Apnea is a characteristic pause in breathing during the sleep period, which is characterized by the absence or significant decrease in air flow for less than ten seconds at the level of the oral cavity and nose. Temporary respiratory arrest is a certain process of reduced oronasal flow of air or amplitude of respiratory movements by thirty percent, in contrast to the initial thoracoabdominal movements within 10 seconds, at which oxygen saturation decreases by four percent. Many respiratory episodes last from 10 to 30 seconds, but sometimes it can last more than a minute.
There are several types of apnea: obstructive, central and mixed. For obstructive sleep apnea, closure of the upper respiratory tract at the time of inspiration is characteristic, when the oronasal flow disappears and the respiratory effort is maintained.
Apnea of a central character arises with a lack of respiratory stimuli, and simultaneously there are no oronasal flow and respiratory movements. With a mixed type, a combination of obstructive and central forms of non-respiration is noted, and today is a special case of obvusive apnea. The episodes of the latter are completed by activation. In this case, a transient sleep state occurs with short-term cerebral activity during the waking period, but basically this is not a complete behavioral awakening.
This pathological condition is considered the most common and occurs in any age group. But, as a rule, on the basis of various surveys, we can conclude that almost 5% of people suffer from apnea from thirty to sixty years. In this case, the probability of formation of a temporary respiratory arrest proportionately increases with respect to body weight and age.
In addition, obstructive sleep apnea in males in middle age is three times more common than in the female half. For a long time it was assumed that the onset of apnea is directly affected by the excess weight of middle-aged men. But in recent decades, it has been shown that obstructive sleep apnea is more common in older people than in young people. In addition, for the older age group, an insignificant role is assigned to sex, age, and body weight, accompanied by a minimal symptomatic picture, for the development of apnea.
As a rule, there are many causes of apnea. For the main reason, one can refer to the process of a significant narrowing or complete decrease in the lumen of the upper respiratory tract at the pharyngeal level. At the time of contraction of the breath, the soft palate, which is in a free hanging position, begins to vibrate frequently enough in the duct where the air passes and thus snoring appears. The first place among the factors that affect the development of apnea, is obesity of the second degree and the third. As a rule, patients from this predisposing group seek qualified help already in very severe forms of apnea, although the weight is gaining a long time. But alcohol and potent sleeping pills, which have the effect of muscle relaxant nature on the central nervous system, cause pauses in the process of breathing in the form of long and frequent stops.
Depending on the origin of the cause of formation, apnea can be anatomical and functional. To the anatomical causes of apnea are those that provoke an organic physical narrowing of the lumen. This is, first of all, obesity and the formation of fatty deposits around the pharynx in the form of adenoids, which are considered a significant pathology of childhood. At this point, oxygen starvation is noted in connection with snoring and a minor stopping of breathing in a dream, which can lead to the problem of growth, formation and disruption of the child's intellectual development.
Congenital pathology of the pharynx and nose structure is among the etiological factors of apnea development. These include the congenital narrowing of the lumen of the pharynx and nasal passages; palatal tongue with some elongation and thickening; a small, backward-shifted lower jaw having a malocclusion (retrognathia, micrognathia).
Among the acquired reasons, there are the presence of a curved nasal septum, puffiness of the mucosa against the background of allergic rhinitis, and an expanding lower nasal concha. In addition, even sleep itself leads to relaxation of the respiratory muscles and then apnea occurs. Against the backdrop of the onset of menopause or when the thyroid gland is broken, apnea also appears as a result of the lack or lack of certain hormones that affect the muscle tone of the soft palate. Sometimes sleep apnea occurs even among the younger generation, who do not have all of the above abnormalities, so that a temporary stop of breathing can be alcohol before going to bed and smoked cigarettes.
In addition, as a result of insomnia, the hypnotics taken, which have a muscle relaxant effect, can cause a decrease in the muscle tone of the pharynx, and this causes apnea.
Apnea is a syndrome of obstructive respiratory arrest during sleep, which is characterized by a multitude of symptoms. After awakening caused by stopping breathing, that is, apnea syndrome, a person restlessly moves his arms and legs. This is due to lack of oxygen and during the fast phase of sleep, which leads to increased sleepiness during the day, mood swings, memory loss and depression . Very often people with the apnea syndrome are given the wrong diagnosis - insomnia. Also, often sleep apnea develops almost asymptomatically, so the increased fatigue of patients is mistakenly considered a sign of aging.
