Apnea definition. What is sleep apnea? Description of the symptoms and causes of the dangerous syndrome. Treating sleep apnea with a doctor

Sleep Apnea - Symptoms and Treatment

What is sleep apnea? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of Dr. Bormin S. O., a somnologist with an experience of 5 years.

Definition of disease. Causes of the disease

sleep apnea- suspension of breathing during sleep, which leads to a complete absence or decrease in pulmonary ventilation (more than 90% in relation to the initial air flow) lasting from 10 seconds. There are two types of respiratory failure: obstructive and central. Their significant difference lies in the respiratory movements: they occur in the obstructive type and are absent in the central one. The latter type of apnea is a rare case of the disease. Therefore, obstructive sleep apnea as a common type of sleep apnea is subject to more detailed consideration.

Obstructive sleep apnea syndrome(hereinafter OSAS) - a condition characterized by:

• snore,
• intermittent obstruction (collapse) of the airways at the level of the oropharynx
• lack of ventilation of the lungs with saved respiratory movements
• decrease in oxygen levels in the blood
• gross violations of the structure of sleep and excessive daytime sleepiness.

The prevalence of this disease is high and, according to various sources, ranges from 9 to 22% among the adult population.

The cause of this disease, as the name suggests, is airway obstruction. It leads to various pathologies of the ENT organs (more often hypertrophy of the tonsils, in children - adenoids), as well as a decrease in muscle tone, including due to an increase in mass (adipose tissue is deposited in the walls of the airways, narrowing the lumen and lowering the tone of smooth muscles) .

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

One of the most common and noticeable symptoms is snoring. Its prevalence in the adult population is 14–84%. Many people think that people who snore do not suffer from OSAS, so snoring is not dangerous to health and is only an irritant for the second half and a social factor. However, this is not quite true. Most patients with snoring have respiratory disorders of varying severity, and such a sound phenomenon can act as an independent pathological factor due to vibrational trauma to the soft tissues of the pharynx. Most often, the symptoms of OSAS are noted by relatives who, with horror, fix a sharp cessation of snoring and respiratory arrest, while the person makes attempts to breathe, and then he begins to snore loudly, sometimes tossing and turning, moving his arms or legs, and after a while breathing is restored again. With a severe degree, the patient may not breathe for half the time of sleep, and sometimes more. Apneas can also be recorded by the patient himself. In this case, a person can wake up from a feeling of lack of air, suffocation. But most often, awakening does not occur, and the person continues to sleep with intermittent breathing. In cases where a person sleeps alone in a room, this symptom may go unnoticed for a very long time. However, like snoring.

Other, equally serious symptoms of this disease include:

• severe daytime sleepiness with sufficient sleep time;
• feeling of weakness, fatigue after sleep;
• frequent nocturnal urination (sometimes up to 10 times a night).

Often, symptoms such as daytime sleepiness and unrefreshing sleep are underestimated by patients, believing that they are absolutely healthy. In many ways, this complicates the diagnosis and leads to a false interpretation of symptoms. Also, many people associate frequent nighttime urination with urological problems (cystitis, prostate adenoma, etc.), are repeatedly examined by urologists and do not find any pathology. And this is correct, because with severe breathing disorders during sleep, frequent nighttime urination is a direct consequence of the pathological process due to the impact on the production of natriuretic peptide.

sleep apnea pathogenesis

The resulting collapse of the airways leads to a cessation of the flow of air into the lungs. As a result, the concentration of oxygen in the blood drops, which leads to a short activation of the brain (micro-awakenings, repeated many times, the patient does not remember them in the morning). After that, the tone of the muscles of the pharynx increases for a short time, the lumen expands, and an inhalation occurs, accompanied by vibration (snoring). Constant vibration injury to the walls of the pharynx provokes a further drop in tone. This is why snoring should not be regarded as a harmless symptom.

The constant decrease in oxygen leads to certain hormonal changes that change carbohydrate and fat metabolism. With severe changes, type 2 diabetes mellitus and obesity can gradually develop, and weight loss without eliminating the underlying cause is often impossible, but normalization of breathing can lead to significant weight loss without strict diets and exhausting exercises. Repeatedly repeated micro-awakenings do not allow the patient to plunge into the stage of deep sleep, thereby causing daytime sleepiness, morning headaches, and a persistent increase in blood pressure, especially in the early hours of the morning and immediately after waking up.

Classification and stages of development of sleep apnea

Obstructive sleep apnea has three levels of severity. The criterion for division is the apnea-hypopnea index (hereinafter AHI) - the number of respiratory stops during one hour of sleep (for polysomnography) or per hour of the study (for respiratory polygraphy). The higher this indicator, the more severe the disease.

With moderate severity, there is a risk of metabolic disorders and cardiovascular complications, and with severe, this risk increases many times over.

Complications of sleep apnea

With untimely diagnosis and lack of treatment, the disease progresses, and as a result, complications develop, sometimes irreversible. Influencing a wide range of metabolic processes, this pathology naturally leads to an increase in body weight. One of the main pathological factors is low oxygen content.

