of a segment of the upper airway. The degree of collapsibility can be quantified by the balance between occluding or extraluminal pressures of the surrounding tissues. Patients can experience snoring, unrefreshing sleep, witnessed apnoeas, waking with a choking sensation and excessive daytime sleepiness. OSAHS has a broad range of consequences, including cardiovascular, metabolic, and neurocognitive sequelae. Treatment options include lifestyle measures, in particular weight loss, and strategies to maintain upper airway patency overnight, including continuous positive airway pressure, mandibular advancement devices and positional modifiers.

Sleep disorders in pregnancy.

Sleep disturbances are common in pregnancy and affect sleep quality. The maternal body is going through constant physical and physiological changes to adapt to the growing fetus. Sleep disorders may manifest at any point during pregnancy; some may result in adverse maternal or fetal outcomes. A strong clinical suspicion is crucial to identify sleep disorders in pregnancy and their management should be evaluated with a multidisciplinary team approach. In this review, we provide an overview of changes in sleep during pregnancy and summarise the key features of common sleep disorders in pregnancy, including practical tips on their management. Educational aims: To provide an overview of common sleep disorders in pregnancy and their management options.To highlight the impact of the physiological changes in pregnancy on sleep.To outline the type of sleep studies available to investigate sleep disorders in pregnancy.

Going viral: lessons from an accelerated PPE teaching programme during the COVID-19 pandemic.

This article was migrated. The article was marked as recommended. Introduction: at the beginning of the COVID-19 pandemic in the United Kingdom, there was an urgent need to establish a teaching programme to rapidly upskill hospital staff in the use of Personal Protective Equipment (PPE). Aims: to train all members of clinical and non-clinical staff operating within the respiratory department of the Royal Brompton Hospital over a period of one week, using a series of multi-professional simulation-based sessions and to then share the learning points gained in order to assist others facing the same issue. Results: using an iterative style and a mastery learning model, the designated teaching faculty rapidly implemented a situated teaching programme, managing to train all staff members within the given timeframe. Given the time-critical nature of the programme, sessions required considerable flexibility to change to fit a learner-driven agenda, drawing benefits from an andragogical approach and an emphasis on interprofessional learning.

Impact of the novel coronavirus (COVID-19) pandemic on sleep.

BACKGROUND: The COVID-19 pandemic has led to significant changes in daily routines and lifestyle worldwide and mental health issues have emerged as a consequence. We aimed to assess the presence of sleep disturbances during the lockdown in the general population. METHODS: Cross-sectional, online survey-based study on adults living through the COVID-19 pandemic. The questionnaire included demographics and specific questions assessing the impact of the pandemic/lockdown on sleep, daytime functioning and mental health in the general population. Identification of sleep pattern changes and specific sleep-related symptoms was the primary outcome, and secondary outcomes involved identifying sleep disturbances for predefined cohorts (participants reporting impact on mental health, self-isolation, keyworker status, suspected COVID-19 or ongoing COVID-19 symptoms). RESULTS: In total, 843 participants were included in the analysis. The majority were female (67.4%), middle aged [52 years (40-63 years)], white (92.2%) and overweight to obese [BMI 29.4 kg/m2 (24.1-35.5 kg/m2)]; 69.4% reported a change in their sleep pattern, less than half (44.7%) had refreshing sleep, and 45.6% were sleepier than before the lockdown; 33.9% had to self-isolate, 65.2% reported an impact on their mental health and 25.9% were drinking more alcohol during the lockdown. More frequently reported observations specific to sleep were 'disrupted sleep' (42.3%), 'falling asleep unintentionally' (35.2%), 'difficulties falling'/'staying asleep' (30.9% and 30.8%, respectively) and 'later bedtimes' (30.0%). Respondents with suspected COVID-19 had more nightmares and abnormal sleep rhythms. An impact on mental health was strongly associated with sleep-related alterations. CONCLUSIONS: Sleep disturbances have affected a substantial proportion of the general population during the COVID-19 pandemic lockdown. These are significantly associated with a self-assessed impact on mental health, but may also be related to suspected COVID-19 status, changes in habits and self-isolation.

New modalities for non-invasive ventilation.

There is now substantial evidence supporting the use of non-invasive ventilation in acute hypercpanic exacerbations of chronic respiratory failure, and early trials show nocturnal ventilatory support may benefit chronic heart failure patients with sleep disordered breathing. Attention is now being focused on innovative modes which adapt respiratory support to the user's ventilatory pattern, eg adaptive service ventilation and assured volume delivery 'intelligent' ventilation.