Sleep Apnea Syndrome (Sleep Apnea, Night Apnea Syndrome, Obstructive Sleep Apnea Syndrome)
By tradition, many of us consider snoring to be just a minor nuisance, which does not deserve special attention and especially treatment.
However, it is often accompanied by a condition such as apnea, which under certain conditions can cause serious harm to health.
Therefore, you should not ignore it. Apnea - what is it, its sympotomes. Read about it in the article.
What is apnea?
The beautiful name "apnea" hides a rather dangerous state of the body, which consists in a complete stop of respiratory movements.
An apnea attack can occur for a variety of reasons.:
- a decrease in carbon dioxide in the blood due to excessive ventilation of the lungs,
- high blood pressure
- excessive irritation of skin receptors (for example, when diving into water to a great depth).
Sleep apnea called sleep apnea is very common.
Symptoms of Apnea
Apnea is a serious disorder of respiratory function, manifested in the periodic cessation of inhalation and exhalation during sleep.
With this disease, quite long breathing pauses occur, which causes hypoxemia (an increase in the content of carbon dioxide in the body) and hypoxia (oxygen starvation).
At this time, the respiratory centers in the brain are stimulated, leading to constant awakenings.
They are associated with the restoration of breathing and are accompanied by a loud snoring or a noisy breath.
With apnea syndrome, the level of oxygen in the blood decreases significantly, which is accompanied by cyanosis of the limbs and nasolabial triangle.
The number of episodes of apnea is determined by the condition of the body and the severity of the disease. A short stop in breathing can occur from 5 to 100 times per hour, which totals 3-4 hours. This syndrome prevents physiological sleep, making it restless and anxious.
Symptoms of apnea are numerous and the patient himself does not always associate them with snoring and holding his breath during a night's rest, because he does not always know about the presence of the disease and learns about it from others.
Indirect signs of apnea that can be suspected include:
- decreased memory, working capacity, concentrated attention,
- morning headaches and weakness,
- fatigue and drowsiness during wakefulness,
- weight gain
- inhibition of the functions of the cardiovascular system (angina attacks, heart failure, arrhythmic disorders).
If a patient is diagnosed with concomitant pathological conditions (chronic obstructive pulmonary disease, asthma, cardiac ischemia, arterial hypertension, etc.), he is more likely to develop severe forms of the disease.
Sleep apnea syndrome is often combined with Pickwick syndrome, which includes sleepiness during the day, obesity, and heart defects..
Distinguish between central and obstructive apnea. In the first case, the disease is often manifested by apathy, fatigue, and a desire to sleep while awake.
A person is able to suddenly “disconnect” during a conversation, driving a car, etc., and not even notice it. Central apnea is characterized by noisy and irregular breathing during a night's rest, but there are no attempts to take a breath accompanied by light snoring.
In children, this disease is manifested by slowness, behavioral disorders, night and daytime enuresis, excessive sweating, drowsiness, snoring, strange postures during sleep.
Why is apnea dangerous? The lack of proper sleep and constant oxygen starvation in many cases lead to serious consequences in the absence of treatment for the disease.
- depression, which can provoke a constant desire to sleep, fatigue and lethargy,
- the risk of accidents at home and at work associated with delayed reactions,
- frequent trips to the toilet (during apnea often creates significant negative intrathoracic pressure, which leads to overload of the right atrium with blood volume and impaired synthesis of the hormone responsible for the production of urine)
- the appearance of heartburn, also due to increased intrathoracic pressure and the throwing of the contents of the stomach into the esophagus,
- the likelihood of developing myocardial infarction or stroke, since prolonged episodes of hypoxia are detrimental to the state of the brain and heart.
Carotid (nocturnal) apnea syndrome is a respiratory function disorder characterized by intermittent respiratory arrest in sleep. In addition to nocturnal respiratory arrest, sleep apnea syndrome is characterized by persistent severe snoring and severe daytime sleepiness. Sleep apnea is a potentially life-threatening condition, accompanied by hemodynamic disorders and unstable cardiac activity.
Respiratory pauses of 10 seconds with sleep apnea syndrome cause hypoxia (lack of oxygen) and hypoxemia (increased carbon dioxide), which stimulate the brain, which leads to frequent awakenings and the resumption of breathing. After falling asleep again, short-term respiratory arrest and awakening again follow. The number of episodes of apnea depends on the severity of the disorders and can be repeated from 5 to 100 times per hour, taking the total duration of respiratory breaks up to 3-4 hours per night. The development of sleepy apnea syndrome violates the normal physiology of sleep, making it intermittent, superficial, uncomfortable.
According to statistics, 4% of men and 2% of middle-aged women suffer from sleep apnea syndrome, and the probability of apnea increases with age. Women are most prone to developing apnea during menopause. Respiratory dysfunction close to apnea is hypnoea - a decrease in the volume of the respiratory flow by 30% or more compared to normal for 10 seconds, leading to a decrease in oxygen perfusion by more than 4%. In healthy individuals, physiological apnea occurs - short, intermittent respiratory arrests in a dream lasting no more than 10 seconds and with a frequency of no more than 5 in one hour, which are considered a normal variant and do not threaten health. Solving the problem requires the integration of efforts and knowledge in the field of otorhinolaryngology, pulmonology, somnology.
