Sleep apnea syndrome

There are 12 main clinical signs of sleep apnea syndrome: severe snoring, abnormal motor activity in sleep, increased daytime sleepiness, hypnagogic hallucinations, enuresis, morning headaches, arterial hypertension, decreased libido, personality change, decreased intelligence. In order to assume the presence of sleep apnea, it is sufficient to have a triad: a strong snore in a dream, insomnia with frequent episodes of awakening, daytime drowsiness.

In the maintenance of normal breathing, 3 factors play an important role: the stable functioning of the central mechanisms of regulation of breathing, the ability of the upper respiratory tract to freely air into a light, full-scale contraction of the intercostal muscles and diaphragm to provide external respiration. Violations at any of these 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 in a dream are caused by the switching off of arbitrary control, a decrease in the volume of movements of the thorax in the position of lying, and an increase in abdominal pressure on the diaphragm, a drop in the muscle tone of the pharynx muscles, and language Westernization. Irregular breathing during sleep is observed in healthy people. To distinguish these physiological changes from pathological sleep apnea, the index of sleep apnea (the number of stops of breathing during 1 hour of sleep, which normally should not exceed 5) is proposed. Essential and the duration of apnea, which in healthy people does not exceed 10 seconds. The frequency of apnea is higher in men, increases with age, against the background of taking psychotropic drugs (benzodiazepines, barbiturates, etc.) and alcohol.

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

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

• In obstructive sleep apnea, chest movement remains, but there is no oronasal airflow. Anatomic narrowing of the upper respiratory tract with their occlusion are the main factors leading to obstructive sleep apnea. Obesity, short and thick neck, upper respiratory tract operations, chronic vasomotor rhinitis, curvature of the nasal septum, disproportionately large tongue, "bird face", chronic sinusitis, tonsill hypertrophy contribute to the development of obstructive apnea. Of great importance is the combination of these factors.
• Central sleep apnea is characterized by a lack of respiratory movements and oronasal flow of air. This group includes diseases that disrupt the central mechanisms of breathing regulation. These include organic lesions of the brainstem, psychogenic diseases with a pronounced hyperventilation syndrome, peripheral insufficiency of the respiratory musculature with GBS, myasthenia, myopathy. Traditionally, this group includes the syndrome of primary alveolar hypoventilation (the syndrome of the Undine's curse) due to the primary insufficiency of the respiratory center manifested in sleep, that is, with the disappearance of voluntary control of breathing, which leads to the appearance of periodic respiration and hypercapnia. The disease is usually observed in children; typical cyanosis of the skin in the absence of cardiac and pulmonary pathology. The prognosis is unfavorable, and most children die from pneumonia or pulmonary heart disease.

In men, the pathological forms of sleep apnea are detected more often, which is determined by the higher diaphragm standing, the predominance of the ventral type of breathing, the greater propensity to alcohol abuse, the peculiarities of the oropharynx and larynx, the action of androgens (increased appetite, weight gain, accumulation of sodium in the body). In women, this syndrome usually develops against the backdrop of menopause.

Daytime sleepiness is noted in 80% of patients with sleep apnea. The combination of daytime drowsiness, obesity and pulmonary heart has previously been considered as a "peak-Vic syndrome". Violations of wakefulness are explained by the breakdown of night sleep, its fragmentation, the pronounced reduction of its main stages.

Sleep apnea in children can lead to a developmental lag, a decline in academic performance, nocturnal enuresis. In adults with sleep apnea, morning awakening difficulties, "sleepy intoxication" syndrome, decreased mental and motor activity, sexual problems, which together lead to social maladjustment are possible. In 30% of patients with sleep apnea, hypertension is noted. In the period of apnea, there was a significant increase in systolic and diastolic pressure. It is suggested that sudden death of newborns and elderly people in a dream can be associated with sleep apnea.

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

[1], [2], [3], [4], [5], [6], [7], [8],

Treatment of sleep apnea syndrome

Undoubted successes of somnology include the proposed CE. Sullivan method of treatment of patients with obstructive apnea is a method of prolonged positive air pressure, carried out with the help of a special device during sleep. The essence of the method lies in the fact that during night sleep breathing air is fed to the patient's nasal airways at 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 a number of cases, surgical methods of treatment aimed at expanding the pharyngeal space are effective. In some cases, various devices are effective to hold and position the tongue, lower jaw, soft palate (they should be selected individually). Drug treatment (theophylline, progesterone, etc.) has no persistent positive effect. It should be emphasized that the syndrome of obstructive sleep apnea 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. So, for example, a 20% decrease in body weight in obese patients can lead to a 4-fold decrease in the frequency of apnea per 1 hour of sleep.

It should be noted that if it is impossible to adequately diagnose and treat the sleep apnea syndrome, it is important not to prescribe drugs that worsen its course - benzodiazepines, barbiturates, muscle relaxants.