Sleep apnea , also spelled sleep apnea , is a sleep disorder characterized by stopping breathing or a shallow breathing period during sleep. Each pause can last for a few seconds to several minutes and occur multiple times overnight. In its most common form, this follows a loud snoring. There may be a choking or grunting sound as the breath returns. When disturbances interfere with normal sleep, those affected may experience drowsiness or feel tired during the day. In children it can cause problems at school, or hyperactive.
There are three forms of sleep apnea: obstructive (OSA), central (CSA), and a combination of both are called mixtures. OSA is the most common form. Risk factors for OSA include being overweight, family history of the condition, allergies, small airways, and enlarged tonsils. In OSA, respiration is disrupted by airflow obstruction, while in CSA breathing stops due to lack of effort to breathe. People with sleep apnea may not realize they have it. In many cases, this is first observed by family members. Sleep apnea is often diagnosed with overnight sleep studies. For the diagnosis of sleep apnea, more than five episodes per hour should occur.
Treatment may include lifestyle changes, mouthpiece, breathing apparatus, and surgery. Lifestyle changes may include avoiding alcohol, losing weight, quitting smoking, and sleeping on one side. Respiratory equipment including the use of CPAP machines. Without treatment, sleep apnea can increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle crashes.
OSA affects 1 to 6% of adults and 2% of children. It affects men about twice as often as women. While people of any age can be affected, it happens most commonly among those aged 55 to 60 years. Central sleep apnea affects less than 1% of people. This type of central sleep apnea is depicted in the German myth of the curse of Ondine in which the sleeping person will forget to breathe.
Video Sleep apnea
Signs and symptoms
People with sleep apnea have problems with excessive daytime sleepiness (EDS), vigilance disorders, and vision problems. OSA can increase the risk of workplace accidents and accidents. If OSA is not treated, people are at risk of other health problems, such as diabetes. Death can occur from untreated OSA due to lack of oxygen to the body. In addition, people are examined using a "standard test battery" to further identify parts of the brain that may be affected by sleep apnea, including those that govern:
- "executive function", how people plan and start task
- pay attention, work effectively and process information when in a conscious state
- using memory and learning.
Due to disturbances in daytime cognitive conditions, behavioral effects may be present. This can include moodiness, hatred, and decreased attention and energy. These effects can be difficult to solve, leading to depression.
There is evidence that the risk of diabetes among those with moderate or severe sleep apnea is higher. There is increasing evidence that sleep apnea can cause liver dysfunction, especially fatty liver disease (see steatosis). Finally, since there are many factors that can cause some of the effects mentioned earlier, some people do not realize that they are experiencing sleep apnea and misdiagnosed or ignore the symptoms altogether.
Maps Sleep apnea
Risk factors
Sleep apnea can affect people regardless of gender, race, or age. However, risk factors include:
- to be male
- excess weight
- age above 40
- large neck size (larger than 16-17 inches)
- tonsil or tongue enlargement
- small jaw bone
- gastroesophageal reflux
- allergies
- sinus problem
- family history of sleep apnea
- septum deviation
Alcohol, sedatives and sedatives can also increase sleep apnea by relaxing the throat muscles. Smokers experience sleep apnea threefold from people who never smoked.
Central sleep apnea is more commonly associated with one of the following risk factors:
- to be male
- age above 65
- have cardiac abnormalities such as atrial fibrillation or atrial septal defects such as PFO
- strokes
High blood pressure is very common in people with sleep apnea.
Mechanism
When breathing is stopped, carbon dioxide is formed in the bloodstream. Chemoreceptors in the blood stream record high levels of carbon dioxide. Brain gesture to wake up people who sleep and breathe in the air. Breathe normally will restore oxygen levels and the person will fall asleep again.
Diagnosis
Sleep apnea can be diagnosed by evaluation of symptoms, risk factors and observation, (eg excessive daytime sleepiness and fatigue) but the gold standard for diagnosis is a formal sleep study (polysomnography, or sometimes a reduced home-based test channel). A study can establish a reliable index of disorders, derived from the number and type of hourly sleep events (Apnea Hypopnea Index (AHI), or Risk Factors for Respiratory Disorders (RDI)), related to the formal threshold, over which the patient is considered to be suffering from sleep apnea, and the severity of their sleep apnea can be quantified. OSA Light (Obstructive Sleep Apneas) range from 5 to 14.9 events per hour, OSA is decreasing in the range of 15-29.9 events per hour, and severe OSA is a patient who has more than 30 events per hour.
