The disease, known as “obstructive sleep apnea syndrome” (OSAS) in English and “obstructive sleep apnea syndrome” (TUAS) in Turkish, briefly known as sleep apnea or apnea disease, is a vital respiratory disorder that results from respiratory distress during sleep and causes sleep disturbance. Sleep apnea syndrome is defined as the cessation of airflow for at least 10 seconds during sleep. As a result of respiratory pauses, the amount of oxygen in the blood decreases and the amount of carbon dioxide increases. Although insomnia is the most common sleep-related disease, the most well-known one recently has been sleep apnea syndrome. Sleep apnea is a respiratory syndrome disease caused by the combined effect of several different disorders. For medical diagnosis, a test is performed in which many parameters are measured during sleep. This test is called polysomnography (PSG). Some parameters such as apnea, hypopnea and hyperpnea are very important in order to diagnose not only sleep apnea but also other respiratory diseases and plan treatment processes. These are respiratory parameters and express different situations from each other. There are different types of sleep apnea syndrome, and which one is determined by the parameters during polysomnography. What are the Types of Sleep Apnea? What is Obstructive Sleep Apnea Syndrome? What is Central Sleep Apnea Syndrome? What is Compound Sleep Apnea Syndrome? What is Apnea? What is hypopnea? What is Hyperpnea? What Are the Symptoms of Sleep Apnea? What Are the Consequences of Sleep Apnea?
What is Syndrome?
Syndrome is a collection of complaints and findings that appear to be unrelated to each other, but appear as a single disease when combined.
What are the Types of Sleep Apnea?
- obstructive sleep apnea syndrome
- central sleep apnea syndrome
- compound sleep apnea syndrome
What is Obstructive Sleep Apnea Syndrome?
As the muscles and other tissues in the upper respiratory tract relax, the airway narrows and snoring occurs. In some cases, the relaxed muscles completely close the airway and breathing stops. These muscles belong to the tongue, uvula, pharynx and palate. This type of apnea is called obstructive or obstructive sleep apnea syndrome.
Due to the blockage, the amount of oxygen in the blood decreases. The brain perceives this lack of oxygen and reduces the depth of sleep, allowing respiration to be restored. For this reason, the person cannot sleep a quality sleep.
During obstructive sleep apnea, respiratory effort is observed in the thorax (chest) and abdomen (abdomen). The person's body physically exerts breathing effort, but breathing cannot occur due to congestion.
What is Central Sleep Apnea Syndrome?
Central or central sleep apnea syndrome is the condition of respiratory arrest, which is experienced due to the fact that the central nervous system does not send signals to the respiratory muscles or the muscles do not respond correctly to the incoming signals.
In people with central sleep apnea, the oxygen level in the blood decreases and the patient wakes up. Patients remember the waking or arousal period more than people with obstructive sleep apnea.
Although respiratory effort is observed in the thorax (chest) and abdomen (abdomen) during obstructive sleep apnea, respiratory effort is not observed during central sleep apnea. Whether there is a blockage or not, the person's body does not physically make an effort to breathe. In tests for central sleep apnea, “RERA”, that is, measurements of thorax and abdomen movements play a very important role.
Central sleep apnea (CSAS) is less common than obstructive sleep apnea. It can be classified within itself. There are several types of primary central sleep apnea, central sleep apnea due to Cheyne-Stokes respiration, and so on. In addition, their treatment methods also differ.
Generally, PAP (positive airway pressure) treatment is applied. In particular, it is recommended to use respiratory devices called ASV, which is one of the PAP devices. The device type and parameters should be determined by a physician and the patient should use the device as determined by the physician. In addition, there are different treatment methods. The treatment methods of central sleep apnea can be listed as follows:
- Oxygen therapy
- Carbon dioxide inhalation
- Respiratory stimulants
- PAP therapy
- Phrenic nerve stimulation
- Cardiac interventions
Which of these will be applied and how is determined by the physicians according to the condition of the disease.
What is Compound Sleep Apnea Syndrome?
In patients with compound (complex or mixed) sleep apnea syndrome, both obstructive and central sleep apnea are seen together. Such patients usually have symptoms of obstructive sleep apnea. Even if obstructive sleep apnea is treated, central sleep apnea symptoms still occur. During respiratory arrest, discomfort usually begins as central apnea and then continues as obstructive apnea.
What is Apnea?
The temporary cessation of breathing is called apnea. If breathing stops temporarily, especially during sleep, it is called sleep apnea. It can occur due to a blockage or the inability of the nervous system to control the muscles.
What is hypopnea?
In the evaluation of sleep apnea, not only the cessation of breathing (apnea) but also the decrease in breathing, which we call hypopnea, is very important.