To date, the relationship between sleep apnea and cardiovascular disease is clear. In a long-term study, a significant increase in cardiovascular risk and consequences (for example, arterial hypertension) with impaired breathing has been proven.

Along with this, OSAS can lead to heart attacks and strokes over time, which are often fatal. In addition, apnea is one of the causes of resistance (resistance) to antihypertensive therapy (pressure reduction). And therefore, it is generally accepted that people with consistently high blood pressure numbers against the background of adequate antihypertensive therapy need to exclude sleep apnea.

Sleep Apnea Diagnosis

Numerous scales and questionnaires are used as a screening method for verifying respiratory disorders, but the Berlin questionnaire is the most common. According to recent studies, it is the most specific, especially when combined with computerized pulse oximetry. All diagnostic devices are divided into 4 classes.

Complete polysomnography (grade 1) is the "golden method" in modern medicine. This is a study that allows you to evaluate the function of the body at night by recording parameters:

• electroencephalograms;
• eye movements;
• electromyograms;
• electrocardiograms;
• breath flow;
• respiratory movements;
• movements of the lower extremities;
• body position;
• blood oxygen saturation.

All sensors are securely attached with hypoallergenic materials to the patient's body. In addition, a video recording of all movements of the patient is carried out. All data is transmitted to the recording station, where an experienced technologist evaluates the parameters and, if necessary, corrects the position of the sensors. The study is carried out in the most comfortable conditions: a separate ward isolated from external noise with a suitable temperature and humidity, a comfortable bed with the ability to choose a pillow suitable for a particular patient. There is also the possibility of placing an accompanying person, which is important for the smallest patients. All this is done in order to minimize external influences on the patient's sleep.

The study begins in the evening, 1-2 hours before the usual time for the patient to fall asleep. Installation of all necessary sensors takes from 30 to 60 minutes. The patient spends the night in the department, and in the morning, after removing the sensors, he goes home. Decryption usually takes about 2-3 days.

Polysomnography can be performed on small children (almost from birth), and elderly people, and pregnant women. There are no contraindications to this type of diagnosis. However, the procedure should be postponed if there is an acute respiratory viral infection, exacerbation of chronic diseases.

This study allows you to determine the characteristics of sleep, its structure, motor and respiratory disorders, the relationship of various parameters and stages of sleep. Also, polysomnography allows you to accurately determine whether the existing pathology (insomnia, daytime sleepiness and other symptoms) is primary, or whether it is caused by other causes.

What are the symptoms of a polysomnographic study?

• regular snoring (more than 3-4 nights per week);
• respiratory stops recorded by the patient and his relatives;
• severe drowsiness during the day;
• unrefreshing sleep;
• frequent urination at night;
• awakening from a feeling of suffocation, lack of oxygen;
• discomfort in the legs or arms when falling asleep, regular movements of the limbs in a dream;
• gnashing of teeth, sleepwalking;
• violations of heart rate and conduction of the heart, observed mainly at night;
• increased blood pressure in the early morning hours and immediately after waking up, poorly amenable to drug therapy;
• sleep disturbances in other somatic pathologies (stroke, chronic heart failure, obesity, type II diabetes mellitus, etc.);
• previous OSAS therapy (to monitor effectiveness).

Based on the results of a polysomnographic study, it is possible to accurately determine the severity of OSA and will allow choosing the appropriate method of treatment.

Sleep Apnea Treatment

OSAS therapy is aimed at restoring oxygen levels, eliminating snoring, increasing vigor during the day, reducing respiratory arrest and normalizing sleep. In the modern world, there is a wide range of therapeutic measures, including surgical and conservative treatment, as well as lifestyle modification (weight loss, first of all, etc.). Before starting treatment, it is necessary to conduct a full diagnosis to determine the severity of OSA.

Timely treatment leads to a significant reduction in clinical symptoms, and most importantly, to the prevention of disease progression.

Surgical methods include ENT interventions (uvulopalatoplasty, etc.) and orthognathic operations. Uvulopalatoplasty is effective for uncomplicated snoring (isolated, extremely rare) and for OSAS of mild, less often moderate severity. It should be performed after a thorough follow-up examination (polysomnography, sleependoscopy). In severe OSAS, ENT surgery is contraindicated due to low efficiency and sometimes aggravation of the condition.

Operations on the upper and lower jaw (orthognathic) can be used for any severity of the disease. They are quite effective, but the preparation for them is very long (about a year), and the operation itself is very time-consuming. This method can be used when the patient refuses CPAP therapy.

As an alternative to orthognathia, intraoral devices are used. Their goal, like the methods of surgical treatment, is to expand the airways at the level of obstruction. Abroad, there is a method of electrical stimulation of the hypoglossal nerve, which has proven its effectiveness for any severity of the disease, but it is very expensive, and is not currently available in Russia.