Most likely causes of apnea syndrome
The causes of apnea vary depending on its type.
- Central apnea is associated with a genetic predisposition, serious brain injuries, or congenital atrophy of certain parts of it.
- Obstructive apnea is diagnosed with impaired airway. Often it is due to congenital features: enlargement of the tonsils, soft palate or palatine tongue, narrow nasal passages, short neck of considerable thickness.
Studies have confirmed that middle-aged and older males are more likely to suffer from nighttime respiratory arrest.
The reason for this is a decrease in the firmness and elasticity of tissues throughout life, which leads to excessive relaxation of the muscles of the pharynx. Apnea is also often seen in patients with Alzheimer's syndrome and Parkinson's disease.
At risk are people suffering from endocrine disorders and overweight, since adipose tissue, which is deposited on the walls of the pharynx, leads to narrowing of the lumen of the upper respiratory tract.
Also among the possible causes of apnea, it is worth mentioning the presence of polyps in the nose, smoking, a small beveled lower jaw.
Apnea not only causes some inconvenience to the patient and others, but also significantly affects the quality of life and health, requiring immediate treatment.
Disruptions in the regulation of respiratory function from the central nervous system in central carotid apnea syndrome can be caused by injuries, compression of the brainstem and posterior cranial fossa, brain damage in Alzheim-Peak syndrome, and postencephalitic parkinsonism. In children, primary insufficiency of the respiratory center occurs, causing alveolar hypoventilation syndrome, in which there is cyanotic skin, episodes of sleep apnea in the absence of pulmonary or cardiac pathology.
Obstructive sleepy apnea syndrome is more common in obese people, endocrine disorders, prone to frequent stress. Anatomical features of the upper respiratory tract predispose to the development of obstructive sleep apnea syndrome: short thick neck, narrow nasal passages, enlarged soft palate, tonsils or palatine tongue. In the development of carotid apnea syndrome, a hereditary factor is important.
The development of obstructive sleepy apnea syndrome occurs as a result of pharyngeal collapse that occurs during deep sleep. The decline of the airways at the level of the pharyngeal region during each episode of apnea causes states of hypoxia and hypercapnia, signaling the brain to awaken. During awakening, airway function and ventilation are restored. Violations of the patency of the upper airways can develop behind the soft palate or the root of the tongue, between the posterior pharyngeal wall and the choanas - the internal nasal openings, at the level of the epiglottis.
According to the pathogenetic mechanism of the development of carotid apnea syndrome, its central, obstructive and mixed forms are distinguished. Syndrome of central carotid apnea develops as a result of a violation of the central mechanisms of regulation of respiration due to organic lesions of the brain or primary insufficiency of the respiratory center. Sleep apnea with the central form of the syndrome is due to the cessation of the supply of nerve impulses to the respiratory muscles. The same developmental mechanism underlies the periodic Chain-Stokes breathing, which is characterized by the alternation of superficial and rare respiratory movements with frequent and deep, then turning into apnea.
Syndrome of obstructive carotid apnea develops as a result of lowering or occlusion of the upper respiratory tract while maintaining respiratory regulation by the central nervous system and respiratory muscle activity. Some authors include obstructive sleep apnea syndrome in the syndrome complex of obstructive apnea-hypnoea, which also includes a number of respiratory dysfunctions that develop in a dream:
- Hypoventilation syndrome - characterized by a steady decrease in lung ventilation and blood perfusion with oxygen.
- Pathological snoring syndrome
- Obesity Hypoventilation Syndrome - gas exchange disorders, developing against the background of excess weight gain and accompanied by a persistent decrease in blood perfusion with oxygen with day and night hypoxemia.
- Respiratory tract obstruction syndrome - a combination of impaired patency of the upper (at the level of the pharynx) and lower (at the level of the bronchi) airways, leading to the development of hypoxemia.
Mixed sleepy apnea syndrome involves a combination of central and obstructive mechanisms. The severity of the sleep apnea syndrome is determined by the number of apnea episodes:
- up to 5 episodes of apnea per hour (or up to 15 apnea-hypopnea) - no sleepy apnea syndrome,
- from 5 to 15 apnea per hour (or from 15 to 30 apnea-hypopnea) - mild sleep apnea syndrome,
- from 15 to 30 apnea per hour (or from 30 to 60 apnea-hypopnea) - moderate sleep apnea syndrome,
- over 30 apnea per hour (or more than 60 apnea-hypnoea) - severe sleep apnea syndrome.
Often, patients with sleep apnea syndrome themselves are unaware of their disease and learn about it from those who sleep nearby. The main manifestations of sleep apnea syndrome are snoring, restless and intermittent sleep with frequent awakenings, episodes of respiratory arrest in a dream (according to the testimonies of the people surrounding the patient), excessive motor activity in a dream.
