Sleep apnea. Sleep apnea syndrome and cardiovascular risk factors

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.

A plump, red-faced fellow was sitting on the box, sunk in a slumber.
- Amazing little one! said Mr Pickwick. Does he always sleep like this?
- Asleep! said the old gentleman. - He always sleeps. In his sleep, he follows orders and snores while serving at the table.

Charles Dickens
The Posthumous Papers of the Pickwick Club

It is believed that snoring in a dream, although it can create significant inconvenience for others, is a kind of norm. In fact, in many cases this is far from the truth. Snoring is not just a sound phenomenon, it can indicate difficulty in passing air through the upper respiratory tract during sleep.

Here's how it goes. During sleep, all our muscles relax and the muscles responsible for keeping the pharynx open are no exception. As a result, the air passing through the upper respiratory tract at this time causes vibrations in their walls, similar to how a flag is rinsed with gusts of wind. This vibration of the soft tissues of the oropharynx leads to the sound of snoring. If such fluctuations are large enough, then the walls of the pharynx periodically completely close, for some time not allowing air to enter the lungs, while the chest continues to make respiratory movements, unsuccessfully trying to take another breath. Such respiratory arrests associated with periodic obstruction of the upper respiratory tract are called obstructive sleep apnea.

If breathing stops occur frequently, then, medically speaking, such a person suffers from obstructive sleep apnea syndrome.

Other possible causes of sleep apnea

Sometimes even in quite healthy people in certain phases of sleep, a short-term cessation of breathing may occur due to a failure in the mechanism of its regulation by the central nervous system - the so-called central apnea. A feature of central sleep apnea is the absence of respiratory movements of the chest with normal airway patency. Such rare respiratory pauses are a variant of the norm, are not accompanied by health problems and do not cause disturbances in the functioning of the cardiovascular system.

However, if the mechanisms of central regulation are unstable all the time and such respiratory disorders occur frequently, then a person develops a disease - central sleep apnea syndrome with the onset of symptoms that pose a serious threat to the patient's health or even his life. Most often, central sleep apnea occurs in patients with chronic heart failure or stroke.

In the event that both obstruction of the upper respiratory tract and a violation of the excitability of the respiratory control center in the brain become the cause of the development of sleep apnea syndrome, the prognosis of the disease worsens even more.

Why is obstructive sleep apnea dangerous?

The cessation of breathing leads to oxygen starvation. This in turn stimulates the brain, forcing it to wake up in order to avoid death by suffocation. In this case, not a complete awakening usually occurs, but a short-term transition to a state of drowsiness, which in most cases is not stored in the patient's memory. Nevertheless, this time is enough to increase muscle tone, restore the patency of the upper respiratory tract and normalize the breathing process. After the blood is sufficiently saturated with oxygen, the person falls asleep again, the muscle tone decreases again and the whole cycle of abnormal respiratory events repeats again and again.

In patients with severe sleep apnea, respiratory arrest can occur almost every minute, due to which from a third to a half of the time spent in sleep, the person does not breathe at all and may develop severe respiratory failure.

Emergency micro-awakenings, which allow the patient with sleep apnea to breathe, are stressful for the body, accompanied by the release of adrenaline, which causes vasospasm and overload of the heart. Combined with oxygen starvation caused by sleep apnea episodes, this leads to accelerated wear and tear on the cardiovascular system.

In addition, micro-arousals caused by episodes of obstructive sleep apnea disrupt the normal structure of sleep, making it ragged and superficial. As a result, those deep stages of sleep almost completely disappear, during which there is a good rest and analysis of the information accumulated during the day. Instead of normal sleep, such a person spends most of the night in an unsuccessful struggle for his own breath.

Risk factors: when and who gets obstructive sleep apnea

Obstructive sleep apnea syndrome is not the only, but the most common breathing disorder directly related to sleep. It can occur at any age from childhood to old age, in men and women, but is usually most common in overweight middle-aged men.

External manifestations and consequences of obstructive sleep apnea syndrome

The main symptoms of this disease are night snoring and excessive daytime sleepiness, which is a natural consequence of sleep disorders associated with apnea.

The concept of drowsiness is quite subjective. Therefore, long-term ill people can partially get used to their condition and perceive it as a feeling of tiredness, weakness or fatigue during the day, finding an explanation for this in a tense rhythm of life and overload at work. However, drowsiness usually becomes apparent when the person is relaxed, and is manifested by falling asleep while resting, reading, watching television, and in severe cases even during vigorous activity and while driving.