Nevertheless, the main method of treatment today is non-invasive ventilation with constant positive pressure (CPAP therapy). The essence of this therapy is to create an air flow that prevents the collapse of the airways. At the beginning of therapy, a trial course is carried out to select the operating mode of the device, to educate the patient. After that, the patient uses the device already at home on their own and only at night. This method is recommended for patients with moderate to severe OSAS and has virtually no contraindications. In addition to its main goal - the elimination of respiratory arrests - using this method, it is possible to significantly reduce weight, reduce the number of antihypertensive drugs in resistant arterial hypertension.

Forecast. Prevention

With timely initiation of treatment, the prognosis of the disease is favorable. Preventive measures include:

• adherence to the rules of a healthy lifestyle to prevent obesity;
• regular physical activity;
• throat muscle training (playing wind musical instruments, vocal lessons, various exercises).

But the main way to prevent serious consequences is timely diagnosis and treatment.

Apnea syndrome (ICD-10 code) is characterized by a systematic and short (about 8-10 seconds) cessation of breathing during sleep. The condition is dangerous, because with frequent attacks, the body begins to experience oxygen starvation, which negatively affects the general state of health. But the paradox is that the person himself may not even suspect that he has this problem. It is possible to identify such violations of the respiratory system only by undergoing polysomnography (a study during which various physiological states of the body are studied during sleep).

Origin mechanism

Apnea is always a consequence of the development of other pulmonary pathologies, which are characterized by respiratory arrest for 8 or more seconds. But even such short breaks are dangerous, as they provoke the development of:

• Hypoxia (characterized by a lack of oxygen in the body);
• Hypercapnia (accumulation of carbon dioxide in the blood).

These conditions stimulate various structures of the brain, as a result of which the patient often wakes up at night and the act of breathing is restored. However, after the sleep phase begins, the apnea episodes resume. Upon awakening, lung function returns to normal. And so in one night the patient can wake up very often, which accordingly negatively affects his general condition - restless sleep provokes increased irritability and fatigue, reduced efficiency and concentration.

Important! It is difficult to say exactly how many such episodes occur in one night. Depending on the severity of the violation of the respiratory system, the patient can experience from 4 to 90 attacks per night, and if we take into account the fact that on average a person sleeps 8-9 hours a day, with such disorders during sleep, breathing stops for a total of 2-3 hours.

Sleep apnea syndrome provokes physiological losses. The more often such episodes occur, the higher the risk of developing negative consequences. Long pauses in breathing disrupt the process of oxygen entering the body, while carbon dioxide ceases to be removed from it, from which the work of the brain suffers in the first place.

As long-term medical practice shows, sleep apnea is more often detected in men than in women. Moreover, in the first case, the reason for this is often obesity and alcohol consumption, in the second - hormonal disorders in the body associated with the onset of menopause or pregnancy. It should be noted that the older a person becomes, the higher the risk of developing this condition. And if it has already been detected in a patient, then the likelihood of an increase in the duration of respiratory arrest increases significantly.

There is another condition that is very often confused with sleep apnea. This is hypnoea. It is characterized by disorders of the respiratory system, which are also mainly manifested at night. The only difference is that during hypnea, the process of air entering the body is not interrupted. However, the patient has seizures, in which there is a decrease in the respiratory flow (in other words, the number of breaths and exhalations decreases), which also provokes the development of hypoxia.

Important! There is also such a thing as physiological apnea, which is often recorded in perfectly healthy people. But in this case, episodes of respiratory arrest are observed rarely and no more than 5 times per night. Such a condition is not considered a pathology and belongs to the category of a norm that does not threaten human health.

Varieties and causes

Sleep apnea can be caused by a variety of factors. And it is on them that the form of the disease depends. So, for example, in medicine, only 3 varieties of this syndrome are distinguished:

• Central;
• obstructive;
• Mixed.

Central apnea develops against the background of a violation of the passage of nerve impulses. Normally, they should go to the muscles, and with the development of this disease, they are involved in the diaphragm. In other words, the body receives a command to compress the lungs, but there are no commands to straighten them. Therefore, breathing stops.

The development of central apnea can be provoked by the following factors:

• CNS disorders;
• Damage to nerve endings, for example, during trauma or surgery;
• Organic lesions of the brain.

In children, the development of apnea most often occurs against the background of primary insufficiency of the respiratory center, which, as a rule, is detected even at birth. As for adults, in this case, the pathology often occurs as a result of organic lesions of the brain (trauma, tumors, edema, etc.).

In most cases, sleep apnea is a consequence of Pickwick's syndrome, which is characterized by heart failure, overweight, and daytime sleepiness. If a child suffers from apnea, then the development of this disease can also be suspected in him by the presence of severe snoring during sleep, involuntary body movements at night, urinary incontinence, increased irritability, tearfulness, developmental delay from peers.