As a result of inferior sleep, patients develop neurophysiological disorders, manifested by headaches in the morning, weakness, excessive daytime drowsiness, decreased performance, irritability, fatigue during the day, decreased memory and concentration.
Over time, patients suffering from sleep apnea syndrome, increase body weight, develop sexual dysfunction. Carotid apnea syndrome negatively affects cardiac function, contributing to the development of arrhythmias, heart failure, angina attacks. Half of patients with sleep apnea syndrome have a concomitant pathology (arterial hypertension, coronary heart disease, asthma, chronic obstructive pulmonary disease, etc.), which significantly aggravates the course of the syndrome. The development of sleep apnea is often found in Pickwick syndrome, a disease that combines insufficiency of the right heart, obesity and daytime sleepiness.
In children, breathing through the mouth during the daytime, night and daytime urinary incontinence, excessive sweating in a dream, drowsiness and slowness, behavioral disturbances, sleep in unusual postures, and snoring may indicate sleep apnea syndrome.
Sleep disorders with carotid apnea syndrome can seriously affect the quality of life. A decrease in concentration of attention in the daytime increases the risk of injuries and accidents at work, at home and everyday activities.
An increase in the frequency of apnea episodes directly affects an increase in morning blood pressure. During respiratory breaks, a heart rhythm disturbance may develop. Increasingly, carotid apnea syndrome is called the cause of stroke in young men, ischemia and myocardial infarction in patients with atherosclerosis. Carotid apnea syndrome aggravates the course and prognosis of chronic pulmonary pathology: COPD, bronchial asthma, chronic obstructive bronchitis, etc.
In recognizing sleep apnea syndrome, contact with the patient's relatives and their participation in establishing the fact of respiratory arrest in sleep is important. To diagnose sleep apnea syndrome, the method of V.I. Rovinsky is used in outpatient practice: one of the relatives, during the patient’s sleep, detects the duration of respiratory pauses by using a clock with a second hand.
On examination, patients usually have a body mass index (BMI)> 35, which corresponds to II degree of obesity, neck circumference> 40 cm in women and 43 cm in men, blood pressure values exceed 140/90 mm RT. Art.
Otolaryngologist is consulted for patients with carotid apnea syndrome, during which the pathology of ENT organs is often detected: rhinitis, sinusitis, curvature of the nasal septum, chronic tonsillitis, polyposis, etc. The study of the nasopharynx is supplemented by pharyngoscopy, laryngoscopy and rhinoscopy using a flexible fibroend.
A reliable picture of the presence of carotid apnea syndrome allows you to establish a polysomnographic study.Polysomnography combines a long (over 8 hours) simultaneous recording of electrical potentials (brain EEG, ECG, electromyograms, electrooculograms) and respiratory activity (air flow through the mouth and nose, respiratory efforts of the abdominal and chest muscles, saturation (SaO 2 ) blood oxygen, the phenomenon of snoring, body posture during sleep). When analyzing a polysomnography record, the number and duration of sleep apnea episodes and the severity of the changes occurring are determined.
A polysomnography option is a polygraphic study - nightly recording of the body's electrical potentials, including from 2 to 8 positions: ECG, nasal respiratory flow, chest and abdominal effort, oxygenation of arterial blood, muscle activity of the lower extremities, sound phenomenon of snoring, body position during sleep.
Treatment of carotid apnea syndrome
The treatment program may include the use of non-drug, drug and surgical methods of influencing the cause of the disease. General recommendations for mild disturbances of night breathing include sleep with a raised head end of the bed (20 cm higher than usual), exclusion of sleep in supine position, instillation of xylometazoline (galazolin) in the nose at night to improve nasal breathing, gargling with a solution of essential oils, treatment pathology of ENT organs (chronic rhinitis, sinusitis), endocrinopathy, the exclusion of sleeping pills and alcohol, weight loss.
During sleep, it is possible to use various oral devices (lower jaw extenders, tongue holders) that help maintain airway clearance, oxygen therapy.
The use of over-the-air apparatus CPAP-therapy (CPAP ventilation), which ensures the maintenance of a constant positive pressure of the airways, normalizes night breathing and improves daytime well-being of patients with sleep apnea syndrome. This method is today considered the most promising and effective. The appointment of taking theophylline does not always give the desired effect in patients with obstructive night apnea. With the central form of carotid apnea syndrome, a positive effect from taking acetazolamide is possible.
Surgical interventions for carotid apnea syndrome are considered auxiliary in cases of existing abnormalities and defects in the structure of the upper respiratory tract or their chronic diseases. In some cases, adenoidectomy, correction of the nasal septum and tonsillectomy can completely eliminate the causes of carotid apnea syndrome. Operations on uvulopalatopharyngoplasty and tracheostomy are performed for extremely severe disorders.