But it's not just a bad quality of being awake. Oxygen starvation of the brain during sleep, combined with drowsiness during wakefulness, leads to a weakening of memory, attention, and reaction speed in a person. As a result, patients with severe sleep apnea not only find it difficult to cope with their work, but are much more likely than other people to experience car accidents, accidents at work and at home.

The following complaints are also common:

• increased mobility during sleep;
• nightmares;
• waking up, sometimes with a feeling of lack of air;
• nighttime heartburn;
• frequent urination at night;
• sweating during sleep;
• dryness and unpleasant taste in the mouth at night and in the morning after waking up;
• morning headaches;
• decreased sexual desire and potency.

As mentioned above, obstructive sleep apnea has an extremely negative effect on the state of the heart and blood vessels. Direct consequences of obstructive sleep apnea include:

• arterial hypertension, which is difficult to respond to traditional drug treatment, including with an increase in blood pressure during a night's sleep;
• dangerous cardiac arrhythmias;
• heart failure;
• high risk of myocardial infarction and stroke.

A significant proportion of deaths, including sudden deaths, formally related to cardiovascular problems, are actually a direct or indirect result of undiagnosed and therefore untreated obstructive sleep apnea. The results of many scientific studies prove that with severe sleep apnea, the likelihood of death from cardiovascular disease increases by 4-5 times.

Impact of sleep apnea on life expectancy

Obstructive sleep apnea not only significantly worsens, but also shortens life. One third of untreated patients with severe obstructive sleep apnea die within the next ten years. At work, I see many patients with sleep apnea between the ages of 40 and 65. But among older people, not just snoring elderly people, but patients with a severe form of obstructive sleep apnea are practically not found. Over the long years of my medical practice, perhaps, there will be a little more than a dozen patients with a newly diagnosed severe form of sleep apnea who would have crossed the 70-year mark. Where do you think all these people go?

On the other hand, timely effective treatment not only significantly improves the quality of life, but also radically reduces the likelihood of dangerous cardiovascular complications, creates all the prerequisites for living to a deep and happy old age.

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 illness. 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 an abrupt 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 nocturnal 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 addressing 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 morning hours and immediately after waking up.

Classification and stages of development of sleep apnea

Obstructive sleep apnea has three degrees 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 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. Polysomnography also 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).

According to 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.

During the period of night sleep, the body does not rest: it functions, but in a different way. The brain evaluates the state of the body, creating dreams, and the organs and tissues continue to maintain vital functions. But at night, many people experience breath-holding attacks - sleep apnea, in which there is a lack of oxygen.

Sleep apnea is a disorder in which breathing stops suddenly during sleep. Episodes of respiratory failure last from a couple of seconds to several minutes. The brain reacts to the lack of oxygen, awakening a person. "Oxygen starvation" is not obvious, which allows the disease to proceed latently for many years.

The result of such a pathology are diseases of the nervous system, disruption of the functioning of internal organs and systems.

A healthy respiratory act is:

• regulated breathing process;
• free flow of air;
• well-coordinated functioning of the diaphragm, intercostal muscles.

Dysfunction of any component initiates sleep apnea. At the moment of wakefulness, the structure of the lumen of the airways is tense, during sleep it is relaxed. This condition causes a slight narrowing of the lumen of the tissues of the pharynx, causing snoring.

Based on the episodes of apnea / hypopnea, which indicates the number of attacks per hour, the following degrees of the disease are distinguished:

• easy (up to 15 repetitions);
• medium (up to 30);
• severe (more than 30).

The apnea index reflects the severity of the disease and the frequency of respiratory delays.

Breath holding can be recorded in a healthy person. However, when more than five seizures occur in an hour, apnea is diagnosed. Depending on the factors that provoked the disease, there are three types of disorders:

1. Obstructive - air circulation is disturbed.
2. Central - improper functioning of the center of respiration.
3. Mixed combines both factors.

Obstructive sleep apnea is the most common. Airway occlusion occurs due to:

• enlarged tonsils;
• polyps in the nasal passages;
• adenoids;
• soft tissues of the nasopharynx (frequent inflammatory diseases);
• due to a deviated nasal septum;
• chronic runny nose.

Important! In healthy newborns, physiological disorders of breathing during sleep are also possible. A child in a dream is able to hold his breath for a few seconds. Such attacks are considered normal and do not require special therapy.

With obstructive sleep apnea, breathing stops when falling asleep up to thirty cases per hour. The patient at the same time suffocates, uttering snoring. Then breathing is restored, the person falls asleep, not remembering what happened.

