OSAS: Obstructive Sleep Apnea Syndrome

OSAS is characterized by the presence of apneas that are the intermittent cessation of breathing of over 10 seconds long. Hypopneas (apnea together with desaturation of oxygen in the blood and transient awakening, called arousal) can also occur in a number greater than 10 episodes / hour.

SAOS is characterized by a picture of continuous awakenings during the night (conscious or not), next to snoring (in most cases) with the consequent daytime sleepiness and secondary neuropsychiatric and cardiocirculatory disorders. It affects up to a 4% of the general population, especially to overweight men with a history of arterial hypertension and coronary heart disease.

Why do apneas occur?

The control of respiration is carried out by 2 mechanisms, one automatic and other voluntary. The automatic route is the one that works during sleep. There are a series of receptors in charge of sending a series of stimuli to maintain the working ventilatory muscles and for the muscles that are responsible for maintaining the open airspace. There must be a correct coordination between both muscle groups for correct breathing.

When it exists some defect in the muscles, in their nerve pathways or in this coordination obstructive sleep apnea occurs. There are also a series of anatomical factors that can overload these muscles such as:

• Lingual hypertrophy (large tongue)
• Tonsil hypertrophy (large tonsils)
• Mandibular malformations and obesity.

These factors have an indication of surgery to correct the problem. Other triggers of OSAS are alcoholism, kyphoscoliosis, acromegaly, and hypothyroidism among the most common.

Signs of SAOS

The nocturnal snoring and the daytime sleepiness are the most frequent symptoms. Between the nocturnal symptoms also stand out:

• Insomnia
• Sweating,
• Enuresis
• Gastroesophageal reflux
• Seizures
• Sleep disruption

While between the daytime symptoms, even though daytime hypersomnolence is the most frequent, there are also:

• Headache (typically improves during the day)
• Decreased libido
• Impotence
• Psychiatric disorders
• Dry mouth
• Voice disturbances
• Memory deficit
• Intellectual decline
• Irritability among others.

It is useful to spouse explanation about the . These report snoring at night, followed by episodes of shortness of breath that subside with a snort to regain the rhythm of regular hoarseness. East Pattern They explain it repeatedly throughout the night.

How is it diagnosed?

The diagnosis is based on a detailed clinical interview and physical examination of the patient, followed by a polysomnography, which today is the diagnostic test to confirm the disease. It consists of the collection of a series of physiological variables during sleep and is carried out in a hospital. Among the variables that are studied, the following stand out:

• Eye and muscle movements
• Airflow in the mouth and nose
• Oxyhemoglobin saturation
• Intensity of snoring

In this way, OSA is classified according to the number of apneas per hour, associated symptoms and oxyhemoglobin desaturation and it is correlated with associated mortality. A number greater than 50 apneas per hour is considered serious, while a number between 10-20 apneas / hour, mild. The increased mortality of these patients is mostly due to cardiovascular disorders.

Treatment types

Treatment should be aimed not only at improving symptoms but also at correcting the physiological alterations that occur in OSA.

Hygienic-dietary measures

• weight loss as the main factor to correct, especially in mild and moderate cases
• Alcohol withdrawal
• Avoid stimulants like caffeine
• Avoid prolonged naps during the day
• Avoid relaxing drugs at night
• Sleeping in a lateral position
• Get regular exercise

CPAP

It is the treatment of choice in moderate and severe cases. Consists in apply pressure positive and continues over the airway through the nose overnight. Its use must be indefinite, since it is not a curative treatment. There are usually no problems in terms of tolerance and clinical improvement is spectacular.

Surgery

When there are specific anatomical alterations of the upper airway that can be corrected, such as large tonsils and nasal obstruction. When there are no obvious anatomical alterations of the upper airway, there are other surgical options without fully demonstrated efficacy, such as: uvula correction (uvulopalatopharyngoplasty) or on the mandible.

Other treatments

• Drugs such as progesterone, amitriptyline, theophylline or oxygen therapy have been used without clear improvement and are therefore practically not used.