Patients, in the presence of nocturnal apnea, complain of lack of vivacity after sleep, they have morning fatigue and weakness after the night. At the same time, they constantly feel tired and sleepy throughout the day. In addition, such patients are able to fall asleep during a break at work and driving a car. In the morning, there is pain in the head, which recurs in the daytime on the back of the neck and neck. Most patients with apnea are very irritable, they have a lability of emotional character, memory decreases. Also in such patients there is muscle ache, that is , restless legs syndrome ; decreased sexual desire and develops a weakness of sexual nature.
Typical symptoms of nocturnal complaints are: a strong reproduction of snoring with increased motor activity during sleep and bruxism, talking in a dream, episodes of nocturnal awakenings, and sometimes there is enuresis. It is important to remember that snoring with apnea is characterized by periodicity and after silent periods, the silent phases of apnea occur.
When researching an objective character, hypertension of unexplained etiology is found. It is believed that a reduced oxygen content in tissues and organs causes stimulation of the chemoreceptors of arteries and veins, causing an exciting effect of neurons and enhancing the vasoconstrictor effect of nerves on arterioles and arteries.
Night apnea often occurs accompanied by heart rhythm disturbances. In this case, 95% of patients develop sinus arrhythmia, 35% have sinus bradycardia , and 25% have atrioventricular and sinoauric blockade.
Signs of tachycardia, ventricular and supraventricular extrasystole are more often observed in elderly people with pathological heart diseases. Many patients with a history of nocturnal apnea develop a stroke, a heart attack , and sometimes a sudden death. With the development of pulmonary hypertension while listening to the heart, an accent of the second tone on the LA is revealed.
Since many patients with the diagnosis of apnea suffer from excessive body weight, they detect Pickwick's syndrome in the form of daytime hypoxemia and hypercapnia, arterial hypertension, polycythemia, pulmonary heart, hypotholeamic obesity. With an increase in the neck in volume, there is a risk of formation of SSA (sleep apnea syndrome).
To diagnose apnea at night, the Rovinsky method is used.
Apnea in a dream
This pathological condition is called respiratory arrest. As a rule, it is not dangerous if you yourself hold your breath if necessary. For example, an untrained person can not breathe for almost forty seconds. But sleep apnea is an unconscious cessation of breathing. On average, it can last up to thirty seconds, and sometimes reach three minutes. In many patients, such a stop of breathing is 10-15 times during one hour of sleep. A re-emerging symptoms of sleep apnea, cause already a syndrome of this condition.
In sleep, apnea can be of a central type, in which the brain during this period does not send signals to the muscles of respiration for a while, therefore they are inactive, and breathing stops at the same time.
Obstructive type of sleep apnea develops at the moment when the brain receives a signal, and the airflow is interrupted by the narrowed lumen of the airway.
With a mixed type, the central apnea occurs at the beginning, which translates into obstructive apnea.
The patients with sleep apnea sleep very badly, they get a pain in the head in the morning, they lose their ability to work, they constantly feel tired, their attention and memory worsen, they want to sleep during the day, they are irritable, the sexual desire is reduced, impotence develops. This is all noted during the waking period, and in sleep apnea is manifested by strong snoring, nocturnal enuresis, nocturia, bruxism, sleep talk, heavy legs, tingling, and sometimes pain, somnambulism and hypnagogic hallucinations.
Apnea in a dream can cause a heart attack, stroke, heart rhythm disorder and sudden death.
In the risk factor are people older than sixty years. This is due to the fact that with age, the elasticity of the soft tissues of the pharynx is gradually lost. In addition, men stop breathing, and in women, sleep apnea usually appears during menopause. Typically, this is due to the level of progesterone. One of the reasons for the development of sleep apnea is obesity (70%), since the muscles involved in breathing, as well as those involved in the process of breathing itself, and the muscles of the mouth and pharynx are covered by the fat layer, and this leads to functional disruption of the lungs. Thus, respiratory failure develops, and episodic sleep apnea not only increases in sleep, but also becomes longer, which makes the syndrome on a background of excess weight heavier.
Disorders in the endocrine system with acromegaly , hypothyroidism , alcohol abuse, tranquilizers, hypnotics and sedatives, various deformities, as well as pathologies of the oral cavity, pharynx and nose cause sleep apnea.
This pathological condition can be determined on the basis of a patient's questionnaire, and also by conducting a complex polysomnographic study that includes pulse oximetry, oxycapnography, impedance plethysmography, pneumotachography, electrocardiography, electromyography, electrooculography, and electroencephalography.
The danger of sleep apnea is the formation of hypoxia. At the same time, the air flow ceases to flow, and oxygen becomes inadequate in the blood, and the person who has just snored ceases, then begins to become blue. As a result, the patient constantly wakes up, and this disturbs the homogeneity of sleep, that is, during the deep sleep phase, relaxation of the musculature is noted, blood pressure is lowered and certain hormones are produced. A frequent waking up does not allow the body to fall asleep deeply and recover overnight.
