Index
Togglesleep apnea summary
Sleep apnea is a disorder in which the patient, during sleep, stops breathing abruptly and remains that way for a few seconds until he wakes up to start breathing again. These episodes can be repeated several times and disturb the sleep of the person, who wakes up tired and with the feeling that he did not sleep at all.
There are 3 main types of sleep apnea: obstructive sleep apnea, central sleep apnea and mixed sleep apnea. In the first case, the blockage of breathing is caused by an abnormal relaxation of the muscles of the airways. In central apnea, the brain does not send adequate signals to control breathing. Mixed apnea is characterized by a mixture of the two types.
There are not enough data on the percentage of patients with apnea, but it is estimated that men are the most affected, especially after the age of 35. The main cause of obstructive apnea is the relaxation of muscle structures that block breathing. In central apnea, stroke or brain tumors, they prevent signals from being sent to the muscles that regulate breathing.
The main risk groups for the disease are: obese, smokers, men, people who have had a heart attack or stroke and patients with a family history of apnea. The main symptoms of the patient with apnea include snoring when sleeping, headache during the day, fatigue and tiredness, concentration and memory difficulties and changes in the sleep pattern.
The diagnosis is made with an interview with the doctor and through the nocturnal polysomnography exam, which monitors the patient’s sleep pattern. Recently, researchers from USP tested a diagnostic method based on measuring the regularity of snoring during sleep. This method showed a high correlation with polysomnography data from patients with apnea. Apnea is considered a serious disease that, when not properly treated, can lead to serious cardiovascular complications and even death.
Initial treatment is based on changing lifestyle habits to try to control and reduce symptoms. If they don’t work, there are special devices that make breathing easier. If the patient suspects apnea, it is important that he consult a doctor so that he can indicate the best treatments and tips. Avoiding alcohol, tranquilizers, reducing weight and playing sports have beneficial effects on symptoms.
Definition
Sleep apnea or simply apnea is a sleep disorder in which breathing stops and starts again. These episodes of shortness of breath can last a few seconds and, in many cases, are enough to disrupt sleep. The patient does not wake up, but there is a change from a deeper sleep to a more superficial sleep. Thus, the patient usually snores during the night and wakes up tired, as if he had not slept.
Sleep apnea can occur in three ways :
– Obstructive sleep apnea is the most common form that occurs when the throat muscles relax. – Central sleep apnea (in English: central sleep apnea ) is so named because the central control (brain) does not send the correct signals to control breathing. – Mixed or complex sleep apnea (in English: complex sleep apnea syndrome ), apnea that combines both types, obstructive and central.
Epidemiology
Sleep apnea occurs in about 25% of men and nearly 10% of women.
Causes
Apnea is caused by the suppression of breathing during sleep. Depending on the type of apnea, it has different causes:
In obstructive apnea, the muscles in the back of the throat relax and the air passage becomes obstructed and eventually closes when the patient inhales. The concentration of oxygen in the blood decreases and this sends signals to the brain that wakes the patient up from sleep so that he can breathe again. This awakening is usually not noticed by the person. This event can happen up to 30 times an hour, making the patient’s sleep not peaceful and restful.
Central apnea is a rarer type in which the brain fails to send signals to control the breathing muscles. In this case, the main causes are heart disease or stroke. As with obstructive sleep apnea, the patient may wake up several times during sleep and this makes the night less restful.
In mixed apnea, the problem is as much with the upper part of the breathing apparatus as with the systems that control the rhythm of breathing.
Among the causes identified as responsible for apnea are:
– Smoking (active and passive)
– Increased neck circumference
– Use of medications such as muscle relaxants and sedatives
– Use of alcohol
During childhood, sleep apnea can occur, and some of the main causes are the enlargement of adenoids and tonsils in the neck and congenital malformations.
Groups of risk
Some types of patients may be at increased risk of developing sleep apnea.
For obstructive and central apnea, the main risk groups are:
– Obese patients, which is one of the main risk groups for the disease. The fat deposit around the neck can narrow the airways and impair breathing.
– Patients with a large neck circumference, since the thicker the neck, the more the internal structures of the throat may be compressed.
– Hypertensive patients.
– Patients with narrow airways due to congenital reasons.
– Male patients (both for central and obstructive apnea).
– Elderly over 65 years (both for central and obstructive apnea).
– People with a family history of sleep apnea.
– Smokers, as cigarettes increase the amount of fluid and inflammation in the airways.
– Patients who use sedatives, tranquilizers, alcohol or myorelaxants, since these substances relax the muscle tone of the airways.
– People who sit for a long time, as studies suggest that body fluids are exchanged when the patient lies down at night, causing narrowing of the airways.
– Patients who have already had a heart attack (in the case of central apnea).
– Patients who have had a stroke or brain tumor (in the case of central apnea), as this condition can disrupt the sending of information to the muscles that control breathing.
Symptoms
The symptoms of central and obstructive apnea are very similar, which can make the diagnosis complicated and difficult (also read below the differences in symptoms between men and women). Some main signs are:
– Excess sleep during the day (hypersomnia).
– Loud snoring during sleep (more common in obstructive sleep apnoea).
– Irregular pattern snoring. Recently researchers from USP detected that irregular snoring can be an indication of apnea.
– Episodes of interruption of breathing during sleep. These symptoms are observed by someone.
– Headache during the day.
– Difficulty sleeping (insomnia).
– Waking up with a dry mouth and sore throat .
– Abrupt awakening accompanied by shortness of breath, which is more common in the obstructive type.