Forecast and Prevention
Sleepy Apnea Syndrome is far from a harmless disorder. Clinical symptoms increase over time and can cause severe disability or death in 40% of patients in the first 5 years of the disease, 50% in the next 5 years and in 94% of patients with 15 years of illness.
Mortality rates in patients with sleep apnea syndrome are 4.5 times higher than those in the general population. The use of CPAP therapy has reduced mortality by 48% and increased life expectancy by 15 years. However, this method does not affect the pathogenesis of carotid apnea syndrome.
Prevention of possible sleep apnea complications necessitates the participation of specialists in pulmonologists, otolaryngologists, cardiologists, and neurologists in the treatment of the syndrome. In the case of sleep apnea syndrome, we can only talk about non-specific prophylaxis, which includes normalizing weight, quitting smoking, taking sleeping pills, alcohol, and treating diseases of the nasopharynx.
Central sleep apnea is characterized by the fact that the cause of breath holding is the brain. And to be absolutely accurate, then the cessation of the supply of nerve impulses by the brain, causing the body to breathe.
The reasons for this behavior can be many, from a stroke or any other disease, to taking medications, drinking alcohol or smoking.
By the way, spending the night on high plateaus, with a height of over 4,500 meters, can also provoke sleepy apnea.
Obstructive sleep apnea differs from central sleep apnea in that the culprit in holding the breath is weak throat muscles, as a result of which they close and block the airways.
This process occurs as follows - a sleeping person stops snoring and freezes for a short period of time without breathing, but his chest continues to rise and fall. After a while, the sleeping person snores and either continues to sleep peacefully or snore.
If you understand in more detail, as a result of blocking the respiratory tract, oxygen ceases to flow into the body and an excess of carbon dioxide is formed, which ultimately provokes snoring. And a person, during the cessation of air supply, passes from the phase of deep sleep to a surface state, up to awakening. Hence the lack of sleep and a broken condition in the morning.
Learning to diagnose apnea correctly.
Diagnosis of apnea is the most important part in the disease-cure chain, but it is unlikely that a sleeping person is able to remember what processes happen to him during sleep, so it is extremely difficult for a potential patient to recognize sleep apnea. But if you notice the following symptoms in yourself, you should think:
decreased sexual activity,
dry mouth after morning awakening.
These signs indicate problems with sleep, and if you sleep for at least 7 hours, we recommend that you study sleep immediately. For a thorough analysis, you need at least video or audio recording equipment, and ideally, the presence of others who can tell you about everything that happened at night.
Keep a diary in which you will reflect everything that happens to you:
How many times woke up
State after waking up,
Time to go to bed and time to rise
This diary must be kept for 2 weeks, and it will help a specialist in the treatment of night apnea, a somnologist, in determining the exact picture of the disease and prescribing a complete treatment.
In addition, to determine the severity of apnea, the doctor can prescribe polysomnography, a special diagnosis, during which the patient is comprehensively examined during sleep.
Undoubtedly, night sleep apnea has its own risk group, which includes people:
regular smokers and drinkers
Persistent nasal congestion
suffering from diabetes.
During menopause, a woman has enormous changes in the body, and unfortunately this is not always asymptomatic. According to statistics, 0.6% of women suffered from sleep apnea in the premenopausal period, while 5.5% of women who had menopause experienced problems with sleep apnea.
Recommendations for amateurs
Each person suffering from sleep apnea can improve their sleep and without resorting to the services of a doctor, in particular, you must follow these tips:
Exclude food intake 3-4 hours before bedtime,
Switch to low-calorie and vitamin-rich foods, which in turn will help to reduce overweight,
Increase physical activity throughout the day,
Avoid drinking alcohol and smoking 2-3 hours before bedtime,
try to sleep on your side, for which you can sew a small ball in your pocket between the shoulder blades. This procedure at first will not be very pleasant, but over time, a person will get used to sleeping on his side,
These simple recommendations will not save the patient from sleep apnea, but will improve sleep quality.
What to cut and where to paste ...
If we talk about medical methods of treatment, then there are three:
Surgical - is to expand the lumen in the airways. The use of this method must be approached with extreme caution, since it is not shown to everyone, and the decision should be made by the doctor.
Using special applicators - this method is a selection
the dentist special devices that fix the tongue and slightly push the lower jaw forward during sleep, which leads to the cessation of airway obstruction. However, this method is not popular in the Russian Federation.
CPAP - therapy is the most effective method in eliminating symptoms, but not treating the disease as such. Oddly enough, this therapy is currently the most popular and often used. CPAP - therapy consists in using a special device that supplies oxygen to the human body at night. The mask gives inconvenience, but over time, well-being makes itself felt and the patient simply forgets about this inconvenience.
Description of the disease, its symptoms and signs
The main symptom of sleep apnea is short-term respiratory arrest during sleep.
Attacks can be single or occur at short intervals.
In severe cases, up to 400 episodes of cessation of the process of oxygen supply to the lungs can be observed in a patient during one night.
This condition is not the only sign of apnea.
