Sleep apnea syndrome is a disease that progresses with attacks characterized by a decrease in blood oxygen level following the cessation of breathing during sleep, a subsequent wakefulness reaction, and then recovery of breathing.
It is a disease that progresses with attacks in the mouth and nose for 10 seconds or more. The cessation of airflow is called apnea, and the decrease in airflow for 10 seconds or more is called hypopnea.
There are two main types of apnea:
Type I Apnea is obstructive sleep apnea and the loss of respiratory effort during sleep. It is the cessation of airflow at the level of the mouth and nose, although it continues (abdominal and chest breathing continues).
Type II Apnea is central sleep apnea and is the cessation of both respiratory effort and airflow during sleep.
What are the risk factors for Sleep Apnea?
Age: The frequency after the age of 65 is 2-3 times higher than that between the ages of 30-64. It is usually observed in children between the ages of 2-6. It is less common in children who have had tonsillectomy.
Gender: Although it is approximately twice as common in men as in women, it is also seen as frequently in women as men after menopause.
Obesity: There is a definite relationship between obesity and apnea formation. In people who are overweight, the accumulation of fat pads in the pharynx increases, which increases the tendency for obstruction in the upper respiratory tract.
Genetics: Similar findings are more common in relatives of patients.
Anatomical Risk Factors: All factors that reduce the width of the upper airway contribute to the formation and increase of the severity of the disease. Head and facial anomalies, such as a chin tucked back or a small chin, and nasal septum deviation narrow the upper airway passage, creating a tendency to sleep apnea. Another cause of obstruction is increased soft tissue mass in the upper airway due to fat deposition or large tonsils.
Sleeping in a supine position: Increases the severity of sleep apnea by causing the tongue base to block the upper respiratory tract.&nb sp;
Alcohol and Smoking: It has been shown that alcohol increases the severity of sleep apnea because it disrupts pharynx muscle activity and reduces the wakefulness response to apneas.
What are the symptoms of sleep apnea?
Snoring: Snoring is the most common symptom of respiratory disorders. Obstructive sleep apnea syndrome is detected in 35% of patients with snoring complaints. Snoring is observed in 70-95% of patients with sleep apnea.
Witnessed Apnea: Patients may sometimes not realize their apnea, and this may be noticed by a nearby person, mostly their spouse. The patient may complain of waking up with a feeling of air hunger or suffocation, or waking up to the sound of his own snoring.
Excessive Daytime Sleepiness: As a result of recurring apneas during sleep, the patient's sleep is frequently interrupted, the patient spends most of the night in superficial sleep and cannot fall into deep sleep. As a result, the patient feels the need for excessive sleep the next day. While mild cases describe drowsiness only in a quiet environment, in severe cases, drowsiness may also be observed while eating, talking or driving.
Recent weight gain has increased. and inability to lose weight
Excessive sweating in the chest and neck at night
Rising at night, incontinence at night
Sexual impotence
Nocturnal heart rhythm disorders
Gastroesophageal reflux
Depression, anxiety
Forgetfulness, attention deficit, concentration difficulties, learning problems
Morning headache
Morning dry mouth
Teeth grinding at night, drooling
Insomnia
Sleepwalking
What is recorded during sleep during polysomnography?
Electroencephalography (EEG) for brain activity
Electrooculography (EOG) for eye movements
Electromyography (EMG- submentalis) for jaw and leg movements and tibialis)
Oronasal airflow for mouth-nose breathing
Chest and abdominal movements for chest and abdominal breathing
Oxygen saturation for oxygen measurement
Electrocardiography (ECG) for heart rhythm
Body position
Video recording throughout the night
With these parameters, the presence of apnea, its type (obstructive/central), and apnea duration are evaluated. By detecting this, the patient's apnea-hypopnea index and therefore the severity of the disease are determined.
The value obtained by dividing the sum of the number of apneas and hypopneas in sleep by the sleep time in hours as a result of the polysomnographic study is called the apnea-hypopnea index. Grading of OSAS is done according to the Apnea Hypopnea Index (AHI) value determined as a result of PSG. This rating is very important for the treatment approach.
In addition, the duration of apneas and hypopneas is evaluated in which lying position of the patient and in which periods of sleep the apneas and hypopneas increase, as well as the number of apneas and hypopneas.
Sleep stages are evaluated to understand the quality of sleep and whether it is sufficient.
Snoring, heart beats, blood oxygen levels and leg movements are also evaluated during sleep.
If AHI is less than 5, it is normal.
Values between 5-15 indicate the presence of sleep apnea syndrome along with clinical findings.
Values above 15 indicate the presence of sleep apnea.
How is sleep apnea treated?
With weight loss, AHI decreases and sleep quality improves.
It has been observed that sleep-related breathing disorders improve in patients with mild position-dependent sleep apnea by preventing them from sleeping in the supine position.
There is no accepted drug treatment.
Positive airway pressure is another treatment for sleep apnea. CPAP (Continuous Positive Airway Pressure) treatment can be applied to all sleep apnea patients with AHI over 5 and signs of the disease. With this method, improvement can be achieved in both objective and subjective measures of daytime sleepiness in patients with moderate and severe sleep apnea.
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