In addition, there is a suggestion that the resulting hypoxia, pressure fluctuations within the chest that occur during sleep apnea, awakening or the superficial phase of sleep cause a significant activation of the sympathetic part of the nervous system, vasospasm and increased blood pressure.
For the treatment of sleep apnea in sleep, the use of hypnotics, sedatives, and alcohol and food intake before bedtime is abolished, and if necessary, reduce excess weight. A good result is shown by the method using the apparatus of constant positive airway pressure. This method is easily practiced at home, although it does not cure patients of apnea, but restores sleep and refers to the prevention of complications of this condition. If necessary, this device is used by patients every night.
When anatomical defects of the pharynx and nose are resorted to a surgical method of treatment.
Obstructive sleep apnea
Obstructive sleep apnea or respiratory arrest during sleep is formed during a sudden snoring of snoring with a frightening breath stop, after which a person has a loud snoring, he starts to turn and then breathes again. Sometimes obstructive sleep apnea can occur up to 350 times in one night, and such disturbances cause deterioration in the patient's sleep quality. Therefore, a sleepy person complains of the occurrence of headaches, constant drowsiness, his attention, memory, potency in men is reduced, and also irritability arises.
People with obstructive sleep apnea do not remember how they wake up at night. This pathological condition is considered the most common disorder that develops when the soft tissues of the posterior pharynx fall off and close the airways, as a result of which air can not enter the lungs. This all happens because of the relaxation of the pharyngeal muscles.
Obstructive apnea is a certain episode characterized by a lack of air flow for more than ten seconds. The narrowed upper respiratory tract in a dream provokes the development of obstructive apnea. Sometimes the blocking of the breathing process is incomplete, therefore obstructive hypopnea develops, and this leads to continuous, slow and shallow breathing.
Obstructive apnea reduces the oxygen content in the blood, and this causes a lack of it in the lungs. At the same time, the patient may be choking with signs of a snorting sound. This pathological condition is characterized by five or more episodes of apnea in one hour of sleep of the patient with significant drowsiness during the day.
The appearance of obstructive sleep apnea is affected by some characteristics of the neck, skull and face. For example, with a wide neck, the risk of obstructive sleep apnea increases. Also, various abnormalities of the skull and face in the form of micrognatia, retrognathia, narrow upper jaw, enlarged tongue, tonsils and palate can contribute to the formation of obstructive apnea.
But the weakness of the muscles that surround the way of breathing, or their pathology, sometimes exacerbate obstructive sleep apnea.
The risk factors for this pathological condition include sex, age, genetic predisposition, obesity, alcohol abuse, smoking. Typically, this condition is more common in men, but the risk of sleep apnea increases in women during menopause. In addition, it is formed mainly in adults from forty to sixty years old, but can occur even in newborns. But obesity is the main predisposing factor in the formation of this pathology. This is due to the filling of the tissues of the throat with fat deposits.
There are also some diseases that can trigger the development of obstructive sleep apnea. These include: diabetes mellitus , gastroesophageal reflux disease and polycystic ovary.
The symptoms of obstructive sleep apnea are composed of daytime drowsiness, headaches in the morning, irritability, disturbed psycho-emotional functioning and snoring. This, as a rule, arises as a consequence of an interrupted night's sleep. Moreover, snoring occurs mainly as a result of suffocation or shortness of breath in the position on the back. In addition, it often causes the awakening of the patient during the night sleep.
Symptoms of this syndrome can not always be noticed, therefore additional diagnostic methods, such as polysomnography or split-night polysomnography, are used to confirm the diagnosis.
Apnea in children
In children, the sudden stopping of breathing in the sleep period, which is sudden in time, is called apnea syndrome. The movements of the breath at this point stop for ten seconds. In the case of a mild form of the pathological process, respiration is restored automatically. At the same time, due to a lack of oxygen in the blood, the stable vital activity of the child's organism is disrupted. In this case, the children become pale, their fingers and lips turn blue, the heartbeat slows and the muscle tone decreases. This is what provokes a loss of consciousness, which can lead to death in the event of failure to provide timely medical assistance. Typically, this happens at night, when the parents are also asleep and may simply not notice the stopping of breathing.
Apnea of newborns is characterized by a physiological condition, as a result of which there are no respiratory movements at the time of birth. This is explained by the excessive amount of oxygen in the blood. Apnea can develop in children who were born on the 34th week of pregnancy or even earlier, because the central nervous system has not undergone a complete development process, so it can not adequately control breathing.