The changes that the pathology provokes significantly reduce the patient's quality of life.
Additional symptoms of pathology:
- morning headaches
- manifestations of arrhythmia,
- sexual dysfunctions (in men),
- severe snoring during sleep,
- signs of emotional instability,
- tendency to increase blood pressure,
- excessive sweating during sleep,
- decrease in psychomotor reactions,
During an attack of the syndrome, respiratory arrest may be complete or partial.
If the patient feels the problem, then waking up, he restores the oxygen deficiency.
Manifestations of the syndrome in most cases last a few seconds and can not cause death.
An attack of complete cessation of oxygen in combination with chronic diseases increases the risk of sudden death of the patient.
Why does night sickness occur in adults
All the causes of nightly attacks of sleep apnea in adults are combined by one factor - weakness of the pharyngeal muscles.
Such a pathology manifests itself in a peculiar clogging of the throat with a part of the tongue, tonsils or soft palate.
Congenital anatomical features, inflammatory processes in the ENT organs, age-related changes and a number of other reasons can provoke a violation of the motor function of the larynx.
A hereditary predisposition to apnea is not ruled out.
Causes of the syndrome in adults:
- age-related changes in the body (at risk are people over fifty years of age, increases the likelihood of apnea, a combination of aging with a sedentary lifestyle),
- floor (in most cases, the syndrome is diagnosed in men, the cause of this nuance is the anatomical feature of the structure of the larynx, as well as the nuances of lifestyle),
- bad habits (smoking and alcoholism are indirect causes of apnea, but with the established diagnosis, such factors significantly aggravate the patient’s condition),
- diabetes (in most cases, sleep apnea syndrome becomes a concomitant symptom of this disease),
- prolonged or uncontrolled use of sleeping pills (sedatives relax the muscles of the larynx, with constant use there is an addictive effect),
- consequences of hormonal changes in the body (women at menopause and pregnancy are at risk, weakness of the muscles of the larynx becomes a consequence of a natural change in the level of hormones in the body),
- forms of the disease - obstructive, central and others,
- the causes in newborns and children up to a year,
- symptoms in children after a year and adolescents.
What does the term "apnea" mean?
Apnea is a dangerous condition characterized by chest freezing and respiratory arrest. Pathology is associated with somatic diseases, hypocapnia (a decrease in the level of carbon dioxide in the blood).
Night apnea ─ a temporary cessation of ventilation of the lungs (from 10 seconds to 3 minutes) is distinguished in a separate form. If the breath-holding is 60% of the total time allotted for sleep, this indicates a severe course of pathology, requiring urgent medical measures.
Regular stops of the chest (the number of episodes up to 15 per hour) ─ apnea syndrome, which negatively affects the general physical and mental state of a person.
Types of Apnea
Night apnea with the course, severity, danger of complications is divided into groups and types.
Depending on the reduction in the amount of inhaled air, sleep apnea syndrome is complete and partial. In the first case, breathing stops completely, there is no circulation of air flow in the broncho-pulmonary tract. Rapidly compressing the chest, suffocation develops.With a partial violation of the act of breathing in a dream, ventilation of the respiratory organs is reduced to 40-50%. This condition is called hypopnea.
Given the causes of apnea, these types of diseases are distinguished:
- obstructive sleep apnea syndrome ─ occurs against the background of obstruction of the respiratory tract,
- sleep apnea of the central nervous system ─ develops due to impaired brain activity,
- mixed form ─ includes mechanisms, signs of obstructive and central syndrome.
The severity of the pathology is determined by the number of episodes of respiratory arrest per unit time. Light degree ─ 5-15 apnea / hour, moderate ─ 15-30 apnea / hour, severe ─ 30-50 apnea / hour. An extremely dangerous condition for life when the number of stops in the respiratory movements of the chest exceeds 60 episodes per hour.
The development of a central type of disease
The mechanism of the occurrence of central sleep apnea is based on malfunctions of the brain department responsible for respiratory function. The absence of signals in the form of nerve impulses, which are normally sent to the smooth muscles of the bronchi, pectoral muscles, diaphragm, leads to the termination of the act of inhalation-exhalation.
Factors that increase the risk of central development of sleep apnea:
- the use of drugs of narcotic origin that inhibit the activity of the central nervous system ─ morphine, barbiturates, antipsychotics,
- congenital, acquired defects of the brain ─ cysts, lack of cerebral hemispheres in a newborn, expansion of the ventricles of the brain against dropsy,
- neurological diseases causing sleep apnea ─ multiple sclerosis, senile dementia (Alzheimer's disease), epilepsy,
- skull injuries, damage to the cervical spine, benign and malignant tumors,
- acute infections ─ meningitis, encephalitis, brain abscess,
- somatic diseases that disturb blood circulation ─ stroke, atherosclerosis, acute heart failure,
- metabolic disorders, lack of chemical elements ─ hypocapnia (lack of carbon dioxide in the blood), deficiency of K, Mg, glucose, excess Na, proteinuria (high protein content in urine).