A decrease in respiratory flow below 50% of its normal value is called hypopnea. When evaluating sleep apnea syndrome, not only apneas but also hypopneas are taken into account.
With the polysomnography test that can be performed during sleep, the respiratory distress of the patient can be detected. This requires a measurement of at least 4 hours. Apnea and hypopnea numbers are determined according to the results.
If the person has experienced apnea and hypopnea more than five times in 1 hour, this person can be diagnosed with sleep apnea. The most important parameter that helps in diagnosing is the apnea-hypopnea index, briefly referred to as AHI. As a result of polysomnography, many parameters related to the patient emerge. Apnea hypopnea index (AHI) is one of these parameters.
The AHI value is obtained by dividing the sum of the apnea and hypopnea numbers by the person's sleep time. Thus, the AHI in 1 hour is revealed. For example, if the person taking the test slept for 6 hours and the sum of apneas and hypopneas during sleep is 450, if the calculation is made as 450/6, the AHI value will be 75. By looking at this parameter, the level of sleep apnea in the person can be determined and appropriate treatment can be started.
What is Hyperpnea?
The cessation of breathing is called apnea, the decrease in respiratory depth is called hypopnea, and an increase in respiratory depth is called hyperpnea. Hyperpnea refers to deep and rapid breathing.
If the depth of breathing first increases, then decreases and finally stops and this respiratory cycle repeats, it is called Cheyne-Stokes breathing. Cheyne-Stokes respiration and central sleep apnea syndrome can be seen frequently in heart failure patients. BPAP devices used in the treatment of such patients should be able to meet the variable pressure needs.
Unnecessarily high pressure may cause more apnea. Therefore, the pressure required by the patient should be applied at the lowest level by the device. The BPAP device that can provide this is the device called ASV (adaptive servo ventilation).
What Are the Symptoms of Sleep Apnea?
Problems such as high blood pressure, snoring, fatigue, extreme irritability, depression, forgetfulness, concentration disorder, morning headache, uncontrollable fatness, sweating during sleep, frequent urination, heartburn are the symptoms of sleep apnea.
Since it affects the life of the patient and those around him very seriously, the disease needs to be treated. Although there are different treatment methods for this, the most effective is the use of breathing devices called PAP devices. PAP devices used in the treatment of sleep apnea are:
- CPAP Device
- OTOCPAP Device
- BPAP Device
- BPAP ST Device
- BPAP ST AVAPS Device
- OTOBPAP Device
- ASV Device
All the devices mentioned above are actually CPAP devices. Although the working functions and internal equipment of the devices differ, their work is similar, but each of these devices works with different respiratory parameters. The device type and parameters vary according to the disease and the type of treatment.
BPAP types can be recommended for sleep apnea patients in 4 situations:
- In case of obesity-related hypoventilation
- When you have a lung-related disease such as COPD
- In patients who cannot adapt to CPAP and OTOCPAP devices
- In patients with Cheyne-Stokes breathing or central sleep apnea
What Are the Consequences of Sleep Apnea?
If sleep apnea is not treated, it can result in death. Disruption of heart rhythm, heart attack, heart enlargement, high blood pressure, stroke, sexual reluctance, obesity, vascular occlusion, lubrication in internal organs, decrease in work efficiency, problems in social life, traffic accidents, depression, dry mouth, headache, hyperactivity in children, insulin can lead to numerous problems such as resistance, pulmonary hypertension, tension, and excessive stress.
Studies have shown that sleep apnea increases the risk of traffic accidents 8 times. This risk is equivalent to someone with 100 promil alcohol. Studies have shown that snoring increases the risk of heart attack 4 times, and sleep apnea increases the risk of heart attack 10 times.
What is the Distribution of Sleep Apnea in the Community?
Experts state that 2% of women and 4% of men have sleep apnea. These rates indicate that the disease is more common than asthma and diabetes.
What Are the Details in the Physician's Report?
The person who applies to the hospital with the complaint of sleep apnea is hosted in the sleep laboratory for 1 or 2 nights.
A sleep doctor or neurologist examines the parameters resulting from the test. Prepares the necessary device and pressure values for the treatment of the patient in the form of reports and prescriptions. This report can be a committee report (health board report) signed by more than one physician or a single physician report signed by a single doctor.
In the report, the parameters of the night the patient was tested in the sleep laboratory are written. This report is prepared by looking at the titration test results. In the conclusion section of the report, the physician states which device the patient will use with which parameters.
The goal of treatment with ventilators is to eliminate snoring, arousals, apneas, hypopneas, and oxygen deficiency.