Often the disorder is diagnosed:

• in men over 60;
• in women in menopause;
• in obese people;
• with cardiovascular pathologies;
• at elevated pressure;
• in the presence of a hereditary factor.

Smoking is a contributing factor to sleep apnea.

Central sleep apnea is less commonly diagnosed. In this case, there is a temporary violation of the impulses of the brain and the processes of regulation of breathing. The patient remembers the episode after waking up.

Causes of sleep apnea include:

• tumor processes of the brain;
• viral infections;
• trauma;
• stroke.

Reduced performance of the respiratory center in the brain provokes the syndrome.

A mixed type of disorder is manifested by interruption of breathing along with airway obstruction. This form of the syndrome requires immediate therapy, as it provokes a heart attack, coronary heart disease.

How does the syndrome manifest?

Pathology is quite difficult to notice, which affects the start of the examination. Patients do not complain about anything. Often, the only early symptom of sleep apnea is snoring, which is caused by fluctuations in the walls of the airways.

When fixing the following clinical signs, a somnologist consultation is necessary:

• regular awakenings;
• superficial sleep;
• not passing drowsiness;
• hallucinations;
• headache in the morning;
• high blood pressure in the morning, which normalizes on its own;
• belching at night;
• sweating;
• frequent visits to the toilet at night;
• enuresis;
• sexual dysfunction in men;
• infertility;
• completeness;
• heart attack, stroke in the morning;
• diabetes.

The presence of the described signs indicates the progression of apnea. Since these symptoms are explained by oxygen deficiency, this increases the load on the heart, provokes hormonal failure.

Holding your breath in children

The principles of diagnosis and treatment of childhood apnea are similar to those in adults. But the causes and symptoms of pathology are different.

The most common causes of uneven breathing in babies are:

• foreign body in the airways;
• enlarged adenoids;
• abnormal structure of the respiratory tract;
• rhinitis in a chronic form.

The most dangerous type of pathology is obstructive sleep apnea, in which the face becomes pale, breathing is intermittent, limbs turn blue, and the heart rate slows down. Such manifestations of childhood apnea require immediate medical attention, as they can cause sudden death.

If a child holds his breath in a dream, parents should understand what to do in such a situation. It is necessary to draw a finger down along the spine and rub the limbs, chest. Such measures restore respiratory activity.

Sleep apnea in children under 14 years of age and in infants has the following consequences:

• Slow physical development, which is manifested by insufficient weight gain, short stature, muscle weakness.
• Decreased cognitive abilities. Preschoolers and schoolchildren have absent-mindedness, problems in cognitive moments, which affects the grades.

In addition to the occurrence of such complications, the child may experience lethargy or, conversely, excessive activity during the day.

By the way! Daily singing contributes to the prevention and treatment of respiratory disorders during sleep.

A special category is represented by premature babies, who are often diagnosed with sleep apnea. Respiratory dysfunction is explained by insufficient nutrition of tissues, immaturity of the respiratory center and the receptor system.

To prevent respiratory arrest in a child under 3 years old, be sure to ventilate the baby's room, do not overheat the child. Also, children of the first year of life need to sleep without a pillow.

Diagnostic procedure

To confirm the diagnosis, it is necessary to examine a person's breathing during a night's sleep. At the same time, the magnitude of the air flow, the concentration of oxygen in the bloodstream are established, and snoring is studied.

Note! Pathology is not diagnosed in many people suffering from the syndrome.

To determine the degree of lung function, it is necessary to undergo an x-ray, test the vital capacity of the lungs, and evaluate the expiratory rate.

To determine the causes of the disease, blood tests are taken for sugar, hemoglobin, hormones, and urine tests.

The main diagnostic method is polysomnography - a non-invasive method of examination.

During sleep, the device captures biological parameters:

• body position;
• soundtrack of snoring;
• saturation - oxygen saturation of the blood;
• features of breathing through the nose;
• characteristic of abdominal, chest breathing.

For the study, the procedure of pulse oximetry is also used: a special nozzle is attached to the patient's finger, and a measuring bracelet is attached to the wrist. The result of this manipulation is the identification of the level of oxygen in the blood and the pulse rate.

Therapeutic activities

Sleep apnea syndrome is treated depending on the neglect of the disease. Getting rid of snoring will not cure the disease.

Important! If signs of apnea appear, you should immediately consult a doctor, since the pathology initiates long-term complications.