In children, apnea can be caused by various causes. The most important of them is the disrupted work of the central nervous system. As a result, there is no signal from the brain to the muscles of the respiratory tract and the breath stops. As a rule, this happens with premature babies. In addition, causes such as infections of different genesis, anemia , spinal cord trauma or intracranial, drugs, sepsis, enlarged tonsils, increased bilirubin, obesity and hare lip affect the formation of apnea.
To restore breathing, the ventilator is sometimes used, and with obstruction, tracheostomy.
When diagnosing a child, the syndrome of apnea first of all eliminates the cause, which contributed to the sudden stopping of breathing, and then proceed to treatment. To do this, if necessary, remove tonsils, correct arrhythmia or anemia (according to indications). When there are seizures, drugs are prescribed that stop them.
In addition, as a result of the formation of obstructive sleep apnea, children may be slowed down by mental development, and this in the future can lead to problems in school with academic achievement. Also, very often such a breathing disorder during the sleep period contributes to the development of complications in the work of S.S.S. Therefore, this pathological condition in children requires urgent treatment to prevent irreversible processes.
To do this, it is necessary to provide the child with such a position of the head and neck, at which they will be on the same level. Assign medicines to stimulate the respiratory system, apply the method of CPVD and oxygen therapy.
It is important to consider that apnea in children who are born full-term, usually passes by themselves. In the event that the stop of breathing passes without hypoxia, then this is considered normal.
Currently, certain devices are the most effective methods of treating sleep apnea in sleep, to which CIPAP primarily applies. It constantly provides positive pressure in the respiratory tract and is considered the best system for treating this pathological condition. CIPAP is effective and safe even for children. This device reduces daytime sleepiness, improves memory and concentration, reduces the possibility of high pressure. Typically, CIPAP uses about seven hours during the night, and to avoid nasal congestion and dryness in the oral cavity, modern apparatuses are equipped with heating and humidification.
A significant role in the treatment of this disease is assigned to positional therapy, since the position of the body has a strong effect on the severity of apnea. Practically twice as often, there is a stopping of breathing at the position of the body on the side. This may be due to narrowing of the larynx tissues, but with the position on the back, the risk of stopping breathing decreases somewhat. Although this depends on the physiological characteristics of each individual patient. Therefore, first you need to change the position of the body. But with excessive weight, it is advisable to begin to reduce it, but since it is impossible to do this quickly, and the apnea attack needs to be stopped, the patients need to sleep vertically, which allows reaching a high oxygen level or with a raised bed head.
If people who suffer from nocturnal sleep apnea, smoke, drink or drink drugs, they must definitely give up harmful habits that increase the stopping of breathing. And for this, do not take alcohol four hours before bedtime, sedatives and sleeping pills.
Drug therapy, mainly for apnea, is not a useful form of treatment, but in some cases it is simply extremely necessary. Among the drugs prescribed Modafinil in combination with standard therapy with CIPAP. But the narcotic group of drugs is used to treat symptoms of drowsiness.
For the treatment of obstructive sleep apnea, intestinal corticosteroids are prescribed. But sleeping pills, as well as tranquilizers can not be used in the therapeutic treatment of this pathological condition.
In some cases, with contraindications for the treatment of stopping breathing, use of dental equipment, devices or devices of dental properties. They, as a rule, are applied at an insignificant degree of severity of obstructive apnea.
The method of orthodontic treatment allows you to quickly expand the upper jaw and thus provide breathing, and thus create a reduced pressure on the nose.
Surgical methods of treatment include apnea: uvulopalatopharyngoplasty, uvulopalatoplasty with the help of a laser, pillar of palatine implantation and tracheostomy. In the first case, remove soft tissue located on the back of the pharynx, as well as the existing adenoids and tonsils. With this operation, increase the width of the respiratory tract with the open throat, remove some of the muscles that interfere with breathing, improve the movement and closing of the soft palate. However, uvulopalatopharyngoplasty is characterized by a number of complications and even a relapse of apnea.
Uvulopalatoplasty using a laser is used to reduce the snoring of the patient. In this case, a small amount of tissue is removed from the posterior pharyngeal wall, but this method of treatment does not guarantee the long-term disappearance of nocturnal sleep apnea. In this case, this type of surgical treatment is not recommended to perform as a planned intervention, since this operation only worsens the symptoms of the disease.
For the column of palatine implantation is characterized by non-invasive surgical treatment in mild as well as moderate severity of apnea. The focus of this procedure is the process, which reduces snoring. The implant significantly reduces the vibration and movement of the palate. To perform this method, local anesthesia is used, which reduces pain and, in a short time, the body recovers. However, there is insufficient evidence to support the positive effects of this type of treatment.
But tracheostomy is used very rarely today, only on indications, in connection with medical and psychological problems. Sometimes they can use radiofrequency ablation and genioplasty.