Regardless of this medical consensus, apnea events (eg, hypopnea vs apnea, central vs. obstructive), patient physiology variability, and inherent deficiencies and variability of equipment and methods, this field is debatable. In this context, the definition of an event depends on several factors (eg, patient age) and takes into account this variability through multi-criteria decision rules described in some, sometimes contradictory, guidelines. One example of a commonly used apnea definition (for adults) includes a interval of at least 10 seconds between breaths, with neurologic stimulation (3 second or greater shift in EEG frequency, measured at C3, C4, O1, or O2) or blood oxygen desaturation 3-4% or greater, or both passion and desaturation.
Oximetry
Oximetry, which can be done for one or more nights at one's home, is a simpler, but less reliable alternative to polysomnography. This test is recommended only when requested by a doctor and should not be used to test them without symptoms. Home oximetry may be effective in guiding the recipe for positive positive airway pressure that automatically adjusts automatically.
Classification
There are three types of sleep apnea. OSA accounted for 84%, CSA for 0.4%, and 15% of cases were mixed.
Obstructive sleep apnea
Obstructive sleep apnea (OSA) is the most common category of irregular sleep disorders. Muscle tone is usually relaxed during sleep, and at the throat level, the human airway consists of a folded wall of soft tissue that can block the breathing. Sleep apnea occasionally, as many people experience during upper respiratory tract infections, may be insignificant, but severe chronic obstructive sleep apnea requires treatment to prevent low blood oxygen (hypoxemia), lack of sleep, and other complications.
Individuals with low-tone muscles and soft tissues around the airways (eg, due to obesity) and structural features that give rise to narrow airway are at high risk for obstructive sleep apnea. Parents are more likely to have OSA than young people. Men are more likely to suffer from sleep apnea than women and children, though not uncommon in the last two population groups.
OSA risk increases with increasing weight, active smoking and age. In addition, patients with diabetes or "borderline" diabetes have up to three times the risk of having OSA.
Common symptoms include loud snoring, restless sleep, and daytime sleepiness. Diagnostic tests include home oximetry or polysomnography in sleep clinics.
Some treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, and quitting smoking. Many people benefit from sleeping at a height of 30 degrees from the upper body or higher, as if in a recliner. Doing so helps prevent the collapse of the airway's gravity. The lateral position (sleeping on the side), as opposed to the supine position (sleeping behind), is also recommended as a treatment for sleep apnea, largely because the gravitational component is smaller in the lateral position. Some people benefit from various types of oral equipment such as Mandibula's splint progress to keep the airway open during sleep. Continuous positive airway pressure (CPAP) is the most effective treatment for severe obstructive sleep apnea, but oral equipment is considered to be the first-line approach similar to CPAP for mild to moderate sleep apnea, according to AASM treatment parameters. There are also surgical procedures to lift and tighten the tissues and widen the airway.
Snoring is a common finding in people with this syndrome. Snoring is the sound of turbulent air moving through the back of the mouth, nose, and throat. Although not everyone who snores has trouble breathing, snoring in combination with other risk factors has been found to be highly predictive of OSA. However, the loudness of snoring does not indicate the severity of the obstruction. If the upper airway is highly blocked, there may not be enough air movement to make a lot of noise. Even the loudest snoring does not mean that a person has sleep apnea syndrome. The most suggestive sign of sleep apnea occurs when purring stops .
Other indicators include (but are not limited to): hypersomnolen, obesity BMI & gt; 30, large neck circumference (16 in (410 mm) in women, 17 in (430 mm) in men), enlarged tonsils and large tongue volume, micrognathia, morning headaches, irritation/mood/depression, learning difficulties and/or memory, and sexual dysfunction.
The term "sleep breathing disorder" is commonly used in the US to describe a variety of breathing problems during sleep where insufficient air reaches the lungs (hypopnea and apnea). Irregular breathing is associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmia, diabetes, and sleep-driving accidents. When high blood pressure is caused by OSA, it is typical in that, unlike most cases of high blood pressure (called essential hypertension), the reading does not drop significantly when the individual is sleeping. Stroke is associated with obstructive sleep apnea.
