Aprosexia: symptoms and causes of difficulty in maintaining attention.

A type of alteration of attentional capacities that has been associated with lack of rest.

The relationship between sleep disorders and attention deficits has long been studied by medicine. One of the first concepts used to refer to this relationship is "aprosexia", which is specifically used to relate nasal obstructions to sleep disorders, and from there, to cognitive difficulties during wakefulness.

In the following we will see what aprosexia iswhere it comes from and how this concept has evolved to the present day.

What is aprosexia?

The term "aprosexia" is composed of the prefix "a" which indicates "lack of", and the compositional element "prosexia" which can be translated as "attention". In this sense, aprosexia refers to the lack or inability to pay attention.

It is a term that became popular at the end of the 19th century, when a physician named Guye, attached to the University of Amsterdam, wrote a paper entitled "On aprosexia: the inability to pay attention, and other problems of brain function, caused by nasal disorders".

A century before Guye, physicians such as John Jacob Wepfer had described severe headaches, tremors and memory deficits in connection with nasal obstructions. Also, in 1882, a physician named Hack suggested that nasal disorders could be studied from a psychiatric point of view.

But it was finally Huye, in 1889, who introduced the term "aprosexia" to specifically refer to memory deficits and the inability to concentrate for long periods of time.The main cause was nasal obstruction. He studied this mainly in children and young students.

In the same year, William Hill had also concluded that difficulty in breathing was the underlying problem in the development of intellectual disability in some children. For Guye, aprosexia had a physiological character, since it resulted from brain fatigue in turn caused by nasal disorders..

But, for Hill, it was not nasal obstruction per se that resulted in difficulty in paying attention. Rather, it was that the nasal obstruction caused the children to be unable to sleep well, and for this reason they did not perform with sufficient alertness and energy during the day.

Both Hill and Guye argued that addressing nasal obstructions medically, through surgery or other medical treatments, could be an effective remedy for inattention. They also argued that it was necessary to make accurate diagnoses of cases in which a difficulty in breathing at night was causing difficulties in performing different intellectual skills.

Nasal obstruction and sleep disorders

After Guye, in 1892, another physician named Carpenter related sleep disorders to nasal obstructions. For example, hypertrophic rhinitis was related to insomnia and nightmares, and therefore, with difficulties in paying attention and retaining information in wakefulness.. Another physician, William Fleiss, described 130 such cases, and called them "nasal neuroses". Their main symptoms were insomnia and nightmares.

It was finally Wells who in 1898 described 10 cases of people suffering from nasal obstruction, reporting daytime drowsiness. After restoring their breathing, in a few weeks these people recovered from symptoms such as insomnia, drowsiness and reduced listening recovered from symptoms such as insomnia, drowsiness and reduced listening ability..

In conclusion, these studies showed that nasal breathing plays an important role in the maintenance of automatic sleep rhythms. maintenance of automatic sleep rhythms, which in turnwhich, in turn, is relevant in keeping us sufficiently alert during the day.

Sleep apnea and attention deficit syndrome

What used to be known as aprosexia is now called sleep-associated breathing disorders (SARD) and encompasses the following clinical pictures:

• Obstructive hypopnea.
• Increased airway resistance.
• Obstructive sleep apnea syndrome (OSAS)..

The latter can manifest as a complete obstruction or as a partial obstruction with hypoventilation. Among the main causes of mechanical obstruction is hyperplasia (enlargement of an organ) of the tonsils and adenoids.

Recent studies have proven that there is a comorbidity between attention deficit and Respiratory problems during sleep, especially caused by OSA (Torres Molina and Prego Beltrán, 2013). In other words, nasal obstructions can dramatically affect breathing during sleep.. In turn, sleep impairment results in decreased alertness during wakefulness.

For the same reason, one of the elements to take into consideration when trying to determine or rule out a diagnosis of attention deficit is to corroborate whether there are breathing disorders associated with sleep, since the approach in case they do exist may be different.