Sleep apnea

Sleep apnea
International Classification (ICD) G47.-

Basics

Snoring, while considered annoying by many, is rarely seen as a serious symptom of illness. However, in some cases it can be an indication of a breathing disorder, namely obstructive sleep apnea syndrome. In particular, very loud and inconsistent snoring can indicate this condition, which can cause life-threatening pauses in breathing.

Approximately five percent of the population is affected by this condition, with overweight middle-aged men being at particular risk of developing the disease.

Among sleep apneas, obstructive sleep apnea syndrome (OSAS) is a very common form. In this case, the muscles of the palate relax during sleep, which can cause the upper airways to narrow. As a result, the breathing of the affected person is disturbed, which can even lead to respiratory failure. The drop in the partial pressure of oxygen in the blood causes the respiratory center in the brain to react, activating the respiratory muscles. The body tries to compensate for the lack of oxygen with a few, forceful breaths, usually causing the sufferer to wake up, which is also known as arousal. The duration of the pauses in breathing can be only a few seconds, but in some circumstances can last up to two minutes. It is possible for such breathing pauses to occur several times a night, however, most people do not remember being jolted out of sleep by these breathing pauses the next day.

As repeated pauses in breathing make the body less able to supply oxygen, it tries to increase oxygen supply by increasing the output of the heart. In some cases, this can lead to blood pressure problems or cardiac arrhythmias.

In addition to the obstructive form, there is also centrally caused sleep apnea. In this form, the reasons for the pauses in breathing do not lie in the respiratory tract, but in the respiratory muscles. The diaphragm and the respiratory muscles of the chest no longer work satisfactorily, which is why there is a lack of oxygen and the affected person wakes up from sleep. Central sleep apnea mostly affects older people, but this form is usually not very dangerous, which is why it rarely requires medical treatment. However, if there are other health problems, such as heart disease or nerve failure, you should definitely see a doctor.

Causes

There are a number of risk factors that can promote the development of sleep apnea disease: Chief among these are increased body weight, alcohol consumption, and the use of sleeping pills and sedatives. These cause the palate to relax, which can then block the airways. In addition, anatomical changes can promote the occurrence of sleep apnea syndrome. For example, if the tongue or tonsils are enlarged, or the airways are narrowed, this can contribute to the development of sleep apnea syndrome.

In the case of central sleep apnea, the causes of the disease lie in the central nervous system, leading to impaired regulation of the respiratory muscles.

Symptoms

People with sleep apnea often have trouble sleeping through the night due to their condition, which can affect cognitive abilities such as attention and memory. This can also lead to microsleep during the day, which is a great danger for sufferers, especially when driving. Sleep apnea can also affect the psyche in the long run, when depression and anxiety develop due to sleep disturbances. Due to the reduced oxygen supply, sufferers may experience headaches upon awakening. Furthermore, sleep apnea can lead to sexual listlessness and thus to potency problems in men.

Sometimes children are also affected by sleep apnea syndrome. It is suspected that obstructive sleep apnea syndrome may be a cause of "sudden infant death syndrome". Children of school age often become conspicuous by sluggishness and listlessness, as well as by a drop in academic performance.

Diagnosis

Snoring, which is often the first sign of sleep apnea, is usually noticed by the partner. If breathing pauses during sleep are also noticed, the affected person should definitely see a doctor or be observed in a sleep laboratory. For this, the patient has to spend one or two nights in the sleep lab, where his sleep and some vital signs, such as breathing, heart rate, chest movements and oxygen saturation in the blood, are measured. Sometimes daytime mental function tests are also necessary.

Once in a while, obstructive sleep apnea syndrome may be caused by airway polyps or deviated nasal septum. In these cases, it can be helpful to have such anatomical changes diagnosed or ruled out by an ENT specialist.

Therapy

One risk factor that can significantly contribute to the development of sleep apnea syndrome is obesity. That is why it is highly advisable that people suffering from this disease lose weight. Even a small loss of weight leads to an improvement in breathing during sleep, which makes sufferers feel better and more efficient during the day as well.

Furthermore, alcohol consumption can promote the occurrence of sleep apnoea syndrome, which is why it should be limited as far as possible or at least completely omitted two hours before going to bed. Alcohol has an inhibiting effect on breathing and in some cases can also trigger respiratory arrest. In addition to alcohol, medications such as sleeping pills (benzodiazepines) also restrict breathing and can lead to sleep apnea.

To prevent sleep apnea, it is advisable to sleep in a side position. The use of nasal drops can also improve the condition by clearing the airways, but these can cause problems even with prolonged use.

In some cases, sleep apnea can be cured by these actions, but a majority of patients require medical treatment.

CPAP (contineous positive airway pressure)therapy: In this treatment method, the patient is given positive pressure ventilation through a nasal mask to keep the airway open, which can improve breathing problems. This therapy is usually used for the obstructive form of sleep apnea, but recent studies have also shown a positive effect on central sleep apnea syndrome. Most people tolerate this form of therapy, however, there are some patients who cannot cope with the ventilator or feel disturbed.

Bite splints: These splints are fitted directly to the lower or upper jaw of the sufferer and are designed to keep the airway open by shifting the tongue and palate, as well as opening the jaw. The disadvantages of this treatment are that they are very expensive and cannot be used on everyone.

Surgical methods: some anatomical changes can be treated by surgical methods. For example, adenoids, swollen tonsils, or malformations of the palate or jaw, as well as a deviated septum can be treated by surgery in most cases. There is also a surgical method called uvulopalatopharyngoplasty (UPPP), in which tissue is removed from the throat area to clear airways. This method is successful in about half of the cases.

Oxygen therapy: Combined with other forms of treatment, an oxygen supply can have a favourable effect on the sleep apnoea syndrome. Especially in cases of additional cardiopulmonary diseases, ventilation with oxygen via a CPAP nasal mask is necessary to saturate the blood sufficiently with oxygen.

Unfortunately, there are currently no drugs that can directly cure snoring or sleep apnea syndrome.

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