It has been disclosed that people with OSA exhibit tissue loss in areas of the brain that help store memory, thus connecting OSA with memory loss. Using magnetic resonance imaging (MRI), scientists found that people with sleep apnea have a mammary body that is about 20 percent smaller, especially on the left side. One of the key researchers hypothesized that repeated decrease in oxygen causes brain injury.
Sleep sleep apnea
In pure central sleep apnea or Cheyne-Stokes respiration, the respiratory control center in the brain is unbalanced during sleep. The levels of carbon dioxide in the blood, and the neurological feedback mechanisms that monitor them, do not react quickly enough to maintain a flat rate of breathing, with the entire cycling system between apnea and hyperpnea, even during awake. Sleeper stops breathing and then starts again. No effort was made to breathe during the respiratory pause: there was no chest movement and no one was struggling. After episodes of apnea, breathing may be faster (hyperpnea) for a period of time, a compensatory mechanism to remove exhaust and absorb more oxygen.
During sleep, a normal individual "rests" as far as the cardiovascular workload is concerned. Breathing regularly in healthy people during sleep, and the levels of oxygen and carbon dioxide levels in the bloodstream remain constant. Any sudden drop of oxygen or excess carbon dioxide (though small) strongly stimulates the respiratory center of the brain to breathe.
In sleep sleep apnea, basic neurological controls for respiratory and respiratory failure fail to provide a signal for inhalation, causing the individual to miss one or more respiratory cycles. If the respiratory break is long enough, the percentage of oxygen in the circulation will drop to a lower than normal level (hypoxemia) and the concentration of carbon dioxide will build to a higher than normal level (hypercapnia). In turn, hypoxia and hypercapnia conditions will trigger extra effects on the body. Brain cells need constant oxygen for life, and if blood oxygen levels are low enough for long enough, the consequences of brain damage and even death will occur. However, central sleep apnea is more commonly a chronic condition that causes far lighter effects than sudden death. The exact effect of this condition will depend on how severe the apnea and on the individual characteristics of the person experiencing apnea. Some examples are discussed below, and more about the nature of these conditions are presented in the section on Clinical Details.
In each person, hypoxia and hypercapnia have certain common effects on the body. The heart rate will increase, unless there is such severe problems with the heart muscle itself or the autonomic nervous system that makes this increase in compensation impossible. A more transparent area of ​​the body will show the bluish or blackish casts of cyanosis, which is the color change that occurs due to lack of oxygen in the blood ("blue"). Overdose of drugs that are respiratory depressants (such as heroin, and other opiates) kill by dampening the activity of brain respiratory control centers. In sleep sleep apnea, the effects of sleep alone can remove the brain's mandate for the body to breathe.
- Normal Respiratory Breathing: After respiration, the level of oxygen in the blood decreases and carbon dioxide increases. Gas exchange with fresh air lungs is needed to fill in oxygen and cleanse the carbon dioxide blood stream that is formed. Oxygen and carbon dioxide receptors in the bloodstream (called chemoreceptors) send nerve impulses to the brain, which then indicate the opening of the larynx reflex (thus opening between the vocal cords enlarged) and the movement of the ribs and diaphragm muscles. These muscles expand the thorax so that a partial vacuum is created inside the lungs and inlet air to fill it.
- The physiological effects of central apnea: During central apnea, central respiratory movements do not exist, and the brain does not respond to changes in blood levels of respiratory gas. No breath is taken even if the normal signal is inhaled. The immediate effect of central sleep apnea on the body depends on how long the failure to breathe last. At worst, central sleep apnea can cause sudden death. Short of death, blood oxygen droplets can trigger seizures, even without epilepsy. In people with epilepsy, hypoxia caused by apnea can trigger seizures that have been previously well controlled by drugs. In other words, seizure disorders can become unstable in the presence of sleep apnea. In adults with coronary artery disease, a severe decrease in blood oxygen levels can lead to angina, arrhythmia, or heart attack (myocardial infarction). Recurrent long episodes of apnea, for months and years, can cause an increase in carbon dioxide levels which can alter the blood pH sufficiently to cause respiratory acidosis.