Complications

Apnea can cause the following complications:

• metabolic disorder;
• Obesity;
• Disorders of the sexual sphere (men have problems with potency, women have signs of frigidity);
• Arrhythmia;
• angina;
• Heart failure;
• Asthma;
• Obstructive bronchitis;
• Hypertension;
• Cardiac ischemia;
• Atherosclerosis.

Diagnostics

Symptoms that occur against the background of the development of apnea are also characteristic of other diseases. And since it is not always possible to catch the moments of cessation of breathing during sleep, the main method for diagnosing the disease is somography. However, before giving a referral for an examination, the patient needs a preliminary consultation of narrow specialists, as well as to do:

• ECG;
• Ultrasound of internal organs;
• MRI of the brain.

In addition, you will need to pass a set of standard laboratory tests (OAM, UAC, a blood test to determine the level of hemoglobin, etc.). Only after receiving all the data on the patient's condition and confirming the diagnosis with somography, the doctor will be able to prescribe the appropriate treatment for him.

Therapeutic activities

Apnea treatment directly depends on the cause of its occurrence, the age and general condition of the patient. It can be carried out in several ways - conservative and surgical.

In the event that a person has been diagnosed with a mild form of apnea, treatment can even occur without the use of strong drugs and surgical interventions. To do this, you just need to follow some recommendations:

• During sleep, take the correct position of the body - it can be located anywhere, but not on the back, but the head should rise 15 cm above the level of the body;
• The use of vasoconstrictor drugs;
• The use of special devices that provide expansion of the airways during sleep;
• Prohibition of alcoholic beverages and smoking.

In the treatment of apnea, mechanical ventilation gives a good result. With its help, air pressure in the respiratory tract is maintained. However, such devices cannot be used at home. They are used only for inpatient treatment.

In addition, patients are recommended to undergo complex therapy for otolaryngological diseases. For this purpose, various medications are prescribed and, if necessary, surgical interventions are performed (the deviated nasal septum is corrected, neoplasms are removed, etc.).

In other words, it is impossible to say exactly how to cure apnea until the true cause of its occurrence is established. Each case is individual and requires a specific approach. Therefore, if you also experience symptoms of this disease, you should definitely visit a doctor. Only he will be able to establish the true cause of apnea and prescribe the correct treatment.

Sleep apnea is episodes of holding your breath at night, during sleep, the duration of which is at least 10 seconds. In this condition, more than 50 episodes of breath holding can be recorded per night. The patient has severe snoring, restless sleep and a general loss of working capacity. The disease is diagnosed by polysomnography. The causes that caused the pathology are determined during a thorough examination of the ENT organs. In the treatment of this pathology, special devices, medicines and surgical intervention are used, which is necessary to completely eliminate the cause. Oxygen therapy helps a lot.

General characteristics of the disease

Sleep apnea is a severe violation of respiratory function, which is accompanied by regular stops in breathing during a night's sleep. In addition to nocturnal cases, breath holding for this pathology is characterized by significant snoring and abnormal drowsiness during the day. Temporary holding of breath during a night's sleep is considered a very dangerous condition for people, which is accompanied by various disorders of important organs. With sleep apnea syndrome, cardiac activity is severely disturbed.

Repeated respiratory arrests lead to significant oxygen starvation and an increase in the overall level of carbon dioxide in the blood. This stimulates the brain cells and as a result leads to regular awakenings and a sharp restoration of breathing. When a person falls asleep again, he again has a period of cessation of breathing, and he wakes up again. If the patient's condition is too severe, then there can be more than 50 such cessations of breathing in an hour. About 3 hours of time can run during the night when a person does not breathe at all. In humans, sleep apnea disrupts the entire physiology of sleep. Rest becomes incomplete, intermittent and uncomfortable.

Women often suffer from a similar syndrome during menopause. Hypnoea is sometimes diagnosed. This condition is characterized by a decrease in respiratory function by 30% in 10 seconds. compared to the physiological state. Absolutely healthy people may have episodes of respiratory arrest during sleep, but lasting no more than 10 seconds. Normally, such breath holdings should not be more than 5 in one hour. If this condition is not accompanied by other symptoms. That it is considered to be a variant of the norm, this condition does not threaten health at all.

The treatment of this disease is carried out by a group of specialists from different specialties. Not only an otolaryngologist is connected to the consultation, but also a pulmonologist, a somnologist and even a neuropathologist.

According to medical statistics, about 4% of men and 2% of women suffer from sleep apnea. Remarkably, with age, the risk of pathological pauses in breathing during sleep increases.

Reasons for stopping breathing during sleep

Sleep apnea syndrome can occur due to trauma and compression of some parts of the brain. Various diseases in which brain cells are affected can also lead to a similar syndrome.

In children, sleep apnea often leads to primary insufficiency of a special respiratory center, which ultimately leads to oxygen starvation. Babies have bluish skin and short episodes of holding their breath during sleep. Pulmonary or cardiac pathologies in this case are most often not observed.

