Sleep-disordered breathing is a dangerous condition that can lead to chronic hypoxia. The main symptoms include snoring and the presence of sleep apnoea. An in-depth diagnosis and interview with the patient and his or her loved ones is extremely important. In addition, physical examinations, such as an ENT examination, are important to determine where the airway obstruction is occurring. Treatment can be based on conservative methods, which is quite inconvenient for the patient, or on surgical methods.
Table of contents:
- Characteristics of ZOPS
- Types of ASD
- Society with OCD
- Epworth sleepiness scale
- Physical examination
- Additional investigations
- How can IOPS be treated?
- Prevention
- Complications of apnoea
Sleep-disordered breathing syndrome(SIBD) is a disease entity that affects approximately 1% of the population, but the prevalence is on a significant upward trend.
IOPS is a major problem from a clinical point of view, as it causes severe chronic hypoxia. Although the incidence of IOPS is not uncommon, with a particular focus on developing countries, both the symptoms and the causes of incidence and substrate are not fully understood.
Characteristic features of IOPS
The most common symptom, as well as the one that is most quickly and frequently noticed, particularly by those in close proximity, is snoring. An accompanying symptom that is very dangerous from the point of view of hypoxia is apnoea. To diagnose sleep apnoea, certain criteria for the condition must be met.
From a diagnostic point of view, apnoeas are a condition in which there is a lack of airflow through the respiratory tract, and this lasts for no less than 10 seconds. Furthermore, during an ap noea, there is a drop in arterial blood oxygen saturation of approximately 4%. Such an episode must occur at least five times per hour and the duration of the test, no less than six hours.
In the diagnostic process, an in-depth interview is very important, not only with the patient, but also with his/her relatives. It is worth noting that, in addition to nocturnal symptoms such as apnoea, loud and disruptive snoring, frequent awakening, increased activity, increased number of nocturnal visits to the toilet, excessive sweating, a feeling of breathlessness or shortness of breath and chest pain, daytime symptoms can also be noted as a result of nocturnal symptoms. Daytime symptoms include morning fatigue instead of feeling rested, headaches, drowsiness and decreased daytime activity, feelings of fatigue and apathy, sexual dysfunction, decreased intellectual performance and memory deterioration, as well as problems with concentration or excessive irritability.
Types of PMS
When there is a situation during sleep where no air flows through the airways and the direct cause of this is a lack of or impaired respiratory drive, we then speak of central sleep disordered breathing. This is a situation in which the diaphragm and chest muscles do not move and remain motionless for the duration of sleep apnoea.
When muscle function is preserved and the respiratory drive is functional, but there is no airflow in the airways, the cause may be an obstruction or closure of the airways. This is called peripheral sleep-disordered breathing. During such a condition, paradoxical muscle movements of both the diaphragm and the thorax can be observed in the patient.
Another type of disorder is mixed disorder, when both a central and a peripheral type of disorder are present.
Society with OCD
The much more common type of disorder is central disorder with a male predominance. The lower incidence of ZOPS in women is most likely related to the effect of sex hormones on respiratory regularity.
Statistically, it is estimated that approximately 100 000 people in Poland, require diagnosis and treatment for IOPS. The acceleration of the ageing process in the 4th and 5th decades of life, the decline in fitness and the onset of chronic conditions, make this the period when the incidence of IOPS is most frequently observed.
Sleep-disordered breathing, photo: shutterstock
Epworth sleepiness scale
A very useful diagnostic tool used by professionals when interviewing patients is the Epworth Sleepiness Scale. It contains 8 questions focusing on falling asleep in various life situations such as watching TV, reading or driving. The patient is asked to rate, on a scale of 0 to 3, the likelihood of falling asleep in a given situation. The results obtained in this way show which type of sleepiness the patient is facing.
Physical examination
An ENT examination is extremely important in the diagnosis of IOPS in order to determine the site of stenosis or obstruction of the respiratory system. Causes may include nasal deformities, narrow nostrils, nasal polyps, chronic allergies or rhinitis. With regard to the oral cavity and pharynx, obstruction may be caused by hypertrophy of the palatine tonsils, hypertrophy of the tongue or other soft tissues, mandibular abnormalities, soft palate or hypertrophy of the pharyngeal tonsil.
The laryngeal area can also generate airway problems when there are abnormalities of the epiglottis or hypertrophy of the vocal folds. Airway obstruction can also be caused by excess fatty tissue in the neck area, which is usually encountered in people struggling with excessive weight and obesity.
Additional investigations
To confirm an airway obstruction, the patient may be referred for additional investigations. Such investigations include computed tomography, magnetic resonance imaging, functional radiography, upper airway endoscopy or rhinomanometry. Tests that record the functioning of the respiratory system during sleep and any abnormalities in it include polysomnography, which additionally records apnoeas and their sequelae. Assessment polysomnography allows the structure of sleep as well as respiratory function to be determined, as respiratory reflexes and arterial blood oxygen saturation are recorded during the examination.
How to treat OCD?
The approach to treating a patient always depends on the patient's current condition and the degree of development of the disorder. There are two routes of treatment, one of which is based on conservative methods in the form of the use of an apparatus that injects air into the airways during sleep, which is quite burdensome for the patient himself and, moreover, is only symptomatic. The second route of therapy that can be undertaken is surgical treatment, which involves a surgical procedure to remove, eliminate the abnormality that results in airway obstruction and sleep-disordered breathing. Surgical procedures of this type include plastic surgery of the soft palate, plastic surgery of the nasal septum, tonsillectomy, adenotomy, tongue reduction or procedures that alter the position of individual bony elements of the craniofacial region.
Prophylaxis
In the context of OCD, a very important element is prevention, which refers to reducing body weight, avoiding alcohol consumption, taking sleeping pills or tranquillisers, quitting smoking and the sleeping position (it is recommended to lie on your side, not on your back).
Complications of apnoea
Sleep apnoea is an extremely dangerous condition. It can cause many health consequences such as hypertension, ischaemic heart disease and abnormal heart muscle rhythm which can lead to stroke. Apnoea can also cause pulmonary hypertension, falling asleep or excessive sleepiness, which can lead to accidents and sudden premature death. [1]