Mixed apnea
Some people with sleep apnea have a combination of both; the prevalence ranges from 0.56% to 18%. This condition is generally detected when obstructive sleep apnea is treated with CPAP and central sleep apnea appears. The exact mechanism of the central breathing drive loss during sleep at OSA is unknown but most likely related to the wrong arrangement of CPAP care and other medical conditions that the person has.
Management
The treatment of obstructive sleep apnea is different from that of central sleep apnea. Treatment often begins with behavioral therapy. Many people are told to avoid alcohol, sleeping pills, and other sedatives, which can relax the throat muscles, contributing to the collapse of the airways at night.
Continuous positive air pressure
For moderate to severe sleep apnea, the most common treatment is the use of continuous positive airway pressure (CPAP) or automatic positive air pressure apparatus (APAP). This splint of a person's airway is open during sleep through pressurized air. People usually wear a plastic face mask, which is connected with a flexible tube to a small bedside CPAP machine.
With proper usage, CPAP improves results. Whether or not it reduces the risk of death or controversial heart disease with some reviews finding benefits and others not. These variations across the study may be driven by low levels of adherence - those analyzes using CPAP for at least four hours overnight showed decreased cardiovascular events. Evidence suggests that CPAP can increase sensitivity to insulin, blood pressure, and drowsiness. Long-term fulfillment, however, is a problem with more than half of people not using the device appropriately.
Although CPAP therapy effectively reduces apnea and is cheaper than other treatments, some people feel uncomfortable. Some complain of being trapped, feeling uncomfortable in the chest, and skin irritation or nose. Other side effects may include dry mouth, dry nose, nosebleeds, sore lips and gums.
Weight
Excessive weight is considered an important cause of sleep apnea. In a weight-loss study of obese and overweight people, those who lost weight showed a reduction in apnea frequency and an increase in the Apnea-Hypopnoea (AHI) Index compared with controls.
Surgery
Some surgical procedures (sleep operations) are used to treat sleep apnea, although it is usually the third treatment for those who refuse or are not assisted by CPAP care or dental equipment. Surgical treatment for obstructive sleep apnea needs to be done individually to address all areas of obstructive anatomy.
Nasal obstruction
Often, correction of the nasal passage needs to be done in addition to the correction of the oropharynx. Septoplasty and turbinate surgery can improve the nasal airway.
Pharyngeal obstruction
Tonsillectomy and uvulopalatopharyngoplasty (UPPP or UP3) are available to treat pharyngeal obstruction.
The "Pillar" device is a treatment for snoring and obstructive sleep apnea; it's a thin, narrow strip of polyester. Three strips are inserted into the roof of the mouth (soft palate) using a modified syringe and local anesthesia, to strengthen the soft palate. This procedure discusses one of the most common causes of snoring and sleep apnea - the vibration or collapse of the soft palate. It was approved by the FDA for snoring in 2002 and for obstructive sleep apnea in 2004. A meta-analysis 2013 found that "Pillar implants have a moderate effect on snoring and mild to moderate obstructive sleep apnea" and that more studies with evidence levels height is required to arrive at a definite conclusion; it also found that polyester strips worked out of the soft palate in about 10% of the people where they were implanted.
Hypopharyngeal or basic tongue obstruction
Increasing the base of the tongue by promoting the mandibular genital tuberculum, tongue suspension, or hyoid suspension (aka myotomy hyoid and suspension or hyoid development) may help with lower pharynx.
Other surgical options may try to shrink or tighten excess tissue in the mouth or throat; procedures performed at the doctor's office or hospital. Small photographs or other treatments, sometimes in series, are used for shrinkage, while the insertion of a small piece of rigid plastic is used in the case of operations whose purpose is to strengthen the network.
Multi-level operations
Maxillomandibular advancement (MMA) is considered the most effective surgery for people with sleep apnea, as it increases the posterior airway space (PAS). However, health professionals are often unsure of who should be referred for surgery and when to do so: several factors in the referral may include use of CPAP or use of failed devices; a better anatomy than inhibiting surgery; or significant craniofacial abnormalities that impede use of the device.
