Sleep apnea (Obstructive sleep apnoea syndrome)
Summary/Definition
Sleep apnea or obstructive sleep apnea is a sleep breathing disorder in which breathing stops or slows down due to repeated obstruction of the upper airway during sleep, resulting in frequent awakening of the patient. A distinction is made between obstructive sleep apnea (the upper airway narrows or blocks despite the sleeper’s attempts to breathe), central sleep apnea (breathing stops temporarily) and mixed sleep apnea (both symptoms appear together). Among all types, obstructive is the most common. Obstructive sleep apnea occurs when the upper airway narrows during sleep.
Symptoms
① Obstructive sleep apnea
Characterized by repetitive breathing arrest during sleep due to obstruction or collapse of the upper airway, which reduces oxygenation of the blood and causes awakening during sleep to breathe.
② Central sleep apnea
A neurological disorder in which all breathing efforts during sleep cease, often resulting in a reduction of blood oxygen saturation and an inability to achieve restful sleep.
③ Mixed sleep apnea
A combination of the two types mentioned above. Characterized by the fact that it initially starts with central sleep apnea but gradually progresses to the obstructive type.
Common symptoms that appear during sleep include heavy snoring and heavy breathing, which then subside to apnea and then breathing resumes with a very strong and loud sound.
Diagnostics
This diagnosis is made based on the patient’s medical history and by analyzing information from the patient, his or her spouse and family members. During the medical examination, specialists determine the degree of snoring and apnea symptoms of the patient by obtaining answers from the patient about how much he or she sleeps during the day, body weight, body mass index, analyzing the appearance, especially the shape of the face and neck, and examining the patient’s nasal cavity, mouth, pharynx and larynx. This is done to determine the underlying causes of the disease. A polysomnography test is performed to accurately assess the quality of the patient’s sleep. Polysomnography is a modern diagnostic test to investigate sleep disturbances during a night’s rest in a hospital setting. During the sleep test, the patient’s breathing, heart rate, movement and brainwave frequency, blood oxygen saturation, etc. are measured. If necessary, tests to check the area of airway obstruction can be performed at the same time.
Treatment and course of the disease
Treatment consists of drug therapy, in which several types of antidepressants are prescribed to the patient, but their efficacy is unfortunately questionable. Non-pharmacological treatments include the elimination of risk factors for sleep apnea, as well as the use of ventilatory devices and surgical procedures. The main ways to eliminate the risk of the condition are regular exercise and proper sleep posture. Device therapy includes continuous positive pressure ventilator mode (CPAP mode) and controlled pressure ventilation mode (BiPAP mode). Surgery may be performed when previous conservative therapies have been ineffective and there is a clearly narrowed area. These surgeries include uvulopalatoplasty (UPPP) and laser palatoplasty (LPAP).
Complications
The persistent symptomatology of apnea leads to central nervous system dysfunction and causes neuropsychiatric changes such as, daytime narcolepsy, fatigue, personality disorder, cognitive impairment and decreased driving ability, as well as cerebrovascular complications such as arrhythmias, coronary heart disease, high blood pressure, cardiac and respiratory complications, and cerebrovascular disorders.
