About 30% of the entire adult population snores constantly in their sleep. Snoring is a precursor and one of the main clinical manifestations of obstructive sleep apnea (OSA) – a condition characterized by the presence of snoring, periodic lowering of the upper respiratory tract at the pharynx level and cessation of pulmonary ventilation with persistent respiratory efforts, reduced blood oxygen levels, coarse sleep fragmentation and excessive daytime sleepiness.
In clinical practice it is possible to use relatively simple screening rule, with which you can zapodo rit of OSA and to appoint additional examination:
When there are three or more of the following features (first or only indication) necessary for a thorough investigation into the effects of OSA s:
- Instructions for stopping breathing in a dream.
- Indications for loud or intermittent snoring.
- Increased daytime sleepiness.
- Frequent urination at night.
- Prolonged sleep disturbance (> 6 months).
- Arterial hypertension (especially night and morning).
- Obesity 2-4 tbsp.
The probability of sleep apnea is very high (30-50%) in patients with the following somatic diagnoses;
- Obesity grade 2 and above (body mass index > 35).
- Metabolic syndrome.
- Pickwick Syndrome.
- Arterial hypertension of 2 degrees and above (especially night, morning and refractory to treatment).
- Cardiac bradyarrhythmias at night.
- Heart failure 2 degrees and higher.
- Severe COPD (FEV1 <50%) .
- Respiratory failure 2 degrees and above.
- Pulmonary heart.
- Hypothyroidism (reduced thyroid function).
Chronic nocturnal hypoxemia and sleep-dependent respiratory failure
Chronic nocturnal hypoxemia develops in the alveolar hypoventilation caused by diseases such as severe chronic obstructive pulmonary disease, emphysema, bronchial asthma, eneuromuscular disease, morbid obesity form (Pickwick syndrome). Deterioration at night is due to the intercostal muscles being cut off from the act of breathing, a decrease in the diaphragm excursion, and an increase in bronchial resistance during sleep. Night hypoxemia is manifested by the following symptoms:
Frequent waking and unrefreshing sleep
Frequent night urination (> 2 times per night)
Difficult breathing, shortness of breath, or choking attacks at night
Night sweats
Morning break
Morning headaches
Severe daytime sleepiness
Depression, apathy, irritability, reduced mood, memory loss
In cases of suspected obstructive sleep apnea or chronic nocturnal hypoxemia, the patient should be referred to a specialized somnological center for polysomnography, diagnosis and purpose of specific treatment, including the use of non-invasive assisted pulmonary ventilation ( CPAP- therapy) or oxygen concentrator.