Sleep apnea is often diagnosed in people who are overweight, have endocrine diseases, or are subject to regular stress. Some structural features of the respiratory organs also lead to the appearance of an obstructive syndrome. The cause is excessively narrowed nasal passages, too enlarged soft palate, as well as large tonsils or uvula. People with a short and rather dense neck are prone to this pathology. An important role in the development of pathology is played by heredity.

There are two groups of main causes that lead to obstructive sleep apnea syndrome:

• Partial obstruction of the airways - usually such an anomaly occurs at the level of the nasopharynx. This condition is directly related to the structural features of the respiratory organs or to some chronic pathologies. Often sleep apnea occurs in people with obesity, with a severe curvature of the nasal septum, chronic runny nose and in the presence of polypous growths in the nose.
• Violations in the respiratory center of the brain. In a sleepy state, people cannot independently control the process of breathing, so this function is completely transferred to the nervous system. During sleep apnea, parts of the brain lose the ability to control breathing, and due to this, oxygen starvation is observed.

The mechanism of development of pathology is very complex. Sleep apnea develops due to collapse during sound sleep. The airway at the level of the pharynx subsides during each breath hold, resulting in severe hypoxia. In this state, signals are sent to the brain that you need to wake up. Upon awakening, respiratory function is fully restored

Only a doctor can correctly determine the cause of apnea, but for this a person must undergo a series of examinations.

Classification of pathology

Temporary cessation of breathing during sleep doctors divide into three forms:

1. Central. It occurs as a result of a strong violation of special mechanisms in the brain or with severe insufficiency of the respiratory center. With this form of the disease in a dream, impulses from the brain cease to flow to the muscles of the respiratory organs.
2. Obstructive. Occurs when some parts of the respiratory organs collapse. At the same time, normal respiratory function from the side of the central nervous system is completely preserved.
3. Mixed. With this form of the disease, symptoms of the central and obstructive forms of the disease are observed.

The severity of sleep apnea is determined based on the number of cases of holding your breath in one night.

• Less than 5 cases of breath holding per hour - the value of the norm, the diagnosis of apnea is not made.
• From 5 to 15 cases of respiratory arrest - a mild degree of the course of the disease.
• From 15 to 30 episodes of temporary respiratory arrest - moderate severity.
• More than 30 cases of breath holding indicate a severe pathology.

The mixed form of the disease is considered the most severe and difficult to treat. In this case, two causes must be eliminated simultaneously.

If the exact causes of sleep apnea are not identified and eliminated, then any treatment will be useless.

Treatment

Very often, people do not even realize that they suffer from sleep apnea syndrome. They learn about cases of respiratory arrest in a dream from those who sleep next to them at night. The main symptoms of sleep apnea are:

• Restless and often interrupted sleep accompanied by loud snoring.
• At times, a person's breathing stops. There can be many such episodes during the night.
• In a dream, a person is overly active. The patient often has nightmares, he jumps and runs in dreams.
• Abnormal sleepiness during the day.
• Decreased performance and impaired concentration.
• Irritability and inexplicable fatigue during the day.
• Memory deterioration.

After some time, in adults and children with impaired breathing during sleep, body weight is added and sexual dysfunction appears. Regular respiratory arrests negatively affect the function of the heart, contributing to the development of arrhythmias, angina pectoris and severe heart failure. Many patients have serious chronic pathologies such as high blood pressure, coronary artery disease, bronchial asthma and COPD. In the presence of such chronic diseases, a person's condition worsens greatly.

In children, sleep apnea syndrome can be indicated by mouth breathing during the daytime, as well as urinary incontinence both at night and during the day. Adults should be alerted by severe sweating at night, as well as the slowness and lethargy of the child during the day. A sick child often sleeps in some unnatural positions and snores heavily.

Sleep apnea is often associated with Pickwick's disease. This is a pathology that combines a violation of the heart, excess weight and atypical daytime sleepiness.

Diagnostics

When making a diagnosis, it is important not only to examine the patient, but also to listen to relatives who can confirm or refute the fact of holding their breath during sleep. To diagnose apnea, a special diagnostic method is used, in which a relative of the patient detects time periods during which breathing stops.

When examining such patients, the doctor often notes the second degree of obesity. At the same time, the circumference of the neck in women is almost always more than 40 cm, and in men it is more than 43 cm. Blood pressure is almost always elevated in patients of both sexes.

If apnea is suspected, the patient is sent for a consultation with an otolaryngologist. During the examination, violations in the work of ENT organs are often detected. A runny nose, sinusitis, chronic tonsillitis, as well as a pronounced curvature of the nasal septum can be diagnosed.

The most reliable diagnostic method is polysomnography. When analyzing the data obtained as a result of such an examination, not only the number and total duration of breath holding are revealed, but all changes that take place in the body during this time are accurately determined.

A patient with suspected apnea is examined diversified to rule out other pathologies.

