Sleep apnea syndrome

There are 12 main clinical signs of sleep apnea syndrome: loud snoring, abnormal motor activity during sleep, increased daytime sleepiness, hypnagogic hallucinations, enuresis, morning headaches, arterial hypertension, decreased libido, personality changes, decreased intelligence. In order to assume the presence of sleep apnea, it is enough to have the triad: loud snoring during sleep, insomnia manifestations with frequent episodes of awakening, daytime sleepiness.

Three factors play an important role in maintaining normal breathing: stable functioning of the central mechanisms of respiratory regulation, the ability of the upper respiratory tract to freely conduct air into the lungs, full contraction of the intercostal muscles and diaphragm to ensure external respiration. Disturbances at any of the above levels can lead to the development of pathological sleep apnea, which is considered a potentially dangerous condition with a possible fatal outcome. Changes in the nature of breathing during sleep are caused by the switching off of voluntary control, a decrease in the volume of chest movements in the lying position and an increase in abdominal pressure on the diaphragm, a decrease in muscle tone of the pharynx muscles, and a retraction of the tongue. Irregular breathing during sleep is also observed in healthy people. To distinguish these physiological shifts from pathological sleep apnea, a sleep apnea index has been proposed (the number of breathing pauses during 1 hour of sleep, which should not normally exceed 5). The duration of apnea is also significant, which in healthy people does not exceed 10 s. The frequency of apnea is higher in men, increases with age, and against the background of taking psychotropic drugs (benzodiazepines, barbiturates, etc.) and alcohol.

Episodes of apnea can last from 10 to 200 seconds and occur so frequently that in severe cases they take up to 60% of the total sleep time.

Heavy snoring (habitual) is observed in 15.5% of people in the general population, in 29.6% of cases, intermittent snoring is noted. It has been established that habitual snoring, combined with sleep apnea, is a risk factor for coronary heart disease and stroke. Among patients suffering from insomnia, sleep apnea is detected in 18.5% of cases. The prevalence of the phenomenon of daytime sleepiness is also high. There are 2 main types of sleep apnea - obstructive and central.

• In obstructive sleep apnea, chest movement is preserved, but oronasal airflow is absent. Anatomical narrowing of the upper respiratory tract with its occlusion are the main factors leading to obstructive sleep apnea. Obstructive apnea is promoted by obesity, a short and thick neck, operations on the upper respiratory tract, chronic vasomotor rhinitis, curvature of the nasal septum, a disproportionately large tongue, "bird face", chronic sinusitis, hypertrophy of the tonsils. The combination of these factors is of great importance.
• Central sleep apnea is characterized by the absence of respiratory movements and oronasal air flow. This group includes diseases that disrupt the central mechanisms of respiratory regulation. These include organic lesions of the brainstem, psychogenic diseases with severe hyperventilation syndrome, peripheral respiratory muscle failure in GBS, myasthenia, and myopathy. Traditionally, this group includes primary alveolar hypoventilation syndrome (Ondine's curse syndrome), caused by primary respiratory failure, manifested during sleep, that is, with the disappearance of voluntary control of breathing, which leads to the appearance of periodic breathing and hypercapnia. The disease is usually observed in children; cyanosis of the skin is typical in the absence of cardiac and pulmonary pathology. The prognosis is unfavorable, and most children die from pneumonia or pulmonary heart disease.

In men, pathological forms of sleep apnea are detected significantly more often, which is determined by a higher position of the diaphragm, the prevalence of abdominal breathing, a greater tendency to alcohol abuse, structural features of the oropharynx and larynx, and the action of androgens (increased appetite, weight gain, accumulation of sodium in the body). In women, this syndrome usually develops against the background of menopause.

Daytime sleepiness is observed in 80% of patients with sleep apnea. The combination of daytime sleepiness, obesity and pulmonary heart was previously considered as "Pickwick syndrome". Violations of wakefulness are explained by disturbances of nighttime sleep, its fragmentation, and a marked reduction in its main stages.

Sleep apnea in children can lead to developmental delays, decreased academic performance, and nocturnal enuresis. Adults with sleep apnea may have difficulty waking up in the morning, "sleep intoxication" syndrome, decreased mental and motor activity, and sexual problems, which together lead to social maladjustment. Arterial hypertension is noted in 30% of patients with sleep apnea. During the period of apnea, a significant increase in systolic and diastolic pressure is noted. It has been suggested that sudden death in newborns and elderly people during sleep may be associated with sleep apnea.

Diagnosis of sleep apnea is based on the analysis of the leading clinical manifestations and the results of a polysomnographic study during sleep.

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Treatment of sleep apnea syndrome

The undoubted successes of somnology include the method of treating patients with obstructive apnea proposed by CE. Sullivan - a method of prolonged positive air pressure, carried out with the help of a special device during sleep. The essence of the method is that during night sleep, air for breathing is supplied to the patient's nasal airways under a certain positive pressure. The effectiveness of the method reaches 92%, and its use is limited only by the difficulties associated with the need for constant use of the device during sleep. In some cases, surgical methods of treatment aimed at expanding the pharyngeal space are effective. In some cases, various devices for holding and positioning the tongue, lower jaw, soft palate are effective (they should be selected individually). Drug treatment (theophylline, progesterone, etc.) does not have a lasting positive effect. It should be emphasized that obstructive sleep apnea syndrome is not an independent nosological unit, but one of the manifestations of a wide range of diseases. Therefore, it is necessary to influence the etiological factors in each specific case. For example, a 20% reduction in body weight in obese patients can lead to a 4-fold decrease in the frequency of apnea per hour of sleep.

It should be noted that if adequate diagnosis and treatment of sleep apnea syndrome is impossible, it is important not to prescribe drugs that worsen its course - benzodiazepines, barbiturates, muscle relaxants.