sleep apnea syndrome

sleep apnea syndrome

Sleep apnea syndrome can be caused by obstructive (obesity, small size of the oropharynx) or non-obstructive (CNS pathology) causes. Sleep apnea, usually mixed, combines obstructive and neurological disorders. Patients may have hundreds of such episodes while sleeping in a single night. Obstructive sleep apnea is one of the many sleep disorders. The frequency is 4-8% of the general adult population. The predominant gender is male.

Etiopathogenesis

• • Premorbid
  • Narrowing of the lumen of the upper respiratory tract due to enlargement of the tonsils, uvula, soft palate, craniofacial anomalies
  • Altered neurological control of airway muscle tone and ventilation during sleep
  • Obstructive sleep apnea is caused by a transient obstruction of the upper airway (usually the oropharynx) that obstructs inspiratory airflow. The cause of the obstruction is a loss of tone of the pharyngeal muscles or genioglossus muscles (normally causes the tongue to move forward from the back of the pharynx)
  • Central apnea occurs when there is no signal from the respiratory center (causing another breath) during an episode of respiratory arrest. In rare cases, the condition is mediated by neurological disorders
  • Mixed sleep apnea is a combination of obstructive and central sleep apnea in one patient.

Genetic Aspects

• • Sleep apnea (107640, R) may present with sudden infant death syndrome
  • Sleep apnea, obstructive (* 107650, R): snoring, drowsiness, restless movements during sleep, anosmia
  • Central lethal apnea (207720, p): sleep apnea, irregular breathing, urinary incontinence, cyanosis within the mouth, lactic acidosis. The risk factor is obesity.

Clinical picture

• • Symptoms suggestive of nocturnal upper airway obstruction
  • Snoring during sleep is the first sign of the disease
  • Repeated awakenings from lack of air or for an unexplained reason
  • Symptoms due to sleep disturbance
  • Daytime sleepiness

(including episodes of short-term falling asleep)

• • Headaches in the morning
  • Disturbances in concentration, memory, irritability
  • Decreased libido
  • Depression
  • Objective Research Data
  • Periods of no chest wall movement
  • Varied chest movements after apnea resolution
  • Signs of arterial or pulmonary hypertension.

Differential Diagnosis

• • Narcolepsy
  • Bronchial asthma
  • Heart failure
  • Gastroesophageal reflux
  • Sleep associated with an epileptic seizure.

Treatment:

Tactics of conducting

• • Normalization of body weight
  • Refusal to take tranquilizers, sleeping pills or antihistamines, as well as alcoholic beverages before bed
  • Prevention of occlusion by creating continuous nasal positive pressure
  • Tracheostomy as an extreme measure of exclusion from the act of breathing of the upper respiratory tract
  • Surgical expansion of the larynx and tonsillectomy. Drug therapy
  • The drugs of choice are protripteline 10–30 mg/day or fluoxetine 20–60 mg. Note. Food intake can cause an exacerbation of angle-closure glaucoma or difficulty urinating. Caution should be exercised with concomitant supraventricular tachycardia.
  • Alternative products: medroxyprogesterone, acetazolamide (diamox).

Complications

• • Chronic or acute (not often) hypoxia
  • Heart arrhythmias
  • Pulmonary hypertension and cor pulmonale.

ICD G47.3 Sleep apnea