Men over 40 years old, obese people are prone to central sleep apnea.
This is the most common type of pathology. In a dream, the airways are blocked in adults. The act of inhalation-exhalation becomes superficial, then stops for a short period of time. The process of restoring breathing is accompanied by snoring, a choking attack, and sudden movements of the chest. This is due to the fact that the skeletal muscles and diaphragm begins to work intensely.
According to WHO statistics, the disease affects 12 million people.
- people with obesity of different stages,
- people with endocrine diseases ─ diabetes mellitus, hypothyroidism,
- patients over 45 years old
- patients with anatomical features ─ narrow larynx, trachea, wide neck.
Periodic apnea causes allergies, infectious inflammation of the upper respiratory tract. In children, respiratory arrest in a dream of an obstructive form is associated with swelling of the tonsils, proliferation of adenoids, and swelling of the soft palate. Newborns and infants of the first months of life stop breathing due to abnormal development of the jaw, cleft palate, retraction of the tongue, atrophy of the muscles of the larynx, obstruction of the respiratory tract.
Mixed or complex type of disease
In 75% of cases, mixed-type apnea occurs in patients with a history of heart failure. In the pathogenesis of the disease, brain disorders and obstruction of the bronchopulmonary tract are simultaneously involved. Breathing is blocked at the level of the pharynx.
People with a mixed type of pathology traditionally suffer from snoring. Initially, doctors suspect a definitive view, prescribe appropriate treatment, which does not bring a positive result. Only then resort to combination therapy, affecting the processes in the brain.
Some experts attribute the mixed type of disease to obstructive.
To make a diagnosis of the syndrome, you need to talk with the patient's relatives. They should describe how the patient sleeps and confirm the presence of respiratory arrest in a dream. Interviewing a patient, experts find out if he has daytime sleepiness and attacks of falling asleep during the day.
During the examination, it is necessary to check the level of blood pressure, oxygen saturation, patency of the respiratory tract, anomalies in the structure of the facial skeleton, blood counts, the presence of severe concomitant diseases - diabetes, hypothyroidism. Specialists in almost all patients reveal signs of obesity and hypertension.
Otorhinolaryngological examination aimed at identifying the following diseases - rhinopharyngitis, sinusitis, curvature of the nasal septum, tonsillitis, polyposis. Using a flexible probe, specialists examine the nasal cavity, pharynx, sinuses.
Polysomnography allows you to identify sleepy apnea syndrome, determine the number of episodes and their duration, to detect changes in the body. When the patient is sleeping, he is being watched. Electrodes are attached to certain points of the body, with the help of which the registration of the main parameters will occur. During the study, the patient will be monitored by a doctor or specially trained medical staff. Experts record the data of EEG, ECG, electromyography, electrooculography, computer pulse oximetry. Polysomnography lasts 8 hours and is recorded on video. Also determine the flow of air inhaled and exhaled by the patient, the strength of muscle contractions in the chest and abdominal region, the presence of snoring, the patient's posture in a dream, his mobility.
In the presence of complications of the syndrome, additional research methods are needed: ultrasound, cardiographic, dopplerographic, radiographic, scintiographic, tomographic, laboratory.
Features of the manifestation of the obstructive type
In the process of snoring, the mucous membrane of the oral cavity and throat dry up. After waking up, pain is felt during swallowing. In obstructive sleep apnea syndrome, increased sweating is observed. A person can wake up in the middle of the night from a suffocating attack, an acute shortage of air.
A symptom that should alert a person is snoring, interspersed with short fragments of silence (correspond to nocturnal apnea in adults). The severity of snoring increases with weight gain, after taking sleeping pills, alcoholic beverages.
Symptoms are more likely to occur when you sleep on your back Photo dux.se
With the advanced form, people with sleep apnea syndrome develop skin cyanosis. Destabilization of breathing often manifests itself in the supine position, less often ─ on the side. The resumption of air circulation is marked by explosive snoring, muttering, moaning, loud sighs. The motor activity of muscles increases, a person waves his arms and legs, often changes his body position.
Obstructive sleep apnea is characterized by periods of activation that make nightly rest fragmented. A person is not fully awakened, a dream from a deep phase passes into a superficial, restless. Patients cannot objectively assess their condition, only some consult a doctor with a symptom of insomnia ─ disturbance of night sleep, a decrease in its duration and quality. The main complaints are nightmares, anxiety, and frequent awakenings.
With severe syndrome of carotid obstructive apnea, the following physical signs are observed:
- chest tightness, discomfort,
- choking, chest squeezing,
- inexplicable feeling of fear.
Intra-abdominal pressure and diaphragm activity can provoke heartburn, nausea, belching with an unpleasant smell of gastric contents, and reflux. Sometimes a spasm of the larynx and bronchi develops, patients intercept the air flow in movements resembling the act of swallowing.
The treatment of carotid apnea is complex. It is aimed at eliminating the main causative factors through non-drug, drug and surgical exposure.
