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Sleep apnea (respiratory arrest in a dream)

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In the process of sleep, the body is rebuilt on a completely different scheme of work than during wakefulness. Contrary to popular belief, he does not rest at this time - the brain controls the well-being of a person and creates dreams, and internal organs support all vital functions: heartbeat, hormone production, respiration, and others.

However, in some people, in a dream, normal functioning of the body may be disturbed. Due to a number of reasons, less air enters the lungs and the body begins to experience “oxygen starvation”. Doctors call this condition sleep apnea syndrome. How dangerous the disease is, how to detect it and successfully cure it - you will find a competent and reasoned answer to all these questions in this article.

What is "night apnea"

By this term is meant partial or complete respiratory arrest during sleep. These periods last no longer than a few minutes, so they are practically not able to lead to sudden death. The brain manages to notice a deficiency of oxygen, after which it makes a person wake up and restore normal breathing. The disease is hidden and some people may not notice it for several years or even decades.

However, respiratory problems occur every night and cause chronic oxygen deficiency, which continues to persist even in the daytime. The patient has a metabolic disorder, a decrease in the functions of various organs, and hormonal changes. The result is the development of complications and the appearance of other diseases.

The following are the most common complications of sleep apnea:

  • Obesity,
  • Arterial hypertension - an increase in blood pressure of more than 140/90 mm Hg,
  • Diabetes and prediabetes (synonym - “impaired glucose tolerance”),
  • Atherosclerosis is the deposition of plaques on the wall of arteries that feed various organs with blood,
  • Coronary heart disease, including rhythm disturbances, angina pectoris (chest pains), heart attack,
  • Cerebrovascular disease (abbreviated as CVB). This is a group of pathologies in which the brain's nutrition and part of its functions are disturbed: memory, attention, control over emotions, etc.,
  • Chronic heart failure is an irreversible damage to the heart muscle, in which the blood begins to “stagnate” in various organs / tissues.

It should be noted that each of the above diseases reduces life expectancy and reduces its quality. About 500 thousand people die from these diseases every year. Of these, 40-70 thousand people suffered from apnea syndrome, which caused or aggravated the underlying disease. To get rid of him and reduce the risk of developing these pathologies is the main task of the patient who wants to extend his life.

Causes and options for the disease

There are two groups of reasons why a person is faced with this disease.

  • The first is a partial obstruction of the airways. As a rule, impaired patency occurs at the level of the nose or pharynx. It is associated with various anatomical defects or chronic diseases. Often, temporary apnea is observed in patients with obesity, chronic rhinitis, curvature of the nasal septum, polypous rhinosinusitis, etc.
  • The second group of causes is a malfunction of the respiratory center of the brain. Since in a dream a person cannot consciously control the process of breathing, this function entirely rests on the reflexes of the nervous system. During sleep apnea, the brain partially loses control over this process, due to which there are “interruptions” in the supply of oxygen to the blood.

Depending on the cause of apnea, three variants of the disease are distinguished:

  1. Obstructive - this form is associated with impaired air conduction,
  2. Central - oxygen deficiency occurs due to malfunction of the respiratory center,
  3. Mixed - one person has two pathological factors at the same time.

Determining the type of disease is important for selecting the right therapy, which will eliminate the very cause of the disease, and affect the mechanisms of its development. The table below summarizes all the necessary information that will help to understand this issue.

Obstructive

Conditions That May Cause Apnea

(risk factors)

Sleep - at this time the muscles throughout the body relax and are practically not controlled by the brain. The muscles of the pharynx, which provide patency of the respiratory tract, are no exception.

In the presence of one of the factors listed above, they relax too much and close the lumen of the larynx, where air should flow. This leads to a partial or complete respiratory arrest.

When the brain detects a deficiency of oxygen in the blood, it "gives the order" to release stress hormones: adrenaline and cortisol. This leads to an increase in blood pressure, an increase in blood glucose and an awakening of the body.

Awakened body restores muscle tone and normal breathing. Then it falls asleep again, and the cycle repeats again.

Central
  • Obesity, as it is accompanied by the formation of "fat pillows" around the pharynx,
  • Enlarged pharyngeal tonsils (synonym for adenoid growths),
  • Curvature of the nasal septum
  • Abnormal structure of the upper jaw,
  • The presence of polyps (benign tumors) in the nasal cavity - polypous rhinosinusitis,
  • The presence of chronic rhinitis (usually allergic or vasomotor),
  • Acromegaly,
  • Part of neurological diseases: amyotrophic lateral sclerosis, diabetic polyneuropathy, Guillain-Barré syndrome, various myodystrophies.
  • The use of sleeping pills, tranquilizers (haloperidol, chlopromazine) or potent sedatives (diazepam, phenazepam, clonazepam, etc.),
  • Alcohol or drug intoxication,
  • Hypothyroidism,
  • Some neurological pathologies: stroke and condition after a stroke, Parkinson's disease / syndrome, Alzheimer's disease and others.
“Trigger” factor of respiratory disorders
Body response

The mixed option is the most difficult in terms of treatment, since it combines two mechanisms of respiratory failure. Therefore, to eliminate the symptoms, it is necessary to eliminate two causes at the same time. Otherwise, therapy will be ineffective.

Since this syndrome occurs only in a dream, it is quite difficult to detect the disease yourself. However, 100% of people suffering from apnea have characteristic breathing in a dream - periods of loud snoring alternate with interruption of breathing. Others can’t notice this. If a person sleeps alone and does not know that he is snoring, then you should pay attention to other signs of the disease, which include:

  • Frequent nightmares or restless sleep. The lack of oxygen flow to the brain leads to a change in its work and disruption of information processing. This process is manifested by a change in the nature of dreams. They become frightening, chaotic, tense. The sleep process does not refresh the patient and does not allow him to rest, but rather depresses him and causes anxiety,
  • Regular night awakenings. The production of stress hormones and the restoration of breathing are invariably accompanied by interruption of sleep. There can be a different number of such apnea attacks - from single episodes to several tens of times. If they occur constantly (within weeks or months), it is necessary to suspect the presence of a hidden pathology,
  • Daytime sleepiness. For normal performance, people need to sleep 6-9 hours daily. Otherwise, the natural biorhythm fails and a feeling of constant lack of sleep appears,
  • Decreased attention and performance. Over time, air deficiency begins to occur in patients not only at night - it continues to persist during wakefulness. An excess of carbon dioxide in the blood negatively affects the brain, which causes a disruption in its functioning,
  • Decreased mental ability,
  • Emotional lability: unreasonable mood swings, constant irritability, bitterness, tendency to depression,
  • Decreased libido in men and women.

Also, one should not forget about the objective signs of the disease. Constant respiratory arrest during apnea inevitably leads to the development of complications. You can suspect them by the following criteria:

Pathological symptom

An increase in body mass index (BMI) of more than 30 BMI =

Fasting glucose increase:

Whole blood - more than 6.1 mmol / l,

Venous blood (plasma) - more than 7.0 mmol / L.

Change in blood lipid concentration:

Total cholesterol - more than 6.1 mmol / l,

LDL - more than 3.0 mmol / l,

HDL - less than 1.2 mmol / l,

Triglycerides - more than 1.7 mmol / l

Disease complication
Increased blood pressure over 140/90 mm Hg
  • The formation of persistent arterial hypertension and chronic heart failure,
  • Increased risk of vascular accidents: strokes, heart attacks, transient ischemic attacks,
  • The development of cerebrovascular disease.
  • The development of obesity,
  • Increased likelihood of diabetes and prediabetes,
  • The formation of atherosclerosis and coronary heart disease,
  • Perhaps the development of fatty liver damage.

Changing laboratory indicators
The level of C-reactive protein is more than 4 mg / lIncreased risk of heart and vascular diseases: angina pectoris, rhythm disturbances, heart attacks, chronic heart muscle failure.

Diagnosis of the disease

There are two simple methods that can confirm the presence of the disease. The first is a questionnaire - scientists have developed a number of questions with which you can determine the degree of lack of sleep of a person and indirectly assess the presence of "oxygen starvation." This questionnaire is called the Epworth Drowsiness Scale (abbreviation ESS). If you have a desire, you can assess the likelihood of having a disease on your own.

