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Sleep Apnea in Adults (OSAS): causes and consequences

Sleep Apnea in Adults (OSAS): causes and consequences

Top Doctors
Top Doctors editorial
Top Doctors
Created by: Top Doctors editorial
Edited by: at 16/04/2019

Obstructive sleep apnea is a disease in which there is a recurrent collapse of the upper airway during sleep, disrupting breathing and significantly altering sleep quality. It is a very prevalent disorder, especially in men over 40 years, and in its moderate and severe degrees is a risk factor for accidents, develop metabolic and cardiovascular disorders such as arrhythmias, hypertension and coronary disease. Its main symptom are snoring and its consequences are due both to chronic fatigue due to sleep deficit, and to the metabolic stress that is generated by recurrent falls in oxygenation at night. There are multiple treatment alternatives, including positive airway pressure (CPAP) devices and surgery. The greatest therapeutic success is achieved when the patient's management is personalized taking into consideration their problems (drowsiness, annoying snoring, metabolic syndrome), physical characteristics (including age, weight and anatomy of the airway), severity of apnea, the presence of other diseases and their personal preference.

Dr. Gonzalo Nazar Miranda

 

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea Syndrome (OSAS) is a disease in which there is a recurrent collapse of the upper respiratory tract during sleep, particularly at the throat level: muscles that are relaxed in deep sleep make it difficult to flow of air. Initially, partial airway obstruction causes airflow to be turbulent, resulting in a vibration of the walls of the upper airway: the resulting noise corresponds to snoring. In more advanced stages, the collapse of the airway is complete: it stops the respiratory flow and for a few seconds the oxygenation of the lower blood, triggering alarm reactions in the body that cause a superficialisation of sleep that allows recovery muscle tone (activity), airway permeability, and respiratory flow.

What factors influence this condition?

Obstruction of the high-area pathway during sleep may be due to a number of causes, including obesity. In overweight people, fatty deposits occur in the pharyngeal walls and especially in the tongue, increasing the risk of obstructing the airway. Alterations are also found in the anatomy of the nose and throat of these patients, which hamper airflow and contribute to the onset of snoring and apneas. These include deviations of the nasal septum, growth of the inferior turbinates, enlargement of the tonsils, excessive lengthening of the palate, a bulging tongue and a short jaw (retrognatia). It has also been shown that some patients with sleep apnea may have an alteration in the neuromotor tone of the airway musculature, which increases the risk of collapse during sleep, generating a secondary respiratory obstruction. On the other hand, with the passage of the years, there is a gradual laxity of the tissues, including those of the throat, for which snoring and sleep apnea are more frequent in older adults than in young adults.

What are the symptoms or how can they be detected?

The main and first symptom of sleep apnea is snoring. In this respect, an analogy can be made to the "tip of the iceberg": snoring is the visible finding of a major problem that can go relatively unnoticed, such as sleep apnea; therefore, is that any patient who snores regularly and with significant intensity should consult a specialist doctor. In addition to snoring, when a sleep apnea has already been established, the patient usually presents with chronic fatigue, daytime sleepiness, moodiness, memory and concentration problems, poor repair of sleep and headache in the mornings. When the patient consults for these symptoms, it must be determined if there is indeed a sleep apnea and its severity: this can only be done through sleep studies that monitor the patient throughout the night. There are two types of sleep studies: a) polysomnogram and b) respiratory polygraphy. In the first, the patient is hospitalized overnight and measured a series of variables: heart rate, oxygen saturation, respiratory movements, eye movements, muscle activity, airflow, presence of snoring and electrical brain activity (electroencephalogram) which allows to know in which stages of the dream the patient is located. Respiratory polygraphy, on the other hand, is an outpatient examination performed at the patient's home; it measures a smaller number of variables (basically those of respiratory type), that in the majority of the patients are sufficient to determine if they or they do not have obstructive sleep apnea.

What are the treatment alternatives?

Obstructive sleep apnea is a challenging disease, as the treatments are not simple. As it is a biomechanical disorder of the airway, in general there are no pharmacological treatments that are useful. The main treatment strategies are as follows:


How is the life of someone suffering from Obstructive Sleep Apnea affected?

Obstructive Sleep Apnea can affect in multiple aspects the patient who suffers. Firstly, snoring - which is the main symptom of sleep apnea - is often a problem that interferes with the couple's sleep and can seriously alter marital life. The patient with sleep apnea presents with multiple arousals: this causes a series of symptoms secondary to chronic lack of sleep, such as daytime sleepiness, irritability, chronic tiredness, memory disorders, poor academic / work performance and increased risk of committing errors and accidents; A Spanish study published in the New England Journal of Medicine showed that patients with sleep apnea (even in the mild range) are 6 times more likely to have traffic accidents. Finally, low recurrences in nocturnal oxygenation lead to a state of metabolic stress that in the long term increases the risk of developing hypertension, arrhythmias, insulin resistance, diabetes, coronary and cerebrovascular disease. In fact, it has been estimated that the risk of death (from any cause) increases 6-fold in patients with moderate-severe sleep apnea compared to those who do not.

Otolaringology