SLEEP APNEA/HYPOPNEA SYNDROMESleep apnea or Central Sleep Apnea syndrome is characterized by recurrent upper airway obstruction during sleep when the loss of normal pharyngeal tone allows the pharynx to collapse passively during inspiration Which causes Loud Snoring and Breath Pauses (apnea) in affected person
Aetiology and Causes of Sleep Apnea
- Male gender
- Tonsillar hypertrophy
- Nasal obstruction
- Ingestion of alcohol or sedatives before sleep
Clinical features of Sleep Apnea
- If the narrowing is slight, it leads to snoring. If upper airway narrowing progresses to the point of occlusion or near occlusion, a sleeping person increases respiratory effort and try to breathe until the increased effort transiently awaken him. This recurrent cycle of apnea, awakening, apnea, awakening may repeat itself many hundreds of times per night. The patient complains of day - time sleepiness, he feels he has been asleep all night but still he does not feel fresh.
- Bed partner reports loud snoring and often have noticed multiple breathing pauses (apnea).
- The patient also complains of difficulty in concentration, impaired cognitive function, impaired memory and work performance, depression, loss of libido, irritability and nocturia.
- Hypertension and ischemic heart disease are also complications.
- Nasal obstruction
- Narrow oropharynx due to excessive soft tissue folds, large tonsils or prominent tongue. Features of pulmonary hypertension or cor-pulmonale ( see Disorders predispose to cor pulmonale) may be present.
Investigations of Sleep ApneaPolysomnography: this is the overnight study of breathing, oxygenation (oxygen saturation) and sleep quality. It shows apnea episodes as long as 60 seconds, oxygen saturation falls often to a very low level and Brady or tachyarrhythmias.
Treatment of Sleep Apnea• Weight loss
• Strict avoidance of alcohol and hypnotic medications.
• Nasal continuous positive airway pressure (nasal CPAP) is curative in many patients.
• Treatment of curable conditions such as deviated nasal septum.
• Uvulopalatopharyngoplasty: a procedure consisting of resection of pharyngeal soft tissue and amputation of approximately 15 mm of the free edge of the soft palate and uvula is helpful in about 50% of cases.