To do this, you need to answer a few questions below, which will assess your exposure to daytime sleepiness. For each of them there are three possible answers:

  • I do not fall asleep in this situation - 1 point,
  • There is a low probability of a nap - 2 points,
  • I can easily fall asleep - 3 points.

Questions of the Epworth scale:

Can you fall asleep?Your answer
While reading a book, magazine, newspaper, etc.
When watching movies, videos, or TV shows
Being in public places that you periodically visit (cinema, opera, ballet and others)
When driving for a long time (longer than an hour) in a car / bus, being in the passenger seat
In the evening, resting in a prone position
In a conversation with another person
Resting after dinner
Driving in traffic jam / traffic light

With a score of more than 14 points and the presence of risk factors, there is a high probability of the presence of apnea in an adult. In this case, you need to see a doctor who will choose the most appropriate treatment tactic.

The second method is called pulse oximetry. A pulse oximeter is a small device that is worn on the finger of the hand and determines the presence of oxygen deficiency. This study can be carried out in any hospital, it does not require preparation and takes no more than a minute. However, it has one drawback. Pulse oximetry reveals only long-term ongoing obstructive apnea. In other cases, the study will not show deviations from the norm.

Gold Standard Diagnostics

According to European recommendations, the best method for diagnosing the disease is a polysomnographic study. However, in Russia this method is used extremely rarely, only in large scientific centers or private clinics.

The principle of polysomnography is quite simple:

  1. The patient falls asleep or is immersed in a dream using hardware or drug methods,
  2. In the process of sleep, the patient undergoes the following studies: electroencephalography, electrocardiography, assessment of the blood coagulation system, chin electromyogram, pulse oximetry, air flow assessment, counting respiratory movements of the chest and abdomen, leg muscle electromyography,
  3. The doctor evaluates the results and compares them with the norms.

To perform such a comprehensive examination in the Russian Federation is almost impossible. Therefore, the diagnosis of this pathology is based on patient complaints, the presence of risk factors, questionnaire data and pulse oximetry.

Modern treatment principles

To successfully get rid of the disease, you need to know its version (obstructive, central or mixed) and the immediate cause of the pathology (curvature of the nasal septum, the presence of adenoids, etc.). Only after this can we begin treatment of sleep apnea, the purpose of which is to restore the patency of the respiratory tract.

Elimination of the cause of pathology

In 85-90% of cases, the main factor in the occurrence of obstructive sleep apnea is obesity. With an increase in body mass index of more than 30, it is necessary to carry out measures to reduce weight. In most cases, after a decrease in BMI to 20-25, the symptoms of the disease disappear on their own.

At the moment, the market for pharmaceuticals is full of "diet pills", in private clinics they offer various options for operations, and on the Internet there are schemes of strict diets bordering on fasting. For the vast majority of people, all these methods will not bring benefits, but only additionally harm their health.

Rational weight loss can be achieved by regularly observing the following conditions:

  • Refusal from the use of alcohol and nicotine (including cigarettes, smoking mixtures, vapes, etc.). Permissible is a single use of strong alcoholic drinks not more than 50 g. Not more than 2 times a week,
  • The right diet. You should not give up all types of food and starve - these measures are effective only for a short period of time. To reduce weight, just change your diet as follows:
    • Refuse any confectionery, including chocolate, cookies, cakes, pastries and others. These products are sources of digestible carbohydrates that the body does not have time to use for its needs. As a result, they are stored in fatty tissue throughout the body, including in the internal organs (liver, pancreas, heart, blood vessels, etc.),
    • Exclude fatty foods: various products cooked in oil / margarine, fatty meats (veal, lamb, pork, beef), sausages and others,
    • Give preference to protein foods - poultry and cereals,
    • Be sure to include fruits and vegetables in the diet, as a source of fiber and activators of the intestines.
  • Adequate daily exercise is a prerequisite for losing weight. This paragraph does not mean that a person should go to the gym every day and practice for several hours. Enough light running, brisk walking, visiting the pool or doing exercises at home. The main thing is regularity physical exercises.

For most patients, these recommendations are enough to gradually reduce BMI to acceptable values ​​over several years. The main thing is not to deviate from these principles and adhere to the described scheme. Rebuilding your lifestyle is quite difficult, so often people neglect simple methods, being in search of a “magic pill” or other means. Unfortunately, at the moment there is no safe and effective means that would allow to reduce weight without human effort.

Principles for addressing other causes

If apnea is not associated with the development of obesity, you must find the cause of the disease and try to eliminate it. In most cases, this can be done with special therapy or a little surgery.

Various diseases have their own treatment characteristics. For each patient, the doctor individually determines the most optimal approach, depending on the state of his body and the type of respiratory disturbance. Below are the general principles for eliminating pathologies that can cause apnea, and especially the tactics of a doctor in various diseases.

Medical tactics

Adenoidectomy - removal of excess tissue of the nasopharyngeal tonsil. Currently, it is performed without additional incisions - the surgeon performs all manipulations through the nasal passage, using special (endoscopic) instruments.

In addition to surgical treatment, otolaryngologists recommend a course of therapy that eliminates the cause of the disease and prevents the recurrence of the disease. The classic scheme includes:

  • Противомикробные лекарства в форме спреев и назальных капель,
  • Солевые растворы (Аква Марис, Физиомер, Морская вода и т.д.) для промывания носовых ходов,
  • Физиотерапию,
  • Курортолечения в условиях теплого морского климата.

Endoscopic polypectomy - removal of tumor formations through the nasal passage.

Relapse prevention is carried out with local glucocorticosteroid preparations (in the form of a spray). Preparations - Nasobek, Tafen nasal, Budesonide and others.

Apnea DiseaseRecommended Treatment
Surgical - the elimination of pathology is carried out mainly by surgical intervention.Adenoid growths of the pharyngeal tonsils (Adenoids)
Наличие полипов в полости носа
Nasal septum curvatureRhinoseptoplasty is an operation to restore the correct shape of the nasal septum and patency of the nasal passages.
Conservative - improving the patient's well-being can be achieved with the help of pharmaceuticals.Chronic rhinitis (vasomotor, allergic, occupational, etc.)Treatment of this group of diseases should be comprehensive. The classical scheme of therapy, regardless of the pathology option, necessarily includes the following points:

  • Elimination of contact with a factor provoking an increase in the common cold (allergen, industrial dust, stress, etc.),
  • Flushing the nose with sea water solutions,
  • Local anti-inflammatory therapy (glucocorticosteroid sprays).

If necessary, general recommendations are supplemented with specific preparations necessary for a particular patient. The main thing is to achieve control over the disease and maintain patency of the upper respiratory tract.

HypothyroidismSubstitution therapy with thyroid hormone analogues (L-thyroxine).
Diabetes as a risk factor for obesity and disorders of the innervation of the muscles of the pharynxBlood sugar control can be achieved in three main ways:

  • Diet
  • Antiglycemic drugs (the best option for most patients is Metformin),
  • Insulin preparations.
Drug overdose, alcohol / drug intoxicationThe principles for eliminating body poisoning are as follows:

  • Stopping the use of a toxic substance,
  • Waiting for the removal of the toxin from the body,
  • In severe cases, hospitalization of a person in a hospital is indicated for intravenous infusions and the introduction of an antidote (if any).

Treatment of "oxygen starvation"

With a long course of pathology, a lack of air can persist in the blood even after adequate therapy. Since the body "gets used" to a certain concentration of gas in cells and tissues, it continues to maintain its deficiency. As a result, a person has symptoms, despite the excellent airway patency.

To saturate the body with oxygen, American scientists have developed a new technique, called "non-invasive ventilation." Its principle is extremely simple - a mask is put on a person’s face or respiratory tubes are put on a nose, after which a special device starts supplying gas under a certain pressure. This procedure is performed during sleep, and all treatment for apnea occurs at home.

There is only one drawback of this method - the price. For therapy, special equipment necessary for daily use is necessary: ​​CPAP apparatus or BiPAP apparatus. Their cost in Russia ranges from 40 thousand to 200 thousand, when ordering from American sites - half as much. Not every patient can afford such expensive equipment that limits its use.

