وصف
A condition called sleep apnea makes you stop breathing while you're asleep. In an attempt to protect you, your brain wakes you up long enough to breathe, but this keeps you from getting a good night's sleep. Serious difficulties may arise from this syndrome over time. But this illness is frequently quite treatable, particularly if recommended medications are closely followed.
ملخص
- Obstructive Sleep Apnea (OSA) is characterized by repetitive episodes of apnea or hypopnea during sleep, leading to sleep fragmentation, arousals, and decreased oxygen levels. It's one component of a broader spectrum of sleep disorder breathing, which also includes obesity hypoventilation syndrome and central sleep apnea. OSA is primarily caused by narrowing or complete obstruction of the upper airway during sleep.
- Factors contributing to upper airway collapse include the relationship between soft tissue and bony enclosure, lung volumes, and sleep-related decrements in muscle activity. Obesity significantly increases soft tissue, compressing the airway. Decreased lung volume and reduced muscle tone during REM sleep also contribute to airway collapse.
- Common OSA symptoms include snoring, daytime sleepiness, and disturbed sleep. Patients may wake up with breath-holding or choking episodes and may have hypertension, cognitive dysfunction, or cardiovascular diseases. Diagnosis involves considering these symptoms alongside sleep recording results, which show obstructive events. Snoring alone doesn't always indicate OSA.
- OSA can lead to motor vehicle crashes, cardiac arrest, strokes, and infertility due to intra-thoracic pressure changes, sympathetic activation, and hypoxia. Negative pressure and arousals affect the cardiovascular system while hypoxia contributes to inflammation.
- OSA is diagnosed through polysomnography (sleep study), which records sleep signals, respiratory effort, muscle movements, and cardiovascular signals. The Apnea-Hypopnea Index (AHI), determined through sleep study, indicates the severity of OSA. Studies are categorized into different levels based on the level of monitoring and presence of a technician.
- Treatment options range from weight loss and lifestyle modifications to positive airway pressure (PAP) therapy. PAP therapy, including CPAP, BiPAP, and AutoPAP, helps maintain airway patency during sleep. CPAP is the preferred treatment for moderate to severe OSA. Intolerance to CPAP may necessitate alternative approaches, or the utilization of other methods.
- Adjunctive options for mild OSA or CPAP intolerance include intraoral devices, positional therapy, and, in some cases, surgical interventions to correct anatomical issues. Intraoral devices help protrude the mandible and maintain airway patency, but are not as effective as CPAP for reducing AHI. Patient adherence to treatment is crucial for long-term success, and education is important.
- Central Sleep Apnea differs from OSA in that the brain fails to send signals to the lungs to breathe, rather than a physical obstruction in the airway. UARS (Upper airway resistance) is the more common, which is different from obstructive sleep apnea is where the patient is not obese, but still has a sleep apnea symptoms. Primary care physicians should refer patients with suspected sleep disorder breathing to sleep specialists for proper diagnosis and management.
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الدكتور كادلي شيريش كومار
استشاري أمراض الرئة، أخصائي التدخلات وطب النوم، مستشفى كيمز، حيدر أباد
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