Description

Sleep apnea syndrome

What is sleep apnea syndrome?

The symptoms of sleep apnea syndrome are as follows;

– Snoring so loud that you can hear from the next room at night

– Stopping snoring with breathing stops

– Sweating in the chest, head or neck area at night

– Needing to toilet frequently at night – Getting up tired in the morning

– Feeling sleepy and sluggish during the day

– Away from social life in the evening

– Dry mouth in the morning

– Inability to lose weight

– High blood pressure,

– Forgetful and irritable mood

Snoring, which is the most

common symptom of sleep apnea syndrome, is the sound that occurs when the soft
tissues around the pharynx vibrate during breathing. It occurs as a result
of the narrowing of the upper respiratory tract in the area behind the tongue,
and snoring increases in proportion to the size of the narrowing.

Is snoring a common complaint in the society?

In our country, 42 out of every 100 people have snoring
complaints. As the age increases, the rate of complaints increases. This
rate reaches 60% for men aged 60 and up to 40% for women. Anatomically,
body fat is concentrated in the waist and hip region in women, and in the neck
and abdomen in men. For this reason, snoring is more common in men due to
a narrowing around the pharynx. Differences in the muscular structure of
women also play a role in not snoring. As a result of the change in
hormonal balances of women after menopause and their muscle structure
resembling that of men, women start snoring in a similar way and frequency to
men.

It is thought that uninterrupted and regular snoring without respiratory irregularities does not
harm the patient if it does not interrupt sleep. This type of snoring
especially bothers those who share the same room and house with the patient. Sometimes
snoring occurs irregularly and occasionally with respiratory disorders. In
this case, the patient spends a lot of effort to breathe. Respiratory
irregularities also cause the patient to wake up from time to time, which
greatly impairs sleep quality. The patient sometimes comes to the
physician with the complaint that his sleep is interrupted at night, not
realizing that he is awakening because he has breathing difficulties. In
some cases, these awakenings last 5-10 seconds and are not noticed by the
patient. This time, the patient applies to the physician with the
complaints of fatigue and daytime sleepiness.

Snoring is the most important and most dangerous form of snoring, which is interrupted by periods
of silence, that is, breathing stops. Respiratory pauses or decreases
(apnea or hypoapnea) can recur hundreds of times during sleep. Very few of
these are noticed by the patients or their relatives. The clinical
condition of snoring with respiratory arrest is called obstructive sleep-apnea
syndrome. The patient wakes up after each respiratory arrest, and can end
the respiratory arrest only by waking up. As a result of these short-term
and frequent awakenings, the restful phase of sleep cannot be reached and thus
the patient unknowingly sleeps in a poor quality, superficial and short-term
awakenings. The number and duration of these breathing pauses vary
according to the severity of the disease. Respiratory pauses can last from
10 seconds to 1-2 minutes. Their numbers range from 15-20 to 400-500 per
night. It should be considered that the disease progresses seriously in
cases that recurs 60-70 times per hour and breathing stops for up to 15-20
seconds. Oxygen ratio, which is 95%, decreases to 50% due to respiratory
arrest. The impaired breathing pattern is also reflected in the heart
rhythm and irregularities in the heart beat begin to be observed. This can
lead to sudden cardiac arrest, which is a very dangerous consequence in later
years. Sudden deaths can occur during sleep. Patients often feel the
need to urinate frequently throughout the night. The patient, who makes an
effort to breathe during the night, sweats and gets tired, so he feels tired
and sleepy when he wakes up. Most of these patients want to sleep whenever
possible during the day. Sleepiness that continues throughout the day
leads to a decrease in productivity and a tense and troubled mood. Studies
have shown that sleepiness commonly causes traffic accidents. In the long
term, obstructive sleep-apnea syndrome can cause serious problems such as high
blood pressure, heart attack and paralysis as a result of cerebral vascular
occlusion. For this reason, those who show symptoms of sleep apnea
syndrome should be examined in a night sleep laboratory by consulting a
physician. Treatments made in line with the data obtained as a result of
the examination to be made in the sleep laboratory will be much more pleasant. In
the long term, obstructive sleep-apnea syndrome can cause serious problems such
as high blood pressure, heart attack and paralysis as a result of cerebral
vascular occlusion. For this reason, those who show symptoms of sleep apnea
syndrome should be examined in a night sleep laboratory by consulting a
physician. Treatments made in line with the data obtained as a result of
the examination to be made in the sleep laboratory will be much more pleasant. In
the long term, obstructive sleep-apnea syndrome can cause serious problems such
as high blood pressure, heart attack and paralysis as a result of cerebral
vascular occlusion. For this reason, those who show symptoms of sleep
apnea syndrome should be examined in a night sleep laboratory by consulting a
physician. Treatments made in line with the data obtained as a result of
the examination to be made in the sleep laboratory will be much more pleasant.