The Curse of Ondine

The article described many causes that can cause sleep apnea. However, in some people, the disease can occur without any reason. How does this happen? Against the background of complete health, a small child or adult has snoring with episodes of respiratory arrest. These episodes can be much longer than with the classic course of the disease. In some cases, they end in death by strangulation.

This option is called Undina’s Curse Syndrome or idiopathic hypoventilation. The reliable reason for its occurrence is not known to date. Scientists suggest that the syndrome is associated with congenital underdevelopment of the respiratory center or damage to the nerves that are responsible for the work of the respiratory muscles. Most often, it manifests itself in newborns or young children, however, there are cases of late debut of the disease (in 30-40 years).

The legend of Ondine.In German mythology, there is a story about the beautiful mermaid Undine, who lived on the shore of a raging sea. A knight passing by her hut was amazed by the beauty and singing of the girl. Vowing her with his morning breath, he conquered Undine's heart and married her. Over time, the knight forgot about his love and found a new object of sighing. Seeing this, Ondine cursed her husband, depriving him of the ability to breathe while sleeping, retaining only his “morning breath”.

The Curse of Ondine is a diagnosis of exclusion. It can be installed only after all other possible causes are excluded. A distinctive feature of this pathology is the absence of any symptoms, except for respiratory arrest and snoring. No diagnostic method can confirm its presence, therefore, laboratory and hardware methods are needed only to exclude other reasons.

It is impossible to completely get rid of this disease. In severe cases, the patient has to fight for his whole breath all his life, since all respiratory movements are made by willpower. Existing methods of treatment do not affect the cause of hypoventilation syndrome and do not allow to get rid of it. The only way to maintain a decent quality of life for these patients is with CPAP devices for BiPAP therapy.

Nocturnal apnea in children

The principles of treatment and diagnosis of this disease in a child practically do not differ from those in an adult. However, the causes and manifestations of the pathological process have certain characteristics at a young age that you need to know. This will allow you to suspect the disease earlier and timely proceed to confirm the diagnosis.

Apnea in children rarely develops due to tumor processes, lesions of the nervous system and obesity. According to the frequency of occurrence, the following conditions come first in young patients:

  • Ingestion of foreign bodies in the respiratory tract. Various options are possible - the subject can pass from the larynx to the bronchial tree. In this case, a diagnosis can only be made using x-ray examination,
  • Adenoid growths (enlarged nasopharyngeal tonsils),
  • Anomalies in the structure of the airways (deformation of the septum, atresia of the choan, hypertelorism, etc.) or the upper jaw,
  • Chronic rhinitis, often allergic in nature,
  • Acromegaly is the rarest option.

In addition to the classic symptoms, apnea in newborns and young children (up to 14 years old) is manifested by a number of additional disorders. All of them are associated with a lack of tissue nutrition and a constant lack of air. These include:

  1. Growth retardation and physical development. Apnea in newborns can be manifested by a slower increase in mass, compared with normal values. With a long course of pathology, for small patients, the characteristic signs are low growth, weakness of the muscle apparatus and fast fatigue,
  2. Decrease in mental and cognitive functions. In preschool age, it is manifested by distracted attention and difficulties with learning the skills of reading, counting, orientation in time, etc. In schoolchildren, this disease can cause poor performance and discipline in the classroom,
  3. Inhibition / hyperactivity in the daytime.

A separate group of patients are children born earlier than scheduled. With a slight deviation from the norm (for 1-2 weeks), the child may not have respiratory disorders. However, premature birth at an earlier date often causes apnea in premature babies.

The diagnosis, in this situation, rarely causes difficulties. Since the child is not discharged from the perinatal center until his condition is normalized, airway obstruction is promptly detected by a neonatologist and successfully treated in a medical facility. With the late “debut” of the pathology, it is also not difficult to detect it - the mother quickly detects periods of lack of breathing that occur in her sleep, and turns to the pediatrician for medical help.

TOP 5 misconceptions about sleep apnea

There are many articles on the Internet describing this problem. It must be remembered that when reading any information, you need to be critical of it and, first of all, consult your doctor. When analyzing various resources and medical portals, the most common errors of the authors were identified.

Here are our TOP 5 misconceptions about sleep apnea:

  1. Menopause is a risk factor for apnea. To date, scientists have not found a connection between the amount of female sex hormones and the pharyngeal muscle tone. There are no studies or clinical guidelines to support this risk factor. Otherwise, the main contingent of patients with this disease would be women older than 50 years. However, almost 90% of patients are men 30-40 years old,
  2. ARVI can cause the disease. Not a single acute illness causes nocturnal apnea in children. Of course, they can lead to difficulty in nasal breathing, but this violation persists in daytime. This pathology is a consequence of chronic respiratory failure, lasting more than 2 months,
  3. Mandibular splint is an effective treatment. At the moment, European and domestic doctors recommend treating night apnea without using the above methods. Since the tires do not affect the tone of the pharynx, they cannot improve nasal breathing or the work of the respiratory center, their use is not justified,
  4. Tracheostomy and bariatric surgery are good methods for eliminating the disease. A tracheostomy (making an incision in the larynx and installing a tube in it) has only one indication - a life threat due to complete obstruction of the upper respiratory tract. This method is never used to treat sleep apnea.
    Bariatric surgery (for weight loss) is also a last resort in the treatment of obesity, which should not be widely used. Most of the patients with apnea are people who are not bothered by anything. In this case, the risk / benefit ratio of surgical intervention is not comparable - the consequences of such operations may be a hospital infection, adhesions, laryngeal stenosis, etc. Conservative therapy should be preferred.
  5. Bronchodilators and sedatives can treat apnea syndrome. These groups of drugs are not used in therapy. Bronchodilators are substances that expand the bronchi and improve air conduction through lower parts of the respiratory tract. They do not affect the condition of the nasal cavity and pharynx. The main indications for their use: bronchial asthma, COPD, an attack of bronchospasm. With these diseases, breathing can be disturbed not only at night, but also in the daytime.

Sedative pharmacological preparations also do not have a positive effect on the course of the disease. On the contrary, some of them increase the symptoms of central apnea and increase the risk of complications. This fact can be found in the "contraindications" section, with careful reading of the instructions.

Examples of bronchodilatorsExamples of sedatives
  • Salbutamol,
  • Formoterol,
  • Fenoterol,
  • Salmeterol,
  • Berodual, etc.
  • Relanium,
  • Diazepam
  • Sibazon,
  • Lorafen
  • Noofen, etc.

FAQ

At the moment, scientists recommend counting the number of “interruptions” in breathing during sleep, based on which the severity of the condition is determined.

The number of respiratory arrestsSeverity of pathology
5-9Easy
10-19Average
More than 20Heavy

Reducing the depth or frequency of respiratory movements, leading to the accumulation of carbon dioxide in the blood. It is quite difficult to detect hypopnea during a routine examination, so this symptom is rarely used in the diagnosis.

Yes, since the relaxation of the muscles of the pharynx begins to occur already at the stage of falling asleep. In this case, further examination is necessary in order to identify pathology.

This pathology occurs with prolonged respiratory failure, only during sleep. Therefore, acute conditions, such as acute respiratory viral infections or the body's response to vaccination, can not cause sleep apnea.

The principles of therapy do not differ from those in the adult population. The main thing is to determine the cause of the violations, after which you can begin to eliminate it and combat air shortages.

The diagnosis is the responsibility of the therapist / pediatrician. Any competent specialist will be able to suspect a violation, prescribe a further examination and, if necessary, consult other specialists.

What is apnea in newborns and how dangerous is it?

Apnea in newborns is a fairly common occurrence. Short-term respiratory delays in sleep are observed in approximately 60% of infants, and among premature infants this indicator reaches 90%.