Potential complications
Some inpatient and outpatient procedures use sedation. Many drugs and agents used during surgery to relieve pain and to suppress consciousness remain in the body in low numbers for hours or even days afterwards. In individuals with central, obstructive or mixed sleep apnea, these low doses may be sufficient to cause life-threatening irregularities when breathing or collapse in the patient's airways. The use of analgesics and sedatives in these postoperative patients should be minimized or avoided.
Surgery of the mouth and throat, as well as dental surgery and procedures, can cause postoperative swelling of the mouth and other areas affecting the airways. Even when surgical procedures are designed to improve airway, such as tonsillectomy and adenoidectomy or tongue reduction, swelling can negate some effects in the immediate postoperative period. After the swelling heals and the palate becomes tightened by postoperative scarring, however, the full benefits of surgery may be noted.
A person with sleep apnea undergoing any medical treatment should ensure that the anesthesiologist and anesthetist are informed of sleep apnea. Alternative and emergency procedures may be needed to maintain the patient's airway for sleep apnea.
More
Neurostimulation
The diaphragm pacemaker, which involves the application of rhythmic electrical impulses to the diaphragm, has been used to treat central sleep apnea.
In April 2014, the US Food and Drug Administration gave pre-market approval for the use of the upper airway stimulation system in people who could not use a continuous positive air pressure tool. The Inspire Upper Airway Stimulation system feels respiration and applies light electric stimulation during inspiration, which pushes the tongue slightly forward to open the airway.
Drugs
There is limited evidence for the drug but acetazolamide "can be considered" for the treatment of central sleep apnea; it also found that zolpidem and triazolam may be considered for the treatment of central sleep apnea, but "only if the patient does not have an underlying risk factor for respiratory depression". Low-dose oxygen is also used as a treatment for hypoxia but is not recommended because of side effects.
Verbal devices
The oral device, often referred to as the splint of the progress of the mandible, is a specially made funnel that shifts the lower jaw forward and opens a slight bite, opening the airway. This device can be made by a general dentist. Oral appliance therapy (OAT) is usually successful in patients with mild to moderate obstructive sleep apnea. While CPAP is more effective for sleep apnea than oral equipment, oral equipment improves sleepiness and quality of life and is often more tolerable than CPAP.
Nasal EPAP
Nasal EPAP is a tool such as a bandage placed over the nostrils that utilize one's breathing to create positive air pressure to prevent blocked breathing.
Oral pressure therapy
Oral pressure therapy uses a tool that creates a vacuum inside the mouth, pulling the soft tissues of the ceiling forward. It has been found useful in about 25 to 37% of people.
Epidemiology
The Wisconsin Sleep Cohort Study estimates in 1993 that roughly one out of every 15 Americans is affected by at least moderate sleep apnea. It is estimated that in middle age, as many as nine percent of women and 24 percent of men are affected, undiagnosed and untreated.
Untreated apnea sleep costs more than health problems. It is estimated that in the US, the average treatment of untreated sleep apnea patients costs $ 1,336 more than individuals without sleep apnea. This could lead to $ 3.4 billion/year in additional medical costs. Whether medical cost savings occur with sleep apnea treatment remains to be determined.
History
The clinical picture of this condition has long been known as a character, without understanding the disease process. The term "Pickwickian syndrome" sometimes used for the syndrome was created by a famous early 20th-century physician, William Osler, who must have been a reader of Charles Dickens. Description Joe, the "fat boy" in Dickens' novel The Pickwick Papers, is an accurate clinical picture of an adult with obstructive sleep apnea syndrome.
Initial reports of obstructive sleep apnea in medical literature describe very seriously affected individuals, often with severe hypoxemia, hypercapnia and congestive heart failure.
The management of obstructive sleep apnea is enhanced by the introduction of continuous positive air pressure (CPAP), first described in 1981 by Colin Sullivan and colleagues in Sydney, Australia. The first model was large and noisy, but the design improved greatly and in the late 1980s CPAP was widely adopted. The availability of effective treatments stimulates aggressive search for affected individuals and leads to the formation of hundreds of specialized clinics dedicated to the diagnosis and treatment of sleep disorders. Although many types of sleep problems are recognized, most patients who attend these centers experience sleep breathing disorders. The day of sleep apnea awareness was April 18 in recognition of Colin Sullivan.
See also
- Hypoventilation syndrome of obesity
- Congenital central hypoventilation syndrome
References
External links
Source of the article : Wikipedia
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