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OBSTRUCTIVE SLEEP APNEA
SYNDROME

Sleep apnea are intermittent interruptions of breathing, whether from the nose or the mouth, in the subject who is sleeping. Almost all of us do small apneas during sleep but in most cases they are not hemodynamically significant and do not induce medical problems. When this stop lasts for more than 10 seconds, they are considered important. Their duration can be up to 3 minutes. I invite you to check out the attached YouTube video to see how dangerous it is.

If these breaks are less than 5 per hour we will say that the subject is normal. More than 5 per hour we will talk about a mild Obstructive Apnea Syndrome (OAS).

 

N°OF APNEE CLASSIFICATION
5-15 / hour SAO mild
15-30 / hour SAO moderate
>30 / hour SAO severe

The result of this interruption of ventilation, whether partial or complete, induces a decrease in the values of oxygen (O2), an increase in the values of carbon dioxide (CO2). At these values the body reacts with a decrease in heartbeat (bradycardia, risk of sudden death) and a decrease in blood pressure. After a few seconds these same values activate the central receptors that impose the restoration of breathing, first trying to free the airways through the activation of the abdominals, then finally with a sigh or snoring. Inevitably, the patient will then have micro-awakenings that will undermine the quality and architecture of his sleep. While the non-resting of the cardiovascular system, it induces an increased risk of stroke, heart attack, arterial hypertension and pomonaris.

night apneas Dr Viola Zulian
The apneas are divided into:
  • Central apnea: when the nerve impulse to the respiratory muscles disappears. There may be defects in the neuromuscular control of the breath, with a chronic alveolar hypoventilation. The result is similar to the obstructive event but its cause is very different.
  • Obstructive apneas: when the airflow ceases to occlude the oropharyngeal airways. Asphyxia is determined by the establishment of a critical atmospheric pressure that impairs the ability of the dilator muscle (especially the genioglossus) of the airways to maintain the patency. The slowed and ineffective response of these muscles is greater if unfavorable factors such as alcohol and tranquilizers (bezondiazepine) interact.

FACTEURS PREDISPOSANTS

  • Age – between 40 and 65 (even during childhood)
  • Sex, males are twice as involved with females (4% and 2% respectively)
  • BMI, more frequent in overweight subjects in whom excess fat induces collapse of the airways
  • Anatomical abnormalities of the airways (malformations of the soft palate, enlargement of the adenoids can bloc your airway)
  • Chemical agents such as alcohol, tobacco or drugs such as benzodiazepines
  • Familiarity
DIAGNOSIS Dr Viola Zulian
FACTEURS PREDISPOSANTS Dr Viola Zulian

DIAGNOSIS

As we said at the beginning, it is a syndrome and to be defined as such, the SAO must include at least two of the following criteria:

  • Excessive daytime sleepiness (for evaluation see Epworth scale)
  • loud snoring
  • Fatigue in the morning
  • Morning Headaches
  • Nycturia (get up to pee> 2 episodes per night)
  • Decreased libido
  • Irritability, mood disorders such as depression or irritability
  • Memory problems (amnesia)
  • Cognitive and growth delay (child)

These symptoms must be associated with Home sleep apnea testing (polygraphy), a record of sleep and parameters: oxygenation, heartbeat, respiratory movements, nocturnal awakenings, snoring, position in which one sleeps, respiratory flow. When polygraphy highlights several complete (apneas) or partial (hypoapneal) respiratory stops that last more than 10 seconds and are associated with desaturation and / or microrecaps, we will say that the diagnosis is positive.

Therapies Dr Viola Zulian

Therapies

SLEEP HYGIENE MEASURES

  • Weight reduction -exercise regularly
  • Correction of the supine position through devices that prevent the patient from getting on the back; maintaining the lateral position
  • Abstention from alcohol, sedatives and hypnotics -quit smoking
Sleep Dr Viola Zulian
CPAP TREATMENT (continuous positive airway pressure)
A nasal mask supports positive pressures so that the airways do not collapse. To demonstrate its effectiveness, it must be worn at least 6 hours per night. It is an effective treatment that can be limited to a certain period (until the patient loses weight) or last all life long.
In the case of non-tolerance, psychological help must be established through cognitive-behavioral therapies to increase patient adhesion. CPAP is indicated with an IAH> 30 / h or an IAH between 15 -30 / h in the presence of cardiac disease or pneumopathy.

MOUTHPIECE (ORAL DEVICE)
It allows the increase of orofarngeus space and therefore prevents the collapse of the muscles keeping the throat open. The prosthesis compliment is very subjective but many patients who do not tolerate PPC well bear the device better. It is an alternative for some people with mild or moderate obstructive sleep apnea.

UVULOPALATOPHARYNGOPLASTIY
Surgical treatment of the airways if there is a mechanical obstacle like removing tissue from the back and the top of your throat.

TRACHEOSTOMY
In severe cases without any other beneficial treatment.