The main cause of respiratory failure in infants is the lack of formation of the respiratory regulation center located in the medulla oblongata. This center responds to a decrease in oxygen level in the blood and sends a signal to the respiratory muscles, which provides breathing. In newborns, this mechanism does not work well enough, therefore, there may be periods of confused breathing or breath holding for 10 seconds or more. Usually, after a few weeks or months, the work of the respiratory center normalizes and apnea goes away on its own. The fears of parents are caused by the fact that apnea in infants is associated with sudden infant death syndrome (SIDS). But this connection remains unproven.

Other possible causes of respiratory failure in newborns:

1.Central apnea associated with a malfunction of the central nervous system - after exhalation, respiratory movements disappear. The child "stops breathing" his chest does not rise. The reasons:

  • high levels of oxygen in the blood immediately after birth,
  • traumatic brain injury during childbirth,
  • brain hematomas, intracranial hemorrhages,
  • brain malformations
  • increased intracranial pressure.

What is sleep apnea and why is it dangerous?


What is sleep apnea and why is it dangerous? Apnea is a medical term for stopping breathing; it comes from the ancient Greek word ἄπνοια, calm. There are several types of apnea, the causes of this disorder can be both in the obstructive component (obstructive apnea, closure of the respiratory tract), and in a violation of the functions of the central nervous system. Separately, deliberate apnea, breath holding as a part of training, yoga practice or sports, such as freediving, are distinguished. Almost always, sleep apnea is accompanied by snoring, and most people tend to ignore the light and medium stages of nocturnal sleep apnea, apart from brief breathing pauses. And this is fundamentally the wrong point of view!

Sleep apnea not only impairs health and affects mood, but can also cause fatal complications. Although sleep apnea syndrome is quite common, not many are aware of the need for treatment for apnea and its possible consequences. And they can be quite serious, from depression and impotence to a heart attack or stroke. We tell all about apnea: the reasons why it occurs, who is at risk, what are the methods for diagnosing correction (spoiler: playing on the pipe of Australian natives, tennis balls and a visit to the orthodontist helps a lot). So, what is apnea during sleep and wakefulness, what are the types of night apnea, causes, symptoms of apnea in adults and children, and what modern medicine can offer to treat pathology.

What is sleep apnea?

Apnea: what is it in adults and children? This is a breathing disorder that affects about one in six people. Apnea is diagnosed if the respiratory break is more than 10 seconds. Respiratory excursions (movements of the muscles responsible for filling the lungs with air) may be completely absent or observed, but the air flow does not penetrate the airways due to the collapse of the walls of the airways in the larynx.

Although obstructive sleep apnea is better known, there are various types of respiratory distress. A variety of factors and diseases provoke them, and apnea treatment, respectively, is prescribed depending on the cause of apnea.

There are obstructive apnea, a central form of respiratory distress and mixed. Obstructive apnea syndrome is most common, followed by mixed sleep apnea as a consequence of obstructive type.

Apnea and snoring: what is the connection?


Obstructive sleep apnea syndrome is the third stage of the development of the pathological process, which initially manifests itself in such a seemingly harmless and banal phenomenon as night snoring. If we consider the phenomenon of apnea, what is it in adults, and how it is associated with snoring, then there is a fairly clear correlation: the vast majority of patients with episodes of apnea have a long history of snoring.

For various reasons, narrowing of the airways is observed in the larynx. Because of it, the air flow passes along the tracks at a higher speed and causes the walls to vibrate. Вибрацию мы слышим, это — звук храпа, звукового феномена, в клинической картине патологии храп может быть единственным симптомом, а жаловаться на него скорее станет партнер храпящего, чем сам человек.

Если сужение выраженное, развивается повышенное сопротивление воздухоносных путей. Against the background of this narrowing, partial obstruction or the primary stage, the precursor of hypopnea, is already beginning. With it, there is no significant decrease in air flow and pronounced manifestations of desaturation, a decrease in the level of oxygen in the blood. However, there are already activation reactions of brain structures. This means that snoring partially wakes up for 3-15 seconds due to increased respiratory movements. They, in turn, arise due to resistance to the movement of the air flow, which stimulates the brain to stop sleeping. Such a fragmentation of sleep is noticeable from the side: in a typical picture, the sound of snoring increases, at the peak of intensity, the stage of micro-awakening begins, after it the sound volume decreases, and the cycle starts again.

The clinical picture of the syndrome of increased resistance to the airways (VDP) is characterized by snoring and a feeling of daytime drowsiness due to frequent sleep disturbances. Often accompanied by high blood pressure. However, in modern medicine there are no exact diagnostic criteria for this syndrome, although it is he who is a predictor of obstructive sleep apnea and often develops into obstructive sleep apnea syndrome with an increase in the narrowing of the SSS.

Central and mixed types of sleep apnea

The central type of apnea occurs when any respiratory excursions are stopped, since the brain does not send a signal to the muscles responsible for respiratory movements. In the development of this pathology, there are other causes of apnea than with obstruction. In the etiology of this type of apnea, the causes are in deviations in the regulation of respiratory processes during malfunctioning of the brain structures. If during sleep the brain does not transmit impulses to the group of muscles responsible for inhaling, then an apnea attack begins, the body stops breathing.

The list of provocateurs of the development of the central type of apnea includes ischemia and the consequences of injuries, infections of brain tissue, stroke, polyneuropathies, autonomic neuropathy in diabetes mellitus, Parkinson's disease, Alzheimer's disease, cerebral degeneration, Marfan syndrome, etc.

A mixed species develops with the simultaneous action of factors of central and obstructive apnea, the reasons are due to a complex of disorders. The second name of the mixed type is complex apnea syndrome. Today, this type is often considered as one of the pathology options for obstructive apnea syndrome, its complication, since hypoxia during sleep apnea causes disturbances in cerebral blood supply, and the pathology progresses.

The mechanism of development of obstruction as a precursor to sleep apnea


To understand why airway obstruction develops, you need to understand the basic stages of a normal inspiration. When we breathe, during gas exchange, carbon dioxide accumulates in the blood, which causes irritation of special chemoreceptors in the respiratory center. In response, this center sends nerve impulses to the muscles of the pharynx, they come in tone, the lumen of the pharynx expands. After 200 milliseconds (or 0.2 seconds), the same impulse reaches the muscles of the chest and diaphragm, the respiratory movement begins, and the air flow through the already expanded throat due to the difference in pressure reaches the lungs. That is how we normally breathe.

During deliberate apnea, freedivers who dive without scuba hold their breath and suppress the movements of the muscles of the larynx, chest, and diaphragm by willpower. If you just hold your breath, then after a couple of tens of seconds an untrained person will feel the characteristic movements, muscle cramps in the chest and upper abdomen. They are caused by brain signals: when the amount of carbon dioxide in the blood rises, the respiratory center commands the muscles, which is time to inhale.

With prolonged and regular training, freedivers learn to suppress these muscle contractions. In combination with techniques of relaxation, deconcentration of attention and training the body to adapt to oxygen starvation, athletes achieve incredible results for the average person. The duration of apnea can be several minutes.

24 minutes 11 seconds - this is the last world record of breath-holding, conscious apnea. In February 2018, it was installed by a diver from Croatia Budimir Šobat. The experience of freedivers is also used in other sports, as breath holding exercises can help increase the body's stamina.

But if trained people can not breathe a couple of tens of minutes, is it really that second episodes of night apnea are so dangerous? Yes, of course. The body of athletes has adapted to deliberate breath holdings for years, and the entire adaptation complex includes a change in blood composition due to the release of deposited red blood cells, a decrease in the heart rate (in some athletes, bradycardia reaches a frequency of up to 6 beats per minute), and most importantly, the gradual “accustoming” of tissues to a state of hypoxia and compensation for oxygen starvation at the end of a breath hold. During pathological apnea, the body is under stress, trying to turn on protective mechanisms to prevent ischemia, tissue death and death.

Pathological processes occur in a person’s body with respiratory obstruction. Everything happens according to the following scheme: the accumulated carbon dioxide causes irritation of the respiratory center of the brain, impulses go to the muscles of the pharynx. But due to various reasons, it cannot expand sufficiently. This means that with a subsequent inhalation, air enters the lungs at high speed. The Bernoulli rule begins to apply: the higher the speed, the lower the pressure of the gases that make up the flow. At low pressure, the soft tissues of the walls of the pharynx become closed, and an apnea attack develops.

