The disease, known in English as “Obstructive Sleep Apnea Syndrome” (OSAS) and in Turkish as “Obstructive Sleep Apnea Syndrome” (TUAS), or sleep apnea for short, is a vital respiratory disease caused by shortness of breath while sleeping arises and causes sleep disorders. Sleep apnea syndrome is defined as the cessation of airflow for at least 10 seconds while sleeping. Breathing pauses reduce the oxygen level in the blood and increase the carbon dioxide level. Although insomnia is the most common sleep-related illness, the most popular one recently is sleep apnea syndrome. Sleep apnea is a respiratory syndrome disorder caused by the combined effects of several different diseases. For a medical diagnosis, a test is carried out in which many parameters are measured during sleep. This test is called a polysomnography (PSG). Some parameters such as apnea, hypopnea and hyperpnea are very important in order to diagnose other respiratory diseases in addition to sleep apnea and to plan treatment processes. These are breathing parameters and express different situations. There are different types of sleep apnea syndromes and which one is determined by the parameters during polysomnography. What types of sleep apnea are there? 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 a Syndrome?
The syndrome is a collection of symptoms and findings that do not appear to be related to each other, but which come together as a single disease.
What types of sleep apnea are there?
- obstructive sleep apnea syndrome
- central sleep apnea syndrome
- compound sleep apnea syndrome
What is Obstructive Sleep Apnea Syndrome?
When the muscles and other tissues in the upper airways relax, the airways narrow and snoring occurs. In some cases, the relaxed muscles close the airway completely and breathing stops. These muscles belong to the tongue, uvula, throat and roof of the mouth. This type of apnea is known as obstructive or obstructive sleep apnea syndrome.
The blockage reduces the amount of oxygen in the blood. The brain senses this lack of oxygen and reduces the depth of sleep so that breathing can be restored. Because of this, the person cannot get a good night’s sleep.
During obstructive sleep apnea, breathing effort is seen in the chest (chest) and abdomen (abdomen). The person’s body is making a physical effort to breathe, but breathing cannot occur due to congestion.
What is Central Sleep Apnea Syndrome?
Central or central sleep apnea syndrome is the state of respiratory failure that occurs when the central nervous system fails to send signals to the respiratory muscles or the muscles do not respond properly to incoming signals.
In people with central sleep apnea, the oxygen level in the blood drops and the patient wakes up. Patients remember waking up or waking up better than people with obstructive sleep apnea.
Although respiratory effort is observed in the chest and abdomen (abdomen) during obstructive sleep apnea, no respiratory effort is observed during central sleep apnea. Regardless of whether there is a blockage or not, the person’s body makes an effort not to breathe physically. In tests for central sleep apnea, “RERA”, ie measurements of chest and abdominal movements, play a very important role.
Central sleep apnea (CSAS) is less common than obstructive sleep apnea. It can be arranged in itself. There are several types of primary central sleep apnea, central sleep apnea due to Cheyne-Stokes breathing, and so on. In addition, their treatment methods also differ.
PAP (positive airway pressure) treatment is generally used. In particular, it is recommended to use ventilators called ASV, which are part of the PAP machines. The device type and parameters should be determined by a clinician, and the patient should use the device as directed by the clinician. There are also various treatment methods. The treatment methods for central sleep apnea can be listed as follows:
- Oxygen therapy
- Carbon dioxide inhalation
- Respiratory stimulants
- Pap therapy
- Stimulation of the diaphragmatic nerve
- Cardiac interventions
Which of these and how to use is determined by the doctors depending on 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 observed together. Such patients usually have symptoms of obstructive sleep apnea. Even when obstructive sleep apnea is treated, central sleep apnea symptoms still occur. During the apnea, the discomfort usually begins as central apnea and then continues as obstructive apnea.
What is apnea?
The temporary cessation of breathing is known as 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 muscles.
What is hypopnea?