Recommendations of specialists with minor sleep disorders:
- Sleep on a high pillow and on your side allows you to relieve the load from the muscles of the pharynx
- The use of bedtime decongestants that relieve nasal congestion,
- Early detection and treatment of sinusitis, tonsillitis, rhinopharyngitis,
- Fight obesity,
- Refusal of alcohol in the evenings,
- Refusal to take sedatives in the afternoon.
Before going to bed, meditation and massage will help you relax. It is better for patients not to watch TV just before bedtime and not to read a book in bed. It is advisable to reduce noise and dim the light in the bedroom.
The most effective therapeutic measures:
- Hardware treatment - the use of fixatives and masks that are inserted into the oral cavity to extend the jaw and hold the tongue in a position that leaves the airway open. The mandibular splint provides free breathing to a sleeping person. Dilators for the nose, supporting its wings, increase the space for air flow.
- Drug therapy consists in the appointment of local corticosteroids. If apnea syndrome is a manifestation of bronchopulmonary diseases with airway obstruction, the main pathology is treated. Pulmonologists individually select a treatment regimen for each patient. Usually they are prescribed antibiotics, bronchodilators, mucolytics, expectorants and anti-inflammatory drugs. Drugs that eliminate obstruction and facilitate asthma attacks are applied topically as an aerosol through a nebulizer. All patients, without exception, are prescribed prolonged theophyllines, cerebral circulation correctors, moderate sedatives.
- Surgical intervention indicated for patients with an abnormal structure of the respiratory tract. In the presence of adenoids, curvature of the septum or hypertrophic tonsils, adenoidectomy, septoplasty, tonsillectomy, laser soft palate surgery are performed. These operations can cope with the main etiological factors of the syndrome.
- To eliminate the ailment, a special method was developed - CPAP therapy. It is prescribed when frequent and long attacks of apnea practically do not allow patients to sleep and significantly worsen their general well-being. A special apparatus in the form of a mask covering the patient’s mouth and nose supplies air to the respiratory tract. Such manipulation does not allow sagging and subsiding soft tissues relaxed during sleep. A silent mask helps the patient to breathe and prevents collapse in a dream. This hardware-based treatment is considered one of the most effective.
- Traditional medicine helping to cope with apnea: fresh cabbage juice with honey and baked carrots. By regularly consuming these products, you can reduce the manifestations of the disease. Sea buckthorn oil is useful to instill in the nose to facilitate breathing.
Signs to which you should urgently pay attention
Most patients uncritically perceive their condition. There is no clear relationship with the severity of the disease, the number of seizures, and the duration of suffocation at night. Some people with moderate pathology describe their condition in paints, others with a severe form of the disease almost do not complain about their health. Therefore, you should be wary of such manifestations:
- complaints of family members about the uncontrolled snoring of a person,
- chronic fatigue that does not pass after a full sleep (at least 8 hours), prolonged vacation, relaxation at the resort,
- unreasonable mood swings, depression with social well-being, lack of objective reasons for psychological depression,
- malfunctions of the heart, heaviness in the chest, increased pressure, shortness of breath with minor physical exertion.
If a person knows about his diagnosis, you should carefully monitor any changes in the general condition. In the absence of drug therapy, patients with arrhythmias may develop extrasystole ─ an extraordinary, chaotic reduction of the atria and ventricles. This is a common cause of sudden death.
Sleep Apnea Treatment
The goal of therapy for sleep apnea syndrome is to reduce the number of breath holdings and reduce hypoxia (oxygen starvation of tissues, internal organs).
Methods of treating temporary respiratory arrest in a dream include a set of measures:
- change of work and rest regimen, daily routine,
- the use of pharmacological preparations,
- the use of special technical devices,
- surgical operations (according to indications).
How to effectively get rid of apnea, the doctor determines based on diagnostic findings.
Before radically treating sleep apnea, patients are recommended lifestyle correction. Obese people should review their diet. Prescribe a diet that reduces the amount of lipids in the body. Losing weight at least 10% of the total body weight significantly improves the general condition, a person suffocates less in a dream.
If you are overweight, the first thing you need to lose weight at least a little
It is necessary to abandon alcohol, smoking, taking sleeping pills (including drugs). To ensure a safe sleep on your side, use pillows and special devices that do not allow a person to roll over on his back.
With different types of apnea, treatment involves the appointment of medications:
- with congestion of the upper and lower respiratory tract ─ nasal sprays, mucolytic agents for oral administration or inhalation during an exacerbation of chronic inflammation, antispasmodics to eliminate smooth muscle tone,
- to fight obesity ─ drugs that normalize metabolism, drugs that lower blood sugar,
- to eliminate depression, depression, stabilization of the emotional background ─ sedatives,
- to normalize the work of the heart ─ cardiac glycosides.
Therapy of central sleep apnea requires the use of drugs that affect brain activity.