The compliance of the walls of the airways is expressed by a criterion called “closure pressure”, that is, the level of depression at which the area may close. In the presence of dysfunctions, age-related changes, pathologies, edema of the mucous wall, such pressure closes that a healthy person would not cause problems.

Thus, the basis for the development of apnea attacks is the effect of air flow passing through the narrowed lumen of the airways. Why can such a narrowing develop?

Narrowing can develop in the following cases:

  • with physiological and pathological causes of narrowing of the lumen of the pharynx, for example, in overweight people, with diseases of the respiratory system and nasopharynx, abnormal structure of the front part of the skeleton, and also if the muscles of the pharynx are too relaxed (with hypothyroidism, when drinking alcohol, sleeping pills, muscle relaxants , anesthesia, etc.)
  • due to the discoordination of the neurorespiratory nerve impulse, that is, when the impulse arrives late to the pharyngeal muscles, and there is no necessary pause between their toning and respiratory movement of the chest and diaphragm. This can be observed, for example, with a stroke of the brain.

Obstructive sleep apnea: what is it?

Obstructive sleep apnea: what is this condition? The main difference between obstructive apnea is the preservation of respiratory movements (excursions) during a forced pause between breaths. Obstructive Apnea Syndrome or OSAS (an abbreviation for Obstructive Sleep Apnea Syndrome) is a process of hypoventilation, which is caused by multiple episodes of complete absence or insufficiency of penetration of air masses into the airways.

Multiplicity, recurrence of episodes is a prerequisite of obstructive sleep apnea syndrome, as isolated cases of respiratory pauses can be caused by a sharp sound next to a sleeping person, touch, light, vivid experiences during a dream, or even a sudden change in air temperature around (a fallen blanket, air flow from open window).

With hypoventilation, insufficient air intake, the cause of apnea is in excessive relaxation of the muscular apparatus of the pharynx. The lumen in the larynx, through which air should enter the bronchi and lungs, periodically closes. Airflow stops, causing respiratory arrest. That is why obstructive apnea is called obstructive: obstruction in translation is “blockage”.

Obstructive Apnea Syndrome: Severity


There are two main methods for determining the severity and danger of obstructive apnea syndrome: the number of attacks per night and the decrease in oronasal flow and associated manifestations.

The main diagnostic criterion is the presence of at least one apnea symptom from the following:

  • a decrease in the volume of the oronasal air flow by more than half within 10 seconds,
  • a decrease in flow of more than 50% with desaturation of 3% (determined by pulsoksimetrii readings),
  • a decrease in flux of less than 50% for 10 seconds and the presence of an EEG activation reaction, “awakening” of the brain, and a change in sleep phases.

The degree of obstructive apnea syndrome is estimated by the number of apnea and hypopnea attacks (incomplete cessation of breathing) for 60 minutes, or by the severity of desaturation, a decrease in oxygen in the blood. Severe obstructive sleep apnea syndrome corresponds to a desaturation index of up to 80%.

If desaturation and brain reactions can be determined only in a clinical setting, then modern gadgets (or an attentive relative suffering from a patient's snoring) can cope with the number of attacks.

A mild degree of obstructive apnea is diagnosed if within an hour there were from 5 to 15 attacks of respiratory distress. Medium - from 15 to 30, severe - more than 30 attacks. If within an hour there were less than 5 episodes of apnea or up to 15 episodes of sleep apnea and hypopnea, the diagnosis of obstructive apnea is not made, although this situation is also dangerous both for well-being and for the future development of the syndrome.

Why is night apnea dangerous?

Obstructive sleep apnea: what does this condition change in the patient? Naturally, the worse we breathe and the more often our breathing is disturbed, the less oxygen enters the tissues and organs. Hypoxia, oxygen starvation develops. A breathing pause after exhalation for 15-45 seconds provokes the onset of hypoxia, hypercapnia and metabolic acidosis, since each attack is asphyxiation, asphyxiation, although short-term. To nevertheless take a breath at the end of the attack, a stimulus for awakening a person is needed. A drop in oxygen due to airway obstruction dramatically increases the tone of the muscles responsible for inspiration. This causes awakening to prevent death from strangulation. As a rule, a person does not wake up completely, consciousness is not restored, and such episodes are not recorded in memory. And this is the second problem of respiratory distress.

During unconscious reactions of awakening, in order to still inhale during an attack of sleep apnea, the brain needs to “wake up” from sleep, give a command to the muscles of the larynx to enhance tone, and stimulate a respiratory excursion. Let this all happen besides the consciousness of a person, but a complete rest does not work, because the natural structure of sleep is disturbed.

All this leads to disruptions in the functioning of various organs, systems, and dysfunctions of the central nervous system. Well-being worsens, the quality of life as a whole decreases. During the day, absent-mindedness, irritability, fatigue, drowsiness are felt up to sudden attacks of sleep (including, for example, driving).

Consequences of Obstructive Apnea

  • The quality of sleep is reduced. From the very morning a person gets up not enough sleep, not rested, with a lack of energy. The reason is hypoxia and frequent micro-awakenings that disturb the deep stages of sleep.
  • Disturbed emotional background. Chronic lack of sleep leads to increased irritability, aggression or depression, anxiety, and depressive states. The depletion of the psyche with various diseases of the psycho-emotional spectrum may occur. And it's all about breathing disorder during a night's rest.
  • Cognitive abilities decrease, memory, attention span, and reaction speed deteriorate. And this not only affects the performance, but can also lead to an accident. This condition is especially dangerous if the work depends on the speed of a person’s reaction (control of vehicles, machines, mechanisms, manipulations with aggressive liquids). But often even crossing the road becomes much more dangerous.
  • Morning rise is often accompanied by a sensation of headache, dry mouth, general weakness, malaise, and also an increase in blood pressure.
  • Night apnea increases the likelihood of developing heart attacks, strokes, coronary disease of various organs by 4-5 times.

If you ignore the symptoms of apnea, do not identify the causes of apnea on time and do not start treatment, then sleep apnea at night will cause consequences that affect health and day. In this case, deep disturbances in oxygen metabolism, coordination of movements develop, which is dangerous due to falling, injuries, accidents, sudden falling asleep during the day.

This state has a name that appeared in the wake of Dickens' novel. If a person due to fatigue is able to fall asleep everywhere and always, despite the conditions, this is “Pickwick Syndrome”.

Obstructive sleep apnea syndrome: who is at risk?


What is sleep apnea? Can you spot it? Medical statistics say that almost 100% of patients with obstructive sleep apnea have snoring. Partners, relatives, neighbors of patients suffering from apnea complain about it, but to suspect this symptom yourself is not easy. Modern technology helps determine the presence of obstructive sleep apnea. Doctors recommend that everyone who is at risk and observes the symptoms of sleep apnea and its effect on well-being, use the simple methods of primary self-diagnosis. So, who is at risk for obstructive sleep apnea?

Apnea: causes, main provocateurs and predisposing factors of obstruction

  • Age as a predisposing factor: the older the person, the higher the risk of obstructive apnea syndrome.
  • Men suffer from sleep apnea 2-6 times more often than women, since the hormone progesterone stimulates the respiratory center and muscle tone of the pharynx.
  • In women, the risk of pharyngeal obstruction increases during pregnancy and during menopause.
  • Overweight is the main factor that occurs in 7 out of 10 suffering from apnea.
  • Dysfunctions and pathologies of the endocrine system (the most common factors in this spectrum: hypothyroidism, diabetes mellitus, acromegaly).
  • The effects of various drugs, intoxication of the body, iatrogenicity, which cause weakness of the muscles of the pharynx (alcohol-containing drinks and medicines, sleeping pills, narcotic analgesics, testosterone).
  • Respiratory diseases.
  • Deformation of the skeletal tissue of the head, a curved nasal septum, malocclusion.
  • Allergic reactions (rhinitis, swelling of the nasopharyngeal mucosa), polyps of the nasal passages.
  • Infections of the nasopharynx, respiratory system.
  • Retro and micrognathia.
  • Hypertrophic proliferation of tissues of the soft palate, tonsils.
  • Neurological abnormalities that provoke a decrease in muscle tone of the oropharynx.
  • The effect of tobacco smoke on the mucous membranes (especially in childhood).