Treatment for mild sleep apnea includes:

• weight loss;
• therapy of ENT pathologies;
• positional method, when the head of the bed rises 15 degrees;
• the use of devices for the oral cavity, which hold the jaw in the required position;
• the use of special items, the function of which is to prevent a person from sleeping on his back;
• refusal to take drugs that have a sedative, hypnotic effect;
• stop drinking alcohol, smoking;
• regular breathing exercises.

For the treatment of central sleep apnea, pharmacological drugs are prescribed that affect the respiratory center in the brain. In severe cases of obstruction, the only appropriate treatment is CPAP therapy.

Features of some methods of treatment

In the case of a long course of the disease, oxygen deficiency can persist even after correct treatment. This is due to the fact that the cells of the body "adjust" to a reduced concentration of gas and continue to maintain a similar state.

CPAP therapy

Scientists from the USA have developed a unique method of oxygen saturation of the body. The mechanism of its action is to ventilate the lungs with the help of a special mask and breathing tubes.

CPAP is an effective sleep apnea treatment system that produces a continuous flow of air. This system is approved for use in people of all ages and even in children.

After applying the safe CPAP method, patients have an improvement in sleep, attention, and a decrease in drowsiness. In addition, the device reduces the possibility of increasing pressure. Almost all patients feel improvement after the first procedure.

For the best effect, do not remove the mask during the seven-hour sleep. The somnologist must explain to the person how to use the system correctly and without harm to sleep and health, since sleeping with the system is not very comfortable.

Positional Therapy

The position of the body during sleep directly affects the high number of apnea episodes. It has been found that people who sleep on their side have an increased number of seizures. This is due to the narrowing of the tissues of the throat.

The patient must change positions during a night's sleep, looking for the most suitable one. In most cases, if a man sleeps on his stomach, then snoring and the symptoms of the described disorder disappear.

Splint on the jaw

A device resembling a sports cap. The splint secures the lower jaw and tongue in such a way that nothing interferes with free breathing. This remedy is effective for the treatment of moderate sleep apnea. The attending physician will explain how to cure the pathology in this way, choose the right size and appropriate shape of the product individually for each patient.

Pharmacological preparations

The choice of drugs for treatment depends on the type of syndrome. With central sleep apnea, it is necessary to maintain the functioning of the heart and lungs. The doctor will prescribe the required remedy, based on the patient's condition.

Therapy of an obstructive disorder is not amenable to drug methods, since it is impossible to eliminate the adhesion of the walls of the airways with drugs.

Surgical intervention

The radical method is used only for obstructive disorders, since there is no object of influence in central apnea.

The main task of the operation is to expand the lumen in the airways by removing obstacles in the way of the air flow. Polyps, adenoids, enlarged tonsils and other neoplasms often act as barriers.

In the absence of contraindications, the surgical method eliminates breath holding during sleep.

Non-traditional methods of treatment

To resort to traditional medicine should be used with caution. Despite the fact that folk remedies can reduce the swelling of the mucosa, strengthen it, they often become a risk factor for unpredictable allergic reactions.

The most effective means to stop sleep apnea in adults:

• Sea buckthorn oil. It is necessary to bury the nose with oil before going to bed for a month. Sea buckthorn relieves inflammation, promotes better blood circulation.
• Cabbage juice. You should squeeze a glass of juice, strain and add a spoonful of honey to it. Drink the drink at night for a month.
• Baked carrots. Bake root vegetables in the oven and consume before meals. The vegetable will help get rid of snoring.

The described methods can only accompany the main therapy prescribed by the doctor.

Consequences and prevention of the disease

If the manifestations of pathology are ignored, serious complications occur. It is difficult for a person to deal with drowsiness, which can provoke an accident or injury. Apnea causes arrhythmia, which leads to heart attacks and strokes in the early morning.

To prevent such a result, try to follow these rules:

• eat right;
• get rid of extra pounds;
• give up alcohol and smoking;
• sleep on your side.

An effective preventive measure is a special gymnastics that trains the muscles of the tongue, jaw, and pharynx. Exercises contribute to a better passage of a stream of air through the airways, preventing the retraction of the tongue. The specialist must explain to the patient how to properly perform medical manipulations.

Remember that people with untreated syndrome die five times more often than those who turned to a somnologist on time.

Sleep apnea is difficult to diagnose on your own. Therefore, pay attention to the signals of the body, do not ignore unpleasant symptoms. After all, timely therapy can get rid of respiratory arrest in a dream.

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 drowsiness 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 given that the average person sleeps 8-9 hours a day, with such violations 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 is usually 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.