Treatment

Treatment for sleep apnea includes medication, surgery, and physiotherapy. If the degree of apnea is mild, then to eliminate this symptom, it is enough for the patient to sleep with a raised upper body. It is enough to lift the pillows only 20 cm from their normal position. In addition, the treatment of mild degrees of the disease includes the following activities:

• A person should not sleep on their back. It is optimal if the patient with sleep apnea sleeps on his side. Sleeping on your stomach is also not very preferable.
• At night, a couple of drops of vasoconstrictor drops should be instilled into the nose to normalize breathing through the nose.
• Several times a day, the patient should gargle with warm water with the addition of essential oils. If there is an allergy, then it is better to gargle with a solution of soda or salt.
• The patient needs to exercise and normalize nutrition. This is essential for weight loss.
• It is unacceptable to take sleeping pills at night or drink alcohol in the evening.

To treat sleep apnea, your doctor may recommend various devices. Jaw clamps or specific tongue holders help to cope with the problem. All these devices are designed to maintain a normal airway lumen.

CPAP mask ventilation may be used. This method helps to maintain stable positive pressure in the airways. Due to this treatment, breathing during sleep is stabilized and the general well-being of people with sleep apnea improves. This method of treatment is now considered the most effective.

Sometimes patients are prescribed Theophylline, but this drug does not always lead to the expected result, especially with obstructive sleep apnea. With the central form of the disease, treatment with Acetazolamide gives a good result.

Surgical intervention is resorted to if the violation of breathing is associated with anomalies in the structure of the respiratory organs. In certain cases, removal of tonsils, adenoids and correction of the shape of the nasal septum help the patient to completely recover from sleep apnea.

In the most severe cases, when other methods of treatment do not help, pharyngoplasty and tracheostomy are indicated.

Complications

Sleep apnea can significantly impair the quality of life of any person. Regardless of age. Due to sleep disturbance, a person suffers from drowsiness during the day. As a result, reduced performance, impaired coordination and attention. All this can lead to injuries both at work and at home.

Sleep apnea patients almost always have high blood pressure, which greatly increases the risk of strokes and heart attacks. During the period of holding the breath, the work of the heart is very disrupted, which can eventually lead to the development of chronic diseases.

Experts believe that sleep apnea is a common cause of strokes in young people. Sleep apnea significantly worsens the condition of people with chronic pathologies of the lower respiratory organs. It is very difficult for people with bronchial asthma to endure the disease. P After a short pause in breathing, they almost always have an excruciating asthmatic attack.

Don't expect sleep apnea to go away on its own. This life-threatening condition needs to be treated. Particular attention should be paid to children with a similar syndrome.

Cases of respiratory arrest in young children at night are very dangerous, as they can quickly lead to the sudden death of the baby.

Sleep apnea is a life-threatening condition that can lead to both the development of serious pathologies and death. To begin with, the doctor must determine the cause of such an anomaly, and only after that select the optimal treatment. If this condition is associated with a violation of the structure of the respiratory organs, then surgery may be necessary.

Sleep apnea is a condition in which during sleep, the respiratory function stops for some reason, which reduces the supply of oxygen to the brain, after which the person partially wakes up. During awakening, muscle tone is restored and breathing normalizes. A similar syndrome can be repeated up to 10 - 15 times per hour, and sometimes every minute. Sleep apnea is usually accompanied by heavy snoring and a series of deep breaths.

By themselves, frequent respiratory arrests do not carry a mortal danger, which cannot be said about the processes that they “start”. The consequences of this condition, if breathing stops last more than 10 seconds, are very serious due to hypoxia, or lack of oxygen.

Consequences of the syndrome

Metabolism is disturbed, which, in turn, leads to the development of diabetes, high blood pressure, and mental disorders.

According to the latest scientific data, it is sleep apnea that today is one of the main triggers for the development of cardiovascular diseases.

Obstructive sleep apnea is one of the most common causes of car accidents.

The life of people suffering from frequent respiratory arrests is reduced by an average of fifteen years - this is the most important thing!

Main causes of sleep apnea

There are several causes of sleep apnea, and they vary depending on the type of sleep apnea. Central sleep apnea is associated with a malfunction of the brain center responsible for respiratory function. In such cases, holding the breath is due to the fact that the body does not understand when it should breathe.

The causes of obstructive sleep apnea sometimes lie in the narrowing of the upper respiratory tract and are often combined with disorders of the temporomandibular joint. According to the literature, 75% of patients with TMJ problems have temporary breath holdings, and vice versa - most people suffering from this disease have disorders in the TMJ, and most do not even suspect that it is breath holding that causes them to feel unwell.

Obstructive sleep apnea syndrome

Apnea symptoms

In children, the symptoms of sleep apnea are manifested through attention deficit hyperactivity disorder, as well as in the form of urination disorders. But snoring and holding your breath, contrary to popular belief, are not always associated with each other. Not every snorer suffers from breath holding, and vice versa - not all people with sleep apnea snore. The main symptoms of sleep apnea in adults are as follows:

• irritability;
• memory impairment;
• constant feeling of tiredness;
• chronic sleep deprivation.