If we talk about age as a risk factor, the cause of apnea in older people is most often based on a decrease in the general tone of muscle tissue, which includes the muscles of the pharynx. If in general cider obstructive apnea is widespread in the population with a frequency of about 1:10, then at the age of over 60 its frequency reaches 37%, more than 1: 3.

The effect of overweight correlates with the patient’s gender. So, in men, snoring, the precursor of apnea, is most often observed with an increase in body weight by 20% in relation to the norm. In women, this symptom develops with a weight increase of 30% of normal body mass index (BMI).

Apnea: symptoms and well-being with respiratory distress

What is sleep apnea? If you try to figuratively imagine how a person breathes with apnea in a dream, you get a pretty scary movie, a thriller in which someone tries to drown or torture the victim. The victim of apnea syndrome cannot breathe for several seconds, then when it finally turns out to breathe, he takes 2-3 noisy, deep breaths, and the apnea attack begins again in his sleep. This is how the severe stage of apnea syndrome looks like. And, unlike thrillers, this does not happen a couple of times in a few minutes, but during the whole sleep and every night. In severe stages of apnea syndrome, the total duration of seizures can be 2.5-3 hours. How does this affect the body?

There is no doubt that heart rate, blood pressure, and the level of metabolites change due to seizures, all systems begin to function differently than during a quiet sleep. And apnea, the symptoms of which are also observed during wakefulness, is expressed by the following manifestations.

  • Snoring. Almost all people with apnea syndrome caused by airway obstruction have this symptom. But with apnea, snoring is not uniform, it is replaced by periods of silence and is especially intensified if you sleep on your back. After silence, breathing resumes, accompanied by intensification, "explosion" of snoring, sighs, often - moans, muttering.
  • Качеством сна: он не приносит отдыха, отмечается синдром беспокойных ног, неосознанные движения конечностей.
  • Ночные пробуждения часто сопровождаются ощущением удушья, ускоренного биения сердца, тяжести и неприятных ощущений в области груди, страхом.
  • Due to a violation of the release of hormones, urination and the need to visit the toilet are becoming more frequent, in children night enuresis is more often noted.
  • Morning begins with a headache, dry mouth.

The leading clinical symptom is considered excessive drowsiness during the day. Often with apnea, symptoms indicating nightly attacks of respiratory failure, patients relate to other pathologies. Meanwhile, many disorders of the cardiovascular activity are the result of sleep apnea.

Apnea: symptoms that patients rarely know about.

  • Arrhythmia, especially with manifestations during passive nocturnal rest.
  • High blood pressure, with a predominance of attacks of hypertension at night and in the morning.
  • Right ventricular failure (pulmonary hypertension).
  • Polycythemia.
  • Depressive conditions, clinical depression, increased anxiety.
  • Male impotence, decreased sexual desire in women.
  • Deterioration of intelligence.
  • Motor impairment, as a result - frequent injuries.

Adult sleep apnea: how it affects the heart and blood vessels


What is sleep apnea and how does it affect the body? Specialists are well aware of how sleep deprivation affects the cardiovascular system, causing various disorders and even provoking atherosclerosis. Lack of night rest changes the functions of the endocrine system, provokes an imbalance of hormones, worsens well-being, lowers the quality of life and harms health. However, the problem with sleep apnea is not a lack of sleep. A person experiencing respiratory arrest attacks during the night can formally sleep quite a sufficient number of hours, and still feel tired in the morning and sleepy in the afternoon. And the reason is in the various processes that begin due to sleep apnea attacks. Let's see how apnea affects the heart and blood vessels.

Heart rhythm disturbances as a result of attacks of nocturnal apnea

Obstructive sleep apnea: what does this condition change in the functioning of the heart? Episodes of obstructive and central apnea affect the heart rate, the heart contracts “wrong”, too fast, too slow, arrhythmic. In the types of rhythm disturbances due to respiratory distress, two groups are distinguished:

  1. the sinus rhythm changes during sleep,
  2. at night, pathological arrhythmias are observed, during wakefulness they are absent or their severity is significantly lower.
  • Sinus rhythm with sleep apnea in adults

How does the rhythm of the heartbeat change during obstructive sleep apnea in an adult? Groups of respiratory muscles come into a state of increased tone, respiratory movement begins, but the air flow does not reach the lungs. The lungs do not expand, because of this, a pronounced rarefaction of the air-gas mixture is observed in the pleural cavity, capable of reaching -80 mm Hg (normally it should not exceed -10 mm Hg). Such negative pressure provokes enhanced venous return, which leads to overflow and stretching of the right atrium and a sharp slowdown in sinus rhythm. Hypoxemia is increasing, increasing parasympathetic tone, and the rhythm of the heartbeat slows down even more.

Bradyarrhythmia as a form of a protective reaction is observed in four out of five people with apnea syndrome. However, the slowdown of the rhythm continues only until awakening, and the stage of micro-awakening provokes the activation of sympathetic tone and an increase in the rhythm of heart contractions. Such changes - from bradycardia to tachycardia - are a typical clinical symptom of heartbeat disorders during sleep apnea in adults.

To diagnose such violations, holter monitoring is necessary using instruments in which the program allows you to postpone ten-second fluctuations in heart rate (HR) on a trend. If you focus on the readings of various gadgets (fitness bracelets with the function of tracking the phases of sleep and heartbeat) or conduct Holter monitoring with tracking of minute values, the indicators will correspond to the sleep of a healthy person, and the problem will not be identified.

  • Pathological arrhythmias with sleep apnea

Another characteristic feature that indicates attacks of sleep apnea syndrome is heart rhythm disturbance during sleep and the absence of arrhythmia during wakefulness. The manifestation of all classes of arrhythmias is possible, from atrial fibrillation to atrial fibrillation. The reasons are a frequent change in the level of active functioning of the autonomic nervous system, the consequences of hypoxia and metabolic disorders in the tissues of the myocardium.

Pathological arrhythmia with atrial, ventricular extrasystole, CA- and AV-blockades are more often observed in patients with concomitant diseases of the cardiovascular system (cardiopathy, coronary heart disease).

Episodes of Obstructive Apnea and Pulmonary Filling


A change in the filling of the pulmonary artery is one of the consequences of sleep apnea syndrome. In patients with an attack, pulmonary arterial pressure rises, reaching the highest levels at the moment of normalization of breathing and then falling to the initial level.

Pulmonary vasoconstriction (vasoconstriction) occurs for the same reasons as vasoconstriction of a large circle of blood circulation. Increased blood pressure in the pulmonary artery in every fifth patient persists during wakefulness, which often becomes a provocateur of the development of right ventricular failure, which is noted in 15% of cases of obstructive sleep apnea. Moreover, hypertrophy of the right ventricle develops even in the absence of diseases or pathologies of the lungs, which is also a diagnostic sign of night apnea syndrome.

How does night apnea affect coronary blood flow and ischemia of heart tissue?

Syndrome of night apnea contributes to the progression of ischemia of the tissues of the heart muscle. Increased blood pressure, rhythm disturbances, oxygen starvation of tissues and acidosis cause damage to the inner layer of the walls of the coronary vessels.

On average, about 7% of all people suffer from ischemia of heart tissue. However, in combination with attacks of nocturnal apnea, this disease is noted twice as often, and for those who suffer from a severe degree of nocturnal sleep apnea, three times.

There is evidence of a direct correlation of the severity of apnea syndrome and the development of myocardial infarction. Apnea treatment can significantly reduce your risk.

With night apnea syndrome in combination with cardiac muscle ischemia, night-time attacks of angina pectoris may occur, complicated by a mute form of myocardial ischemia. A feature of such episodes is a lower heart rate than threshold heart rate indicators that provoke cardiac ischemia during wakefulness.

