Of OSA, Question 8 from the first paper of 2001 asked the candidates specifically: "What are the potential long-term complications of this syndrome?" Less specifically, the college frequently throws obese hypercapneic patients at the candidates (Question 1a from the second paper of 2000, Question 14 from the second paper of 2011).
The best resources for this, aimed at intensivists:
Table 2 from the Park article (2011) lists some of the defining features of OSA. In order to meet the criteria, one must undergo a formal polysomnographic sleep study, and demonstrate the following features:
This definition comes from a 1999 position statement by the American Academy of Sleep Medicine, which has also been endorsed by the Australasian Sleep Association.
STOP-BANG is a tool devised for pre-admission clinic staff, to screen OSA patients preoperatively and thereby predict those who will have clinically relevant perioperative complications.
The items in this screening tool are as follows
Each item scores a 1 or 0. A total score in excess of 3 has an 84% sensitivity of predicting OSA; a score in excess of 5 predicts moderate-to-severe OSA. Other similar tools exist, of which the best known is probably the Berlin Questionnaire.
Question 8 from the first paper of 2001 also asked the candidates to discuss the pathophysiology of obstructive sleep apnoea. An excellent review article from Thorax (Fogel et al, 2004) is available to answer this. One may summarise by saying that there is a combination of anatomical predisposition and exacerbating factors.
The delicate eyes of visual learners may be offended by this big confusing diagram:
Instead, in a thousand words:
Young et al (JAMA, 2004) offer a good overview of the risk factors:
If one really wanted to, one could come up with a shitload more. Lets face it: how many causes of narrowed upper airway or poor upper airway tone are there? Lets say, drug use is a risk factor. would the rapidly scribbling exam candidate then go on to offer greater granularity, separating the drugs into benzodiazepines, barbiturates, opiates, volatile anaesthetics, etc? Would one mention stroke, adding bulbar palsies? Musclular dystrophy? What about myasthenia gravis? Airway tumours? It could be lost time in return for few marks.
Malhotra, Atul, and David P. White. "Obstructive sleep apnoea." The lancet360.9328 (2002): 237-245.
SHEPARD Jr, J. O. H. N. "Cardiopulmonary consequences of obstructive sleep apnea." Mayo Clinic Proceedings. Vol. 65. No. 9. Elsevier, 1990.
Peter, J. H., et al. "Manifestations and consequences of obstructive sleep apnoea." European Respiratory Journal 8.9 (1995): 1572-1583.
Balachandran, Jay S., and Sanjay R. Patel. "Obstructive Sleep Apnea." Annals of internal medicine 161.9 (2014): ITC1-ITC1.
Jordan, Amy S., David G. McSharry, and Atul Malhotra. "Adult obstructive sleep apnoea." The Lancet 383.9918 (2014): 736-747.
Park, John G., M. D. KANNAN RAMAR, and ERIC J. OLs0N. "Updates on Definition, Consequences, and Management of Obstructive Sleep Apnea." (2011).
American Academy of Sleep Medicine. European Respiratory Society. Australasian Sleep Association. American Thoracic Society "Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research: the report of an American Academy of Sleep Medicine Task Force." Sleep. 1999;22:667-689
Fogel, R. B., A. Malhotra, and D. P. White. "Sleep· 2: pathophysiology of obstructive sleep apnoea/hypopnoea syndrome." Thorax 59.2 (2004): 159-163.
Young, Terry, James Skatrud, and Paul E. Peppard. "Risk factors for obstructive sleep apnea in adults." Jama 291.16 (2004): 2013-2016.