Apnea, which means breathlessness in Greek, is the absence of airflow in the mouth and nose for 10 seconds or more. Hypopnea is defined as a decrease in airflow of at least 30% and a decrease in oxygen saturation of more than 3% for 10 seconds or longer. Apnea Hypopnea Index is obtained by dividing the sum of the apnea and hypopnea numbers observed during sleep by the sleep time in hours.
It is a syndrome characterized by episodes of complete or partial upper respiratory tract obstruction during sleep and often a decrease in blood oxygen saturation. Patients experience low oxygen and minor awakenings after frequent breathing stops throughout the night. This negatively affects both the other organs of the body and the patient's daytime waking life. In studies, the prevalence of OSAS has been found to be between 3-7% in men and 2-4.5% in women.
Many factors are effective in the formation of obstructive sleep apnea. Gender, age, neck thickness, skeletal and soft tissue anomalies, genetics, endocrine problems, concomitant diseases, drug and alcohol use play a role in the development of the disease. Obesity is one of the most important risk factors. The risk increases 8-12 times in patients with a BMI over 29.
Neck thickness over 43 cm in men and 38 cm in women is a risk factor for OSAS.
OSAS is 3 times more common in men than in women.
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Conditions such as anomalies related to the big tongue and uvula, anomalies of the soft palate and hard palate, and large tonsils can be given as examples of anatomical factors.
Thyroid diseases, especially cases where the thyroid gland is underactive. It poses a risk for OSAS.
Alcohol, cigarette and sedative drug use may also affect the upper respiratory tract muscle activity, affecting the formation of OSAS or increasing its severity.
The most common symptom is excessive daytime. is a state of sleep. Patients feel the need to constantly sleep during the day. They express that when they wake up in the morning, they wake up tired as if they had never slept or rested. The patients' bed partners complain of very loud snoring at least 4 nights a week and say that the patient stops breathing occasionally during sleep and then starts breathing again. Morning headache, concentration on work during the day There may also be complaints such as not being able to enter, personality disorders, and decreased libido. Apart from this, patients may also complain of frequent urination at night, head and neck sweating, palpitations, and frequent awakenings.
It causes traffic and serious work accidents due to excessive sleepiness during the day. In addition, since the body's oxygen remains low for a long time during the night, many vital organs are affected. Studies have shown that patients with obstructive sleep apnea have high rates of high blood pressure, heart disease, arrhythmia, stroke, and sudden cardiac death. The gold standard diagnostic method for OSAS is monitoring the patient's brain activity, eye and body movements during the night. It is polysomnography that allows monitoring of respiratory and cardiac parameters. Polysomnography is colloquially known as a sleep test. The test is performed overnight, meaning the patient must be hospitalized overnight and the patient must have slept at least 6 hours that night. The room where the test will be performed must be single and have a toilet and bathroom. The patient must have a comfortable environment at home where he can sleep. The patient is instructed not to sleep on the day of the test, not to drink beverages containing caffeine, and not to use sedatives or sleeping pills, if any. The test must be performed by an experienced technician who is certified in this field. The recording taken throughout the night is then examined by an experienced physician who is certified in this field. In the examination, a patient with an apnea-hypopnea index over 5 is diagnosed with mild OSAS, a patient with an apnea-hypopnea index over 15 is diagnosed with moderate OSAS, and a patient with an index over 30 is diagnosed with severe OSAS.
Apart from this, upper respiratory tract as auxiliary diagnostic methods. Radiological examinations of the upper respiratory tract, other concomitant diseases or thyroid-related blood tests, respiratory function test and chest X-ray can be used in case of any anomalies related to respiratory disease.
In patients with an apnea-hypopnea index above 15, The definitive treatment is compressed air therapy, which we call PAP therapy
. Compressed air therapy is given to the patient through a mask that can be used at home and with respirators that provide the upper respiratory tract with compressed air during sleep.
Apnea-hypopnea index is above 5. In patients with e.g., PAP treatment is recommended if there is accompanying excessive daytime sleepiness, poor quality of life, hypertension, cardiovascular or brain-related pathology.
ENT examination should be recommended to every patient before PAP treatment. If there is an anatomical disorder that can be corrected by surgery that may cause this condition during ENT examination, patients are first recommended surgical treatment. If the apnea hypopnea index is still high in the repeat sleep test 2 months after the surgery, the patient is given PAP treatment.
In some patients, it is observed that during recording, apneas occur only when lying on their back, but not when lying on their side. In these cases, called positional OSAS, patients are recommended bed position therapy.
Apart from this, the patient is advised to lose weight, treat obesity, quit alcohol and cigarettes, and stop using sedative medications, if any, by consulting with their doctor.
Nasal spray may be recommended for patients with nasal congestion due to allergic rhinitis. Oxygen therapy can also be added to patients who continue to have low oxygen levels throughout the night despite PAP treatment. It can be given to patients with mild OSAS that does not improve with changes.
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