How are sleep-disordered breathing diagnosed?

The definitive diagnosis of the disease can be made by observing
the patient in the sleep laboratory during the night. For this purpose,
patients are examined by placing different sensors in various parts of their
bodies. The higher the number and sensitivity of the sensors, the more
detailed and efficient the result will be. In order to perform this highly
sensitive test, patients should be monitored all night long in the sleep
laboratory under conditions as close to home conditions as possible.

As a result of the examinations carried out in the sleep laboratory, the number
and duration of breathing pauses during sleep, the decrease in the amount of
oxygen, irregularities in the heart rhythm and how sleep is affected by these
events are revealed. Thus, the path to be followed in the form and
duration of treatment is determined. Patients with 5 to 15 respiratory
disorders per hour during the night are considered to be mild, those between 15
and 30 are considered to be moderate, and those with more than 30 respiratory
disorders are considered to be patients with severe respiratory problems during
sleep.

Complications due to daytime sleepiness

Although some of the sleep apnea patients do not admit
that they are daytime sleepy, studies show that people with this disease
experience certain levels of sleepiness. Daytime sleepiness causes a
decrease in the efficiency of the patients, the desire to sleep continuously by
moving away from their social and family life, disruptions in their work and
work accidents.

Various studies have been conducted on the traffic accident rate of patients with sleep apnea. All
studies have revealed that, on average, one third of traffic accidents are
caused by patients with sleep apnea. Although the patients said that they
did not sleep while driving, it was observed that the patients experienced eye
dips of 5-10 seconds while driving, and this situation was not noticed by the
patient, according to the EEG recordings and the number of blinking. Even
this distraction outside of sleepiness is enough for traffic accidents.

Complications due to oxygen deficiency

It is observed that patients with sleep disorders experience respiratory pauses of
up to 400-500 times during the night. This oxygen deficiency during the
night causes an excessive load on the cardiovascular system of the person, and this
situation triggers heart enlargement and hypertension in almost half of the
patients. Hypertension disease can be seen in up to 50% of these patients. Lung
problems can also be seen in 20% of these patients, as the lung vessels are
also overloaded.

In patients whose heart rhythm is examined, bradycardia during sleep is followed by tachycardia during
wakefulness. Sometimes other diseases can be added to the rhythm disorder
called bradi-tachy-arrhythmia. These disturbances in heart rhythm can
sometimes even cause the patient to die during sleep.

How should sleep breathing stops be treated?

When treating sleep apnea, the causes, severity, symptoms of the disease, and
the physical and mental state of the patient should be taken into account. Although
none of the treatment options are seen as easy to apply, patients at least
adapt to one of the options.

The most effective treatment of respiratory disorders during sleep is a device
that provides continuous positive pressure air through the nose, which has a
100% effect against the symptoms of the disease. This device, called CPAP
(Continuous Positive Air Pressure), has been used successfully in the treatment
of sleep apnea since the 1990s. Although other treatment methods are
successful in some patients, they are not preferred much considering the risk
of recurrence of the disease and the continuing complications.

Polysomnography

Sleep Test When the patients are told “we need to stay in
the hospital for one night and monitor your sleep”, 90% of them answer “I
cannot sleep”. However, during the nightly sleep test performed on
thousands of patients, patients sleep a similar sleep as they sleep at
home. Some even say they sleep more comfortably than at home. This
concern about not being able to sleep before the test delays the patients’
consultation to the physician and their treatment.

What happens during polysomnography?

When patients come to the sleep center, they are prepared as if they are going
to the hotel. A few hours before normal sleep hours, they come to the
sleep center with toiletries. This time is required for the patient to get
used to the environment and for the bonding of the electrodes that will record
the parameters. Patients are especially asked to be alone and not to be
accompanied by their relatives. Thus, the patient is left alone with the
technician and prepared for the test. When he later wants to sleep, not
too early, he is put in bed and is told that he can sleep. During this
time, the patient gets used to the environment and sleeps easily. Technicians
continue to monitor the patient from another room. They help the patient
to get up when needed and to overcome their problems.

Patients may wake up relatively often because they know that they are watched
during the night and because of the cables attached to their body. However,
even in the most unfavorable conditions, sufficient information about the sleep
efficiency of the patient is collected. When patients are shown morning
recordings, they are surprised at how long they slept so long.

The evaluation and reporting of polysomnography by an experienced physician
takes approximately 1-2 hours. Afterwards, the physician can easily draw
the treatment path by being sure of the symptoms.

As a result, although polysomnography is a test that is accepted with
hesitation at first, it is a laborious test for the patient who surprises the patient
with its results and provides quite a lot of data to the physician, and for
those who evaluate it simply.