When assessing 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 the respiratory flow below 50% of its normal value is known as hypopnea. When assessing sleep apnea syndrome, hypopneas as well as apneas are taken into account.
With the polysomnography test that can be carried out during sleep, the patient’s shortness of breath 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 apnea and hypopnea more than five times in an hour, that person may be diagnosed with sleep apnea. The most important parameter that helps in the diagnosis is the apnea-hypopnea index, or AHI for short. Polysomnography results in many patient-related parameters. One of these parameters is the apnea-hypopnea index (AHI).
The AHI value is obtained by dividing the sum of the apnea and hypopnea numbers by the person’s sleep time. Thus, the AHI is revealed in 1 hour. For example, if the person taking the test slept for 6 hours, and the sum of apnea and hypopnea during sleep is 450, the AHI value if calculated to be 450/6 is 75. Looking at this parameter, the value of sleep apnea becomes can be determined in the person and appropriate treatment can be initiated.
What is hyperpnea?
The cessation of breathing is called apnea, the decrease in the depth of breath is called hypopnea, and an increase in the depth of breath is called hyperpnea. Hyperpnea refers to deep and rapid breathing.
When the depth of breathing first increases, then decreases, and finally stops and this breathing cycle repeats, this is known as Cheyne-Stokes breathing. Cheyne-Stokes breathing and central sleep apnea syndrome are common in patients with heart failure. BPAP devices used in treating such patients should be able to meet variable pressure needs.
Unnecessarily high pressure can lead to more apnea. Therefore, the pressure required by the patient should be applied at the lowest level by the device. The BPAP device that can offer this is the device called ASV (adaptive servo ventilation).
What are the symptoms of sleep apnea?
Problems like high blood pressure, snoring, fatigue, extreme irritability, depression, forgetfulness, poor concentration, morning headaches, uncontrollable obesity, sweating while sleeping, frequent urination, heartburn are the symptoms of sleep apnea.
Since it affects the life of the patient and those around him so severely, the disease requires treatment. Although there are different treatment methods for this, the most effective is the use of respiratory protective devices, so-called PAP devices. PAP machines that are used in the treatment of sleep apnea include:
- CPAP machine
- OTOCPAP device
- BPAP device
- BPAP ST device
- BPAP ST AVAPS device
- OTOBPAP device
- ASV device
All of the above devices are actually CPAP devices. Although the work functions and internal equipment of the devices differ, their work is similar, but each of these devices works with different breathing parameters. The type of device and parameters vary depending on the disease and the type of treatment.
BPAP types can be recommended for sleep apnea patients in 4 situations:
- For obese hypoventilation
- If you have a lung-related condition such as COPD. Suffer
- For patients who cannot adapt to CPAP and OTOCPAP machines
- In patients with Cheyne-Stokes breathing or central sleep apnea
What are the consequences of sleep apnea?
If left untreated, sleep apnea can be fatal. Arrhythmia, heart attack, enlarged heart, high blood pressure, stroke, sexual reluctance, obesity, vascular obstruction, lubrication of internal organs, decrease in work efficiency, problems in social life, traffic accidents, depression, dry mouth, headaches, hyperactivity in children, insulin can cause numerous problems such as resistance, pulmonary hypertension, tension, and excessive stress.
Studies have shown that sleep apnea increases the risk of traffic accidents by 8 times. This risk corresponds to someone with 100 per mille of alcohol. Studies have shown that snoring increases the risk of heart attack four times and sleep apnea increases the risk of heart attack ten times.
What is the distribution of sleep apnea like in the community?
Experts say 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 doctor’s report?
The person applying to the hospital with the complaint about sleep apnea will be placed 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 signed by multiple doctors (health committee report) or a single doctor report signed by a single doctor.
The report records the parameters of the night the patient was tested in the sleep laboratory. This report is generated by looking at the results of the titration test. In the final part of the report, the doctor indicates which device the patient will use with which parameters.
The goal of treatment with ventilators is to eliminate snoring, arousal, apnea, hypopnea, and oxygen starvation.