Sleep Apnea Syndrome
“Well, how are you?”
“Not too bad, thank you, but I find frequently high blood pressure values high, despite the therapy. Moreover I feel tired, I’m irritable and I’ve some difficulties in concentrating myself during my work”.
This conversation, during the annual visit of an overweight patient followed because arterial hypertension, prompted me to pose another question:
“But do you sleep well during night?”
“Not too bad… but is my wife who doesn’t. She says I snore like a locomotive….”
At this time my suspicion became a near-certainty: this man could suffer for a “sleep apnea syndrome”. What is this? It is a serious sleep disorder in which breathing repeatedly starts and stops. This occurs because there are respiratory arrests (apnoeas) that can be very frequent and/or longstanding. In those cases the oxygen saturation in the blood can fall significantly, with obvious consequent damages to the organs function (mainly heart and brain). If we think that apnoeas can last sometimes more than one minute and can happen more than 60 times an hour, we can realise the damage that can follow.
Actually, having severe apnoeas during the night means that our organism is under stress, and is unable to rest as it should. This can explain the symptoms that can occur during the day: irritability, spleepingness, difficulties in concentrating. Moreover the syndrome can cause micro-sleep episodes, may be of a few seconds and not self-perceived. Data from the Italian Superior Institute of Heath reports that the 22% of the serious road accidents are due to people falling asleep while driving, because of this disorder. In children it causes restlessness, attention failure and poor scholastic performances. When those problems are present snoring is an important sign of suspicion.
Today it is well known that those symptoms are only the tip of the iceberg. Frequently there are no clear symptoms but the disorder is there and is linked to poor control of hypertension and increased risk of cardiovascular diseases (as coronary heart disease, arrhythmias, stroke, sudden death).
In adult patients the apnoeas are usually due to an excessive relaxation of the throat muscle during sleep. In children it is prevalently due to adenotonsillar hypertrophy. The disorder is estimated to be present in about 20% of the population over 40 years and in 3% of the children. It is thus important to suspect the syndrome not only in presence of suggestive symptoms, but even in presence of factors as snoring, overweight, arterial hypertension, diabetes, heart failure.
The diagnosis is done by an examination called polysomnography, a polyparametric recoding done during the night sleep. Today are available simple devices that can be put on by the patient itself before going to sleep.
The therapy is not univocal, and consists in looking for the best way to maintain open the upper airway tract during night. It can vary depending on the anatomy of the respiratory tract and on the indications suggested by the polysomnography. It has to be considered if surgically correct possible anatomical abnormalities, if use mandibular advancing devices (MAD), if avoid supine position during sleep or use a device (CPAP) that prevents the nocturnal collapse of the upper airway tract by air positive pressure.
All this has to be evaluated by a doctor expert on this disorder, who frequently has to take advantage of the collaboration of other specialists: cardiologist, othorinolaringologit, dentist, bronchopneumologist.
This article is written by the Doctor Bianconi.