Are snoring and apnea related?

Snoring and sleep apnea, contrary to popular belief, are not always related. Not every snorer suffers from breath holding, and vice versa - not all people with sleep apnea snore.

How is the disease diagnosed?

Diagnostics is carried out in three stages. The first is an examination by a dentist or a somnologist, who identifies the primary signs of the disease and, if necessary, directs the patient for further examination. Next, a special test is carried out, the results of which allow you to more accurately diagnose the presence of breath holdings. However, the final diagnosis is made only on the basis of a polysomnographic study, in which the patient, being under the supervision of a doctor, falls asleep for some time. In some cases, x-rays are also required to detect the disease.

Which doctor to contact with sleep apnea cannot be unequivocally answered. Different specialists should deal with the treatment, depending on the severity of the disease and the causes of its occurrence: dentists, ENT specialists, somnologists, pulmonologists, cardiologists and endocrinologists. Each of them plays an important role in the treatment process. The dentist sees the patient more often than other doctors, therefore, he notices the changes caused by the disease earlier than others, and can prevent its further development. The somnologist makes the final diagnosis. An endocrinologist and a cardiologist treat patients with complex clinical cases. Of course, along with their main specialization, doctors must undergo special training.

Sleep Apnea Treatment

The decision on how to treat sleep apnea is made by the doctor based on an assessment of the clinical situation. If the cause of the disease lies in inflammation of the tonsils or the appearance of adenoids, they must be removed, if overweight - lose weight, if in heart disease - contact a cardiologist, if in excessive overhanging of the tongue of the soft palate - visit a surgeon. In the case when the disease is a consequence of dysfunction of the temporomandibular joint, and this is quite common, the patient is sent to the orthodontist to correct the bite. About the treatment of sleep apnea with folk remedies at home is out of the question.

CPap machines

In the treatment of sleep apnea, there is a generally accepted standard that prescribes the use of a CPAP device (from the English. Constant Positive Airway Pressure), which provides artificial ventilation of the lungs during sleep. But very few patients agree to sleep with tubes in their noses. The only alternative to the CPAP machine for the treatment of sleep apnea is a special intraoral mouthguard, which was invented by a dentist. It should be noted that a mouthguard or sipap device alone will not relieve you of sleep apnea syndrome, they should be used in combination with the main treatment.

Statistics show that about 60 - 65% of patients use a similar mouth guard, while 2 to 14% use the CPAP device, and mostly these are people with severe forms of respiratory dysfunction!

Sleep apnea is a pathological condition that is manifested by breathing disorders that suddenly occur during sleep. Apnea episodes can last from a few seconds to several minutes, which negatively affects all internal organs, and especially the central nervous system.

Sleep apnea is a common pathology that occurs in at least 6% of the adult population. The incidence increases with age.

Airway occlusion in sleep apnea

Causes and risk factors

The most common cause of sleep apnea is obstruction of the airways, that is, mechanical blockage of their lumen (obstructive sleep apnea). During sleep, muscle tissue relaxes, the walls of the pharynx begin to sag inward. At the same time, they not only interfere with breathing, but also vibrate under the influence of an air stream, which we perceive as snoring. However, if the walls of the pharynx sag sufficiently, they will block the lumen of the respiratory tract, resulting in respiratory arrest.

Against the background of apnea in the blood, the partial pressure of carbon dioxide, which irritates the respiratory center, sharply increases. As a result, the brain “wakes up” and gives the command to increase muscle tone. These processes are repeated many times during sleep.

In severe obstructive sleep apnea during the day, a person is often subjected to bouts of irresistible drowsiness. At such moments, patients suddenly fall asleep and wake up after a short period of time.

Predisposing factors for obstructive sleep apnea include:

• elderly age;
• smoking;
• chronic inflammatory processes in the oropharynx;
• anomalies in the structure of the facial skeleton;
• obesity.

Another cause of sleep apnea is a violation of the regulation of the central nervous system of respiratory movements. Under the influence of certain reasons during sleep, the brain stops sending nerve impulses to the respiratory muscles, which leads to respiratory arrest. This pathology can lead to:

• stroke;
• hypoglycemia;
• epilepsy;
• water and electrolyte disturbances;
• prematurity in a child;
• some medicines;
• cardiac arrhythmia;
• hyperbilirubinemia;
• septic conditions;
• severe anemia.

Forms of the disease

Based on the underlying cause of the pathological mechanism, there are:

• obstructive sleep apnea;
• central sleep apnea.

Depending on the number of episodes of respiratory arrest in 1 hour (apnea index), obstructive sleep apnea is:

• mild (5–15 apneas);
• moderate (16–30 apneas);
• severe (over 30 apneas).

Sleep apnea is a common pathology that occurs in at least 6% of the adult population. The incidence increases with age.

Symptoms

The main symptom of any form of sleep apnea is recurring episodes of sudden pauses in breathing during sleep. However, each form of the disease has its own characteristics.

