Sleep disorders

Apnea and sleep

sleep apnea has a fairly typical clinical picture. As a rule, a disease can be suspected already by appearance and information obtained during a conversation with a patient. Patients have a very characteristic appearance, described by Charles Dickens in the character Joe in the Pickwick Papers . He was a fat man with a short neck and a red face, who constantly fell asleep and began to snore in the most uncomfortable situations.

As a real example, a description of a clinical case from 1992 can be given:

A man, 60 years old, has been noticing a decrease in working capacity for several years, especially pronounced in recent years. He feels tired all day, often falls asleep during the day. Previously, he fell asleep only in front of the TV, then when reading newspapers, and, finally, he began to fall asleep in the company of other people and even at work.

Despite the sufficient duration of night sleep (9-10 hours), in the morning he feels tired, his head often hurts. He cannot concentrate at work, often falls asleep, labor productivity is sharply reduced.

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He is mocked for his sleepiness. He can no longer drive a car, as he often falls asleep at the wheel, which has already caused him to have minor accidents. It is also known that the patient has been snoring for many years. His wife sleeps for this reason in another room. During a targeted survey, it turned out that the wife noticed long pauses in her breathing at night with her husband.

On examination, no drastic changes are found. The patient is overweight, there is an increase in blood pressure up to 160/100 mm Hg . Laboratory data are normal, with the exception of a moderate increase in hemoglobin and erythrocytes in the blood. The chest x-ray is normal.”

It must be added that sleep apnea often causes a change in the patient’s voice, he becomes low, hoarse, due to chronic trauma to the structures of the pharynx during snoring.

A specific picture of arterial hypertension that accompanies sleep apnea has also been described : a person wakes up with high blood pressure (mainly diastolic), but after 1-2 hours it normalizes without any treatment.

In general medical practice, you can use a fairly simple rule with which you can suspect sleep apnea and prescribe an additional examination:

If three or more of the following signs are present (or only the first sign), an in-depth study is needed to identify sleep apnea :

  1. indications of pauses in breathing during sleep.
  2. indications of loud or intermittent snoring.
  3. increased daytime sleepiness.
  4. frequent nighttime urination.
  5. long-term sleep disturbance (more than 6 months)
  6. arterial hypertension (especially nocturnal and morning)
  7. obesity 2-4 degrees.

An examination of the ENT organs can provide important information, which allows to identify anatomical defects at the level of the nose and pharynx (polyps, deviated nasal septum, excessive soft palate, palatine uvula and palatine arches, hypertrophied tonsils) and assess their possible contribution to the development of upper airway obstruction . It is possible to use additional examination methods: computed tomography, endoscopy and acoustic rhinometry .

If you suspect sleep apnea , it is recommended to consult a sleep doctor . At the disposal of this specialist there is a complete list of necessary diagnostic tools that will help determine the disease and develop treatment tactics.

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