Patients who do not get a peaceful night’s sleep are usually tired and irritable during the day, with symptoms of dizziness and lack of concentration in daily activities. If you suspect you have apnea and you have these symptoms, see a doctor.
Differences in symptoms between men and women:
Sleep apnea has relatively different symptoms between men and women.
The main symptoms in men are:
– snoring
– panting (rapid breathing)
The main symptoms in women are:
– headaches
– fatigue
– depression
– anxiety
– sleep disturbances
Note : For a correct diagnosis of sleep apnea, it is important that women undergo overnight sleep monitoring at a specialist facility.
Diagnosis
If the medical team determines that the person has symptoms suggestive of sleep apnea, they may recommend a sleep evaluation with sleep specialists or perform an overnight sleep study to objectively assess sleep apnea. Tests include an overnight sleep study called a polysomnogram (PSG). For adults, polysomnography can sometimes be done at home (Home Sleep Test or HST) without the need to stay overnight in a clinic.
Complications
Sleep apnea is a disease considered important and often serious due to the complications it can cause. Drops in the level of oxygen in the blood can lead to cardiovascular problems. One of the main diseases is hypertension, which can be 2-3 times higher in patients with sleep apnea. In addition, sudden death events due to heart failure are higher in apneic patients.
Other less serious complications include:
– Daytime fatigue.
– Complication with some medications, such as anesthetics for surgery.
– Memory problems and Alzheimer’s disease. People who suffer from sleep apnea are more likely to develop Alzheimer’s disease. According to studies carried out by Prof. Holtzman of Washington University in St. Louis ( Washington University in St. Louis ), in the US, people with sleep apnea are at risk of developing mild cognitive impairment an average of 10 years earlier than people without this sleep disorder.
– Changes in the patient’s circadian cycle.
– Headaches.
– Mood swings and depression.
– Concentration difficulties.
Some diseases may be at increased risk as a result of apnea, such as Gastroesophageal Reflux Disease and Attention Deficit Hyperactivity Disorder.
– Gout . A study published in 2018 showed that people with obstructive sleep apnea have a higher risk of developing gout, even several years after an apnea diagnosis. To reach these results, a team led by Edward Roddy and Milica Blagojevic-Bucknall, from the University of Keele, in the United Kingdom, analyzed information from 15,879 patients with obstructive sleep apnea and 63,296 patients who do not suffer from this disease, with a median follow-up of 5.8 years.
During follow-up, 4.9% of patients with apnea and 2.6% of patients without apnea developed gout. Intermittent oxygen starvation due to obstructive sleep apnea is presumed to lead to overproduction of uric acid, causing gout. This study was published on August 30, 2018 in the scientific journalArthritis & Rheumatology (DOI: 10.1002 / art.40662).
– Type 2 diabetes
– Hypertension
Treatments
The first treatment option for milder cases of sleep apnea is lifestyle change. The doctor may suggest weight reduction, smoking cessation or control of some other disease. In cases of moderate to severe apnea, other measures may be adopted.
use of appliances
A frequent practice is the treatment through the use of a nasal mask that increases the pressure (positive pressure) in the airways. This positive pressure is enough to keep the airway open and free for breathing. This breathing mask must be used during sleep and, although effective in many cases, many people do not get used to it due to the possible discomfort caused.
For patients who are very uncomfortable with this mask, there are other devices that automatically adjust the pressure while you sleep. Another measure is the use of devices that keep the patient’s mouth open during sleep.
Surgery
Sleep apnea surgery:
The aim of the surgery is to remove tissue from the nose, throat and neck so that there is no blockage in the airway. The surgeries available in case of apnea are:
– Uvulopalatopharyngoplasty (in English: uvulopalatopharyngoplasty ): involves the removal of tissue from the back of the mouth and the upper part of the throat.
– Somnoplasty (in English: somnoplasty ): a minimally invasive procedure that uses radiofrequency energy to reduce the soft tissues of the upper airways.
– Maxillomandibular advancement surgery : In this surgical procedure, the mandible is moved slightly forward. This increases the space at the back of your mouth and makes breathing easier.
– Tracheostomy (in English: tracheotomy ): This procedure is invasive and indicated for severe cases that put the patient’s life at risk. In it, the doctor makes an opening in the neck and inserts a metal or plastic tube through which the patient can breathe.
– Tonsillectomy or tonsillectomy : procedure to remove tonsil tissue located at the back of the throat, which is a common cause of obstruction in children with sleep apnea.
– Nasal surgery : includes correction of nasal obstructions, such as a deviated nasal septum.
Tips
Many treatments for sleep apnea are still under development. The patient can seek help in alternative therapies such as acupuncture and relaxation.
If you suspect that you have apnea, see a doctor. If you sleep with someone, ask that person to observe some symptoms such as snoring, restlessness and abrupt interruption of breathing. It is important to correctly treat apnea so that it does not generate complications such as high blood pressure and other disorders.
If you suffer from sleep apnea, some ways to sleep can help with the treatment:
– Prefer to sleep on your side or on your stomach.
– Keep the nose area free during the night.
– Some tips to combat fatigue during the day can help, such as drinking ginseng or green tea during the day.
Prevention
If you have cases of apnea in your family or have suffered from it at some point in your life, it is good to follow some prevention tips:
– Try to avoid tranquilizers, myorelaxants and sedatives to sleep, as they relax the muscles and can obstruct the passage of air.
– Reduce your weight, as one of the main risk factors for apnea is obesity.
– Limit alcohol consumption after 6 pm.
– Practice physical exercises regularly. In addition to helping to lose weight, it can improve the patient’s sleep profile.
– Avoid heavy foods before bed.
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