Night Apnea Syndrome and Blood Pressure


More than half of people with nocturnal sleep apnea suffer from hypertension, in this group of patients high blood pressure is diagnosed 2 times more often than among the entire population of the same age. Arterial hypertension with night apnea syndrome is mainly expressed in an increase in diastolic pressure. It should be remembered that apnea syndrome and the development of hypertension have the same factors that increase the risks of pathologies, for example, overweight, age. However, with apnea, symptoms of increased blood pressure at night are an inevitable consequence of exposure to oxygen starvation, restless, disturbed sleep, increasing pathological changes in the kidneys, increased intracranial pressure and other consequences of apnea episodes.

Total periods of hypoxia during nighttime sleep lead to vasoconstriction, and vasoconstriction causes an increase in blood pressure. A change in blood pressure indicators is also observed due to an increase in the sympathetic activity of the autonomic nervous system and catecholaminemia associated with episodes of hypoxia. So, blood pressure rises at the time of apnea manifestations, but even at the end of the attack when breathing is restored, the development of compensatory vasoconstriction of large areas is noted. The purpose of this body reaction is to increase blood supply to the myocardium and brain to reduce the effects of oxygen deficiency. This becomes the cause of the fixation of arterial hypertension after waking up.

How to determine if a person has sleep apnea by measuring blood pressure? In this case, the following symptoms will be important:

  • arterial hypertension is characterized mainly by increased diastolic pressure, which can be determined when measuring indicators on their own or when visiting a clinic,
  • with autometry (regular measurement of pressure by the patient himself), the excess of morning blood pressure over evening is detected,
  • daily monitoring of blood pressure in the hospital shows an increase in blood pressure during sleep or the absence of its decrease (lowering blood pressure in a dream is the physiological norm of a healthy person).

Studies have shown that sleep apnea in an adult, even against the background of no hypertension in the daytime due to nighttime fluctuations in blood pressure, can provoke the development of left ventricular hypertrophy. This form of arterial hypertension depends on the severity of night apnea syndrome and often weakly responds to medication correction. Only apnea treatment helps normalize blood pressure.

Carotid Apnea and the Brain: Danger of a Stroke

Carotid apnea causes marked changes in the filling of the blood supply to the brain. A change in the filling of arteries can cause a critical decrease in cerebral perfusion. In combination with high blood pressure and hypoxemia, it causes acute cerebrovascular accident, cerebral ischemia and stroke.

The more severe the stage of apnea, the higher the risk. In people with apnea syndrome, when examining a violation of the blood supply to the brain, they are diagnosed almost 3 times more often than those who do not suffer from apnea. And if there is a severe degree of respiratory distress, then five times, in 10% of the patient

Definition of the disease. Causes of the disease

Sleep apnea - respiratory arrest during sleep, which leads to a complete absence or decrease in pulmonary ventilation (more than 90% with respect to the initial air flow) lasting more than 10 seconds. Respiratory failure is of two types: obstructive and central. Their significant difference lies in the respiratory movements: they occur in the obstructive type and are absent in the central one. The latter type of apnea is a rare case of the disease. Therefore, obstructive sleep apnea is a more detailed consideration as a common form of apnea.

Obstructive Sleep Apnea Syndrome (hereinafter referred to as OSA) - a condition characterized by:

  • snore,
  • periodic obstruction (decay) of the respiratory tract at the level of the oropharynx
  • lack of ventilation with preserved respiratory movements
  • lowering the level of oxygen in the blood
  • gross disturbances in sleep structure and excessive daytime sleepiness.

The prevalence of this disease is high and is, according to various sources, from 9 to 22% among the adult population.

The cause of this disease, as the name implies, is airway obstruction. Various pathologies of ENT organs lead to it (usually tonsil hypertrophy, in children - adenoids), as well as a decrease in muscle tone, including due to weight gain (adipose tissue is deposited in the walls of the airways, narrowing the lumen and lowering the tone of smooth muscles) .

Symptoms of Sleep Apnea

One of the most common and noteworthy symptoms is snoring. Its prevalence in the adult population is 14–84%. Many people think that snoring people do not suffer from OSA, so snoring is not dangerous to health and is only an irritant for the second half and a social factor. However, this is not quite true. Most patients with snoring have respiratory disorders of varying severity, and such a sound phenomenon can act as an independent pathological factor due to vibration injury of the soft tissues of the pharynx. Most often, OSA symptoms are noted by close ones, horrified by the abrupt cessation of snoring and respiratory arrest, while the person makes an attempt to breathe, and then he starts snoring loudly, sometimes tossing and turning, moving his arms or legs, and after a while breathing is restored again. In severe cases, the patient may not breathe half the time of sleep, and sometimes more. Apnea can also be fixed by the patient himself. In this case, a person can wake up from a feeling of lack of air, asphyxiation. But more often than not, awakening does not occur, and the person continues to sleep with intermittent breathing. In cases where a person sleeps indoors alone, this symptom may go unnoticed for a very long time. However, like snoring.

Other, no less serious symptoms of this disease include:

  • severe daytime sleepiness with adequate sleep time,
  • feeling of fatigue, tiredness after sleep,
  • frequent nightly urination (sometimes up to 10 times per night).

Often, symptoms such as daytime sleepiness and a non-refreshing sleep are underestimated by patients, believing that they are absolutely healthy. In many ways, this complicates the diagnosis and leads to a false interpretation of the symptoms. Also, many people associate frequent nighttime urination with urological problems (cystitis, prostate adenoma, etc.), are repeatedly examined by urologists and do not find any pathology. And this is correct, because with severe respiratory disturbances in sleep, frequent nightly urination is a direct consequence of the pathological process due to the effect on the production of the sodium urethic peptide.

Pathogenesis of sleep apnea

The resulting airway collapse leads to a cessation of airflow into the lungs. As a result of this, the oxygen concentration in the blood drops, which leads to a short activation of the brain (micromotion, repeated many times, their patient does not remember in the morning). After that, the tone of the muscles of the pharynx briefly increases, the lumen expands, and a breath occurs, accompanied by vibration (snoring). Permanent vibrational injury to the walls of the pharynx provokes a further decrease in tone. This is why snoring cannot be considered a harmless symptom.

A constant decrease in oxygen leads to certain hormonal changes that alter carbohydrate and fat metabolism. With severe changes, type 2 diabetes mellitus and obesity can gradually occur, and it is often impossible to lose weight without eliminating the root cause, but normalization of breathing can lead to significant weight loss without strict diets and exhausting exercises. Repeatedly repeated micro awakenings do not allow the patient to plunge into the stage of deep sleep, thereby causing daytime drowsiness, morning headaches, persistent increase in blood pressure, especially in the morning hours and immediately after waking up.

Classification and developmental stages of sleep apnea

Obstructive sleep apnea syndrome has three degrees of severity. The criterion for dividing is the apnea-hypopnea index (hereinafter YAG) - the number of respiratory stops for a period of one hour of sleep (for polysomnography) or per hour of study (for respiratory printing). The higher this indicator, the worse the disease.

Why does a child develop apnea?

In children of primary and school age, mainly occurs obstructive sleep apnea. The main cause of apnea in a child is the collapse (significant narrowing) of the walls of the upper respiratory tract. It develops when the weak muscles of the larynx are not able to withstand the suction action of a stream of air passing through the narrowed airways. Among children under 8 years of age, the prevalence of apnea is 2-5%. It is equally observed in both boys and girls.

A characteristic sign of apnea in a child is periods of silence amid characteristic snoring. After a pause, there is a loud snoring and a period of recovery of breath. In this case, the child tosses and turns in a dream and sometimes wakes up.

In the morning, children complain of dry mouth and sore throat. During the day, they often experience headaches, decreased attention and academic performance. Parents note hyperactivity and mood swings. In severe cases, children have a developmental delay. The reason for the development of symptoms is considered to be a violation of lung ventilation, oxygen starvation of the brain and lack of sleep.