Prediction and prevention of the syndrome
The prognosis of sleep apnea syndrome with proper and long-term treatment is favorable. The progression of pathology and the increase in clinical symptoms leads to disability and even death.
Activities that prevent the occurrence of respiratory arrest in a dream:
- Proper nutrition
- Fighting bad habits
- Remediation of foci of infection in the body,
- Maintaining a healthy lifestyle,
- The optimal mode of work and rest,
- Head protection from injuries,
- Breathing exercises,
- Full healthy sleep.
Apnea syndrome is a serious illness that many often underestimate. It is especially dangerous for young children. To prevent the development of undesirable consequences, it is necessary to diagnose and treat the disease in time.
This is a procedure to remove overgrown soft palate tissue.
The method is based on the technology of radio frequency ablation (evaporation). Using a special electrode, the tissues are heated to 85 ° C. In places of heat exposure, scars appear. The manipulation is carried out on an outpatient basis under local anesthesia, lasting 20-30 minutes. Complications after this procedure are extremely rare. Since the operation is prescribed for severe tissue hypertrophy, several sessions are required to remove it.
The first days after surgery, snoring intensifies.This is due to the fact that after the manipulation appears edema, which delays the normal passage of air through the nose. Within 3-5 days, the patient experiences sore throat, aggravated by eating, talking. Gradually, breathing in a dream in a sleeping person is restored.
Other types of plastic correction
To eliminate the severe form of the syndrome of different types of sleep apnea, the following procedures are performed:
- UPPP ─ removal of enlarged tissue in the oral cavity (tonsils, palate, tongue, nasopharynx). As a result, the lumen of the airways expands, the volume of circulating air increases. The operation is performed under general anesthesia; CPAP is required for quick rehabilitation.
- Correction of the upper or lower jaw. It is indicated for the abnormal structure of facial bones.
- Plastic surgery of the nose, elimination of defects of the nasal septum (septoplasty).
- Linguoplatics, median glossectomy ─ reduction in the size of the back of the tongue using a laser.
- Installation of palatal implants. The device serves as a skeleton for soft tissues, tightens them.
- The advancement of the hyoid bone and its fixation. The epiglottis and tongue are attached to this bone. After the manipulation, the retraction of the tongue into the throat is eliminated.
- Osteotomy (sawing) of the upper and lower jaw, followed by their advance.
The operation is performed in an emergency when the patient’s breathing is completely closed and a high risk of death is created. An incision is made with a scalpel in the neck. Then, with the help of an expander, the tracheal muscle rings are opened and a plastic or metal tube is inserted through which oxygen is supplied to the lungs.
The operation of the tracheostomy is considered as a temporary measure, until the mechanical obstruction of the airways is eliminated.
CPAP or CPAP therapy is a method of using airflow to treat night obstructive and mixed apnea. Artificial ventilation is the supply of air under a given positive pressure. Medical equipment helps not to suffocate when falling asleep. Using CPAP, you can both cure the disease and reduce the severity of advanced form of snoring.
The device for a night sleep with apnea is a compressor that continuously pumps air. The flow of oxygen is directed through a bendable plastic tube. Through the nose, through a special mask (sealed), airflow enters the respiratory tract. This prevents the larynx from closing. There is an opportunity to fully sleep until the morning.
Thanks to sleep therapy, hypoxia is eliminated, the amount of oxygen and carbon dioxide in the blood is leveled, sleep is normalized. In the morning, a person feels rested, healthy, and the severity and pain in the head go away.
Specialist to visit
After the scientists understood the seriousness of the mechanisms of sleep disturbance, a separate science was formed ─ somnology. The doctor treating snoring, respiratory arrest at night, is called a somnologist. The specialist considers the problem from the side of otolaryngology, pulmonology, neurology, makes a final diagnosis.
At the initial visit to the clinic, the person is sent for a consultation with a therapist. It is this doctor who collects an anamnesis, conducts an examination, prescribes tests, diagnostic methods for night apnea. After all research, a decision is made and the appropriateness of referral to a somnologist.
With timely, adequate therapy, the disease passes without negative consequences, the prognosis is favorable. If the disease is not treated, such night apnea leads to long-term complications:
- hypertension, causing the development of a stroke,
- acute cerebrovascular accident,
- different forms of heart failure,
- angina pectoris, myocardial infarction,
- sexual dysfunction
- disability, up to disability status.
To prevent the development of the disease, people prone to apnea should monitor their weight. Strong recommendation ─ quitting smoking, minimizing the use of alcohol. It is important to make regular cardio loads ─ daily walking in the fresh air, cycling, and swimming in the pool.
Inflammatory processes of the nasopharynx and lower respiratory tract should be treated in a timely manner, and the transition to the chronic stage should not be allowed. Screening regularly to detect diseases of the thyroid gland, heart, blood vessels.
Studying the causes and mechanisms of night breathing disorders, scientists came to the conclusion that this is a common disease, the severity of which is underestimated. Multiple apnea without treatment causes severe complications, significantly reducing life expectancy (survival rate of not more than 5 years).