Obstructive sleep apnea is characterized by:

• strong snoring;
• episodes of sudden cessation of snoring and breathing lasting from 10 seconds to 3 minutes;
• restoration of breathing, which is accompanied by a characteristic noise or snoring.

With prolonged apnea, hypoxia develops. Then the cyanosis of the nasolabial triangle becomes noticeable. During episodes of apnea, the patient tries to inhale by tensing the muscles of the abdomen and chest.

With obstructive sleep apnea syndrome, patients often wake up unrested in the morning, feel overwhelmed during the day, experience drowsiness, apathy, and lethargy. Decreased work capacity.

In severe obstructive sleep apnea during the day, a person is often subjected to bouts of irresistible drowsiness. At such moments, patients suddenly fall asleep and wake up after a short period of time (from a few seconds to a few minutes). These sudden sleep apnea are very dangerous, especially if they occur while driving or doing other activities that require concentration and responsiveness. Moreover, the patients themselves do not notice their "outages".

Central sleep apnea is manifested by the occurrence of Cheyne-Stokes type of breathing during sleep. This type of breathing is characterized by periodicity: from slow and very superficial breathing movements gradually intensify, become noisy, deep, frequent, and then the intensity of breathing fades again, until it stops for a short time. As a result, with central sleep apnea, the patient breathes intermittently and noisily. Snoring is not observed in all cases. The main distinguishing feature of central apnea in comparison with obstructive apnea is the absence of respiratory movements of the chest and anterior abdominal wall during episodes of respiratory arrest.

Diagnostics

Sleep apnea is suspected if at least three of the following are present:

• episodes of respiratory arrest during sleep;
• Loud snoring;
• frequent urination at night;
• restless night sleep;
• increased sweating during sleep;
• asthma attacks during sleep;
• headaches in the morning;
• constant feeling of tiredness, daytime sleepiness;
• increased blood pressure, especially in the morning and at night;
• decreased libido;
• overweight.

The gold standard for diagnosing sleep apnea is polysomnography. This is a non-invasive study, during which, with the help of special sensors, the physiological parameters of night sleep are recorded:

• position of the body in a dream;
• snoring sound phenomenon;
• oxygen saturation of the blood (saturation);
• features of chest and abdominal breathing;
• features of nasal breathing.

During this study, the following are also carried out:

• electrocardiography;
• electromyography;
• electrooculography;
• electroencephalography.

The most common cause of sleep apnea is obstruction of the airways, that is, mechanical blockage of their lumen (obstructive sleep apnea).

Computerized pulse oximetry can be used to screen for sleep apnea. To carry it out, a special nozzle is put on the patient’s finger, and a bracelet is put on the wrist. During a night's sleep, the device determines the pulse rate and the oxygen content in the blood (saturation).

Treatment

Therapy for mild obstructive sleep apnea includes the following activities:

• normalization of body weight, if it is above the norm;
• treatment, including surgery, of diseases of the upper respiratory tract;
• the use of intraoral devices that allow maintaining the lower jaw in the correct position and preventing retraction of the tongue;
• positional sleep apnea therapy - the head end of the bed is raised by 15 °;
• the use of devices that do not allow the patient to sleep on his back, that is, in a position that increases the intensity of snoring and the frequency of respiratory arrest;
• stopping the use of tranquilizers, muscle relaxants and hypnotics;
• performing breathing exercises;
• observance of the daily routine.

For moderate and especially severe obstructive sleep apnea syndrome, the only effective treatment is CPAP therapy. This is a hardware technique based on the creation and maintenance of a constant positive pressure in the airways.

Treatment of central sleep apnea is the use of drugs that stimulate the respiratory center of the brain. With their ineffectiveness, a long course of CPAP therapy is carried out.

During CPAP therapy, sleep apnea stops; most patients notice a significant improvement from the first night.

Possible complications and consequences

Sleep apnea syndrome can provoke the development of dangerous diseases:

• arterial hypertension;
• type 2 diabetes;
• brain stroke;
• ischemic heart disease;
• myocardial infarction;
• cardiovascular insufficiency;
• atrial fibrillation;
• immunodeficiency state;
• obesity.

Sleep apnea and snoring bring a lot of discomfort to life, which leads to psycho-emotional problems, including in the family.

Sleep apnea is dangerous for pregnant women. Its consequences may be:

• arterial hypertension;
• fetal hypoxia;
• gestational diabetes;
• preeclampsia (late toxicosis of pregnancy);
• premature birth.

Forecast

During CPAP therapy, sleep apnea stops; most patients notice a significant improvement from the first night. Patients need psychological support, since the treatment takes a long time, sometimes for life, and sleep with a CPAP machine is not always comfortable and aesthetic.

Prevention

Sleep apnea prevention includes:

• maintaining a normal body weight;
• quitting smoking and drinking alcohol;
• sports;
• timely treatment of diseases of the upper respiratory tract;
• compliance with the daily routine;
• refusal of long-term use of sleeping pills.

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