Factors That May Cause Apnea in Children

  • Adenoid hypertrophy - an increase in the nasopharyngeal tonsil.
  • Acute and chronic rhinitis, curvature of the nasal septum. Due to the common cold, the child breathes through the mouth, which can cause temporary weakening of the muscles of the pharynx.
  • Any catarrhal diseases that cause inflammation and swelling of the mucous membrane of the pharynx and larynx, which are accompanied by inflammation of the upper respiratory tract, sore throat, hoarseness, dry cough.
  • Overweight. When the baby is lying, excess fatty tissue in the neck compresses the pharynx, narrowing its lumen.
  • Acromegaly or Down's disease, in which an enlarged tongue blocks the pharynx.
  • Ларингомаляция – спадение на вдохе мягкого хряща в гортани, находящегося над голосовыми связками. Она может быть вызвана генетическим отклонением или воздействием неблагоприятных факторов на плод во время беременности.
  • Нервно-мышечные заболевания:
    • миодистрофии – наследственные заболевания, вызывающие дегенерацию (слабость) скелетных мышц,
    • myasthenia gravis is an autoimmune disease characterized by weak striated muscles.
  • Anomalies in the structure of the facial skeleton:
  • retrogenia - a shift of the lower jaw posteriorly at its normal size,
  • micrognathia - underdevelopment of the upper and lower jaw.

Apnea treatment in children consists in getting rid of a disease that causes narrowing of the airways. In severe cases, surgical treatment is required:

  • removal of enlarged adenoids - 70-100% after adenotonsillectomy, apnea disappears,
  • tonsillectomy - removal of enlarged inflamed glands that violate breathing,
  • straightening the curved nasal septum normalizes nasal breathing,
  • operations to restore the soft palate and jaw with congenital pathologies.

Surgical treatment may not be beneficial for all children. In obesity and neuromuscular pathologies, masks are used that supply air to the respiratory tract under pressure (CPAP therapy). The doctor carries out the selection of humidity and pressure individually. The duration of CPAP therapy is from several months to several years. In severe apnea, lifelong use of the device may be required.

If you notice in a child older than 2 years of breathlessness in a dream, which lasted more than 10 seconds, we recommend that you consult a doctor to identify the causes of apnea.

What is obstructive sleep apnea?

Obstructive apnea is a breathing disorder in a dream caused by blockage of the airways in the pharynx. Muscle weakness and excess tissue in the pharynx lead to an obstacle in the way of the air flow. A person is trying to take a breath, his chest is expanding, but air does not enter the lungs. Such respiratory arrests can last more than a minute and significantly impair the supply of vital organs with oxygen.

Mostcommon causes of obstructive sleep apnea

  • Age-related degeneration of the muscles of the larynx. In older people, the muscles weaken and do not provide sufficient support.
  • Individual features of the structure of the larynx
    • soft palate anomalies
    • enlarged tonsils,
    • an excess of loose fiber under the mucous membrane of the pharynx in the area of ​​the vocal cords,
    • accumulation of fat in the neck.
  • The intake of substances that cause relaxation of the muscles of the larynx
    • alcohol,
    • sleeping pills,
    • sedatives.

Symptoms of obstructive sleep apnea are more visible to relatives, the patient himself may not notice respiratory arrest in a dream at all. Indirect signs may indicate a disease:

  • increased pressure in the morning,
  • paroxysmal cough at night, associated with drying of the mucous membrane of the pharynx,
  • frequent nightly urination, a full bladder indicates an increase in pressure and intensive kidney function,
  • heartburn at night - a sign of a reduction in the stomach and the release of gastric juice into the esophagus with an active reduction in respiratory muscles,
  • weakness and headaches in the morning are associated with impaired blood circulation in the brain.

The treatment of obstructive sleep apnea is described in detail in the main article.

What is central apnea?

What is central apnea? Central apnea is a breathing disorder in a dream caused by a malfunction of the respiratory center located in the medulla oblongata. It is distinguished from obstructive sleep apnea by the absence of respiratory movements of the chest. A person misses 1-3 breaths. He does not breathe for 10-40 seconds. Sleep is disturbing and intermittent, many patients complain of insomnia. In the afternoon, they suffer from drowsiness, fatigue, and poor performance.

In nome, the regulation of breathing in a dream occurs as follows. In the blood vessels are receptors that respond to an increase in the concentration of carbon dioxide in the blood. Receptors send a signal through the sensitive fibers of neurons to the central nervous system, to the respiratory center, and from there, a command is sent through the motor nerve fibers to inhale the respiratory muscles. The diaphragm and intercostal muscles contract, and inspiration occurs. With central apnea, there is a failure in issuing commands, which can be facilitated by a number of factors:

  • Taking drugs that inhibit the work of the respiratory center:
    • sleeping pills
    • preparations containing opium,
    • narcotic drugs.
  • Brain injuries and damage to cranial nerves.
  • Depletion of blood with carbon dioxide after artificial ventilation of the lungs with an oxygen mixture.
  • Lack of formation of the respiratory center in premature babies.
  • Disorders of cerebral circulation in the respiratory center - atherosclerosis, stroke.
  • Brain malformations:
    • dandy walker syndrome
    • hydranencephaly,
    • brain cyst.
  • Brain tumors.
  • Neurological Disorders:
    • epilepsy,
    • multiple sclerosis,
    • Alzheimer's disease.
  • Infectious diseases affecting the brain:
    • meningitis,
    • brain abscess.
  • Metabolic (metabolic) disorders:
    • deficiency of glucose, calcium, magnesium,
    • excess sodium, free ammonium ions,
    • aminoaciduria - increased excretion of amino acids in the urine.

There are several methods for treating central apnea.

1. Blood saturation with carbon dioxide. Carbon dioxide irritates the receptors and stimulates the work of the respiratory center:

  • Methods of superficial controlled breathing. Before going to bed, breathe as rarely and as shallow as possible.
  • Fall asleep, hiding behind the head with a blanket.

2. Drug therapy of central apnea:
  • Prolonged theophyllines (Theopec, Spofillin, Retard) - stimulate the central nervous system and, in particular, the respiratory center, have a bronchodilating effect and contribute to blood oxygenation.
  • Corrections of cerebral circulation (Nimodipine, Cinnarizine, Lomir) improve the blood circulation of the respiratory cent and normalize its work.
  • Mild sedative drugs (Novo-Passit, Valerianachel, Persen) normalize the nervous system during stress.

CPAP treatment for central apnea is futile.

What does apnea lead to?

To understand that holding your breath in a dream is a medical condition that requires serious treatment, you need to know what causes apnea. Stopping breathing during sleep causes severe hypoxia (oxygen deficiency). Such oxygen starvation primarily affects the brain and heart, several times increasing the risk of stroke and heart attack, especially in people with hypertension and coronary heart disease. The danger depends on the apnea index: the number of respiration pauses lasting more than 10 seconds in 1 hour. For example, at the age of 50, an apnea index of over 20 increases the mortality rate by 2 times.

The most common effects of apnea are:

1. Decreased quality of life. Due to chronic lack of sleep associated with frequent awakenings and oxygen starvation, an overload of the nervous system occurs. In the daytime, patients suffer from drowsiness, irritability, apathy, loss of strength. Such people pose a danger to themselves and others when driving a car, and also can not perform work requiring high concentration.
2. Decreased sexual activity and impotence. Genital organs are among the first to suffer from oxygen deficiency and circulatory disorders. Violation of their blood supply leads to a decrease in sexual function in men.
3. High blood pressure. During respiratory delays, the body tries to compensate for the lack of oxygen by increasing blood circulation. The increase in blood pressure is spasmodic, which leads to rapid wear of the heart and blood vessels.
4. Arrhythmias, heart failure. The heart muscle suffers from a lack of nutrition, which violates its automatism and leads to a violation of the heart rhythm - arrhythmia. Fatigue of the heart caused by malnutrition and high blood pressure is the main cause of heart failure, which can lead to death.
5. Myocardial infarction - death of a section of the heart muscle that has lost blood supply. A heart attack provokes jumps in blood pressure, which disrupt the functioning of the blood vessels of the heart.
6. Stroke. High blood pressure in the vessels can provoke a rupture of one of the vessels in the brain. The resulting hemorrhage disrupts the brain.
7. Risk of sudden death. Sleep apnea is associated with sudden infant death syndrome in children under 2 years old. In people older than 50, apnea can cause sudden death in a dream associated with cardiac arrest.

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