Sleep Apnea Syndrome

Sleep apnea syndrome is a disease characterized by a decrease in blood oxygen level following the cessation of breathing during sleep, followed by a wakefulness reaction, and then respiration.

The cessation of airflow in the mouth and nose for 10 seconds or more is called apnea, and the reduction of airflow for 10 seconds or more is called hypopnea.

There are two main types of apnea:

Type I Apnea is obstructive sleep apnea and is the cessation of airflow at the level of the mouth and nose, despite the continuation of respiratory effort (continuation of abdominal and chest breathing) during sleep.

Type II Apnea is central sleep apnea and is the cessation of both respiratory effort and airflow during sleep.

What are the risk factors for Sleep Apnea?

  1. Age: After the age of 65, the frequency is 2-3 times higher than between the ages of 30-64. It is usually observed in children between the ages of 2-6. It is less common in children who have undergone tonsillectomy.

  1. Gender: It is about twice as common in men as in women, but it is as common in women as men after menopause.

  1. Obesity: There is a definite relationship between obesity and apnea formation. Fat pad accumulation in the pharynx increases in overweight individuals, which increases the tendency to obstruct the upper respiratory tract.

  1. Genetics: Similar findings are seen more frequently in the relatives of the patients.

  1. Anatomic Risk Factors: All factors that reduce the width of the upper airway contribute to the occurrence and severity of the disease. Head and face anomalies, such as chin back or small chin, and nasal septum deviation narrow the upper airway passage, creating a tendency to sleep apnea. Another cause of obstruction is the increase in soft tissue mass in the upper respiratory tract due to fat storage or large tonsils.

  1. Sleeping in the supine position: It increases the severity of sleep apnea by causing the tongue root to obstruct the upper respiratory tract.

  1. Alcohol and Smoking: Alcohol has been shown to increase the severity of sleep apnea as it impairs pharyngeal muscle activity and decreases the wakefulness reaction response to apneas.

What are the symptoms of sleep apnea disease?

  1. Snoring: Snoring is the most common finding in respiratory disorders. Obstructive sleep apnea syndrome is found in 35% of patients with snoring. Snoring is observed in 70-95% of patients with sleep apnea.

  1. Witnessed Apnea: Patients may not be able to recognize their apnea at times, which may be noticed by a nearby person, often by their partner. The patient may have complaints of waking up with air hunger or a feeling of suffocation, waking up to his own snoring sound.

  1. Excessive Daytime Sleepiness: As a result of recurrent apneas during sleep, the patient’s sleep is frequently interrupted, the patient spends most of the night in shallow sleep and cannot fall into a deep sleep. As a result, the patient feels the need for excessive sleep the next day. Mild cases describe drowsiness only in a quiet environment, while severe cases may also experience drowsiness while eating, talking or driving.

  1. Recent increase in weight gain and inability to lose weight

  1. Excessive sweating on the chest and neck at night

  1. Do not get up to urinate at night, incontinence at night

  1. sexual impotence (impotence)

  1. nocturnal heart rhythm disorders

  1. Gastroesophageal reflux

  1. depression, anxiety

  1. Forgetfulness, lack of attention, difficulty concentrating, learning problems

  1. morning headache

  1. dry mouth in the morning

  1. Night clenching, drooling

  1. Insomnia

  1. Sleepwalking

What is recorded during sleep in polysomnography?

  1. Electroencephalography (EEG) for brain activity

  1. Electrooculography (EOG) for eye movements

  1. Electromyography for jaw and leg movement (EMG- submentalis and tibialis)

  1. Oronasal airflow for mouth-nose breathing

  1. Chest and abdominal movements for chest and abdominal breathing

  1. Oxygen saturation for oxygen measurement

  1. Electrocardiography (ECG) for heart rhythm

  1. body position

  1. Video recording all night

With these parameters, the presence of apnea, its type (obstructive/central), apnea duration are evaluated. By determining this, the severity of the disease due to the apnea-hypopnea index of the patient

determines.

The apnea-hypopnea index is the value obtained by dividing the sum of the number of apneas and hypopneas in sleep as a result of the polysomnographic study by the sleep duration in hours. OSAS is graded according to the Apnea Hypopnea Index (AHI) value determined as a result of PSG. This rating is very important for the treatment approach.

In addition, the duration of apneas and hypopneas, as well as the number of apneas and hypopneas, are evaluated in which lying position and in which sleep periods of the patient.

By evaluating the sleep stages, the quality of sleep and whether it is sufficient or not is understood.

Snoring, heart rate, blood oxygen levels and leg movements are also evaluated during sleep.

If the AHI is less than 5, it is normal.

Values ​​between 5-15 indicate the presence of sleep apnea syndrome with clinical findings.

Values ​​above 15 indicate the presence of sleep apnea.

How is sleep apnea treated?

  1. With weight loss, a decrease in AHI and an improvement in sleep quality are observed.

  1. It has been observed that sleep-related breathing disorders improve in patients with position-dependent mild sleep apnea by preventing sleeping in the supine position.

  1. There is no accepted drug therapy for treatment.

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