Clinical aspects of sleep apnoe syndrome
Abstract
Sleep apnoe syndrome (SAS) is wide-spead pathology (2–4%) which may jeopardise patients life (sudden night death), there is a strong male predominance in SAS, mean age is 30–55 years (68%). The main markers of SAS are excess weight, especially considerable obesity (more than 120% of ideal weight); increased neck circumference – in male more than 43 cm, in female more than 40 cm; systemic arterial hypertension nasopiiaringeal obstruction; pulmonary hypertension; corpulmonale. The main symptoms of SAS are chronic loud snoring (94%); interrupting of breathing during sleep (54%); excessive daytime sleepiness (especially in transport drivers) (78%); transport and industrial accidents due to hypersomnolence and excessive daytime tiredness (40%); individual character’s changes (48%); morning headaches (36%); sexual dysfunctions (42%). In spite of its wide-spreading, practical doctors recognises the SAS only in 2 cases from 10. There are three main reasons for underdiagnosing SAS. 1) Poor readines of practical doctors to recognise the main markers and symptoms of SAS. 2) The most reliable method of diagnosing SAS is polysomnography, but today these techniques are available only in nonnumerous sleep laboratories. 3) The patients are not aware that chronic loud snoring with sleep apnoes marked by their close relatives is absolute indication to polysomnography for the purpose to diagnose SAS. At present it is possible not only diagnose SAS but also carry out the programmes of optimal managment depending on main symptoms and severity of disease. This programmes include 1) general measures: weight loss with caloric restriction, widening of physical activity, alcohol and hypnotics avoidance, position training (avoid dorsal decubitis); 2) breathing with nasal continuous positive airway pressure (nCPAP) during night; 3) oral appliances (prostetic devices that either pull the tongue or the mandible forward creating a prognatism); 4) surgical management of SAS (uvulopalatopharyngoplasty (UPPP), tonsillectomy, tracheostomy, LAUP, maxillomandibular osteotomy).
About the Authors
S. L. Babak
НИИ пульмонологии М3 РФ
Russian Federation
Russian Federation
A. M. Belov
НИИ пульмонологии М3 РФ
Russian Federation
Russian Federation
S. V. Stebletsov
НИИ пульмонологии М3 РФ
Russian Federation
Russian Federation
R. A. Grigoriants
НИИ пульмонологии М3 РФ
Russian Federation
Russian Federation
References
1. Yong Т., Palta М., Derpesey J., Skattrud J., Werber S., Badr S. The occurence of sleep-disordered breathing amond middle-aged adults // N. Engl. J. Med. 1993. — Vol. 328. — P. 1230—1235.
2. National Heart, Lung, and Blood Institute. Fact Book: Fiscal Year 1993. U.S. Department of Health and Human Services, U.S. Public Health Service, National Institutes of Health, February. - Washington, 1994.
3. Fletcher E.S., DeBehnke R.D., Louoi M.S., Gorin A.B. Undiagnosed sleep apnea in patients with essential hypertension // Ann. Intern. Med. — 1985. — Vol. 103. — P. 190—195.
4. Roth T., Roehrs T.A., Conway W.A. Behavioral morbidity of apnea // Sem. Respir. Med. — 1988. — Vol. 9. — P. 554—559.
5. Findley L.J., Un ve r zagt M.E., Suratt P.M. Automobile accident involving patients with obstructive sleep apnea // Am. Rev. Respir. Dis. — 1988. — Vol. 138. — P. 337—340.
6. Fletcher E.C. The relationship between systemic hypertension and obstructive sleep apnea: facts and theory // Am. J. Med. — 1995. — Vol. 98. — P. 118—128.
7. Strohl K.P., Novak R.D., Singer W. et al. Insulin levels, blood pressure and sleep apnea // Sleep. — 1994. — Vol. 17. — P. 614—618.
8. Guilleminault C., Connlly S.J., Winkle R.A. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome // Am. J. Cardiol. — 1983. — Vol. 52. — P. 490—494.
9. Shepard J.W., Garrison M.W., Grither D.A., Dolan G.F. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea // Chest. — 1985. — Vol. 88. — P. 335—340.
10. Hung J., Whitford E.G., Parsons R.W., Hilman D.R. Association of sleep apnea with myocardial infarction in men // Lancet. — 1990. — Vol. 336. — P. 261—264.
11. Rappoport D.M., Garay S.M., Epstein H., Goldring R.M. Hypercapnia in the obstructive sleep apnea syndrome. A reevalution of the “Picwickian Syndrome” // Chest. — 1986. — Vol. 89. — P. 627—634.
12. Davies R.J.O., Stadling J.R. The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnea syndrome // Eur. Respir. J. — 1990. — Vol. 3. — P. 509—514.
13. Brouillette R.T., Fernbach S.K., Hunt C.E. Obstructive sleep apnea in infants and children // J. Pediatr. — 1982. — Vol. 100. — P. 31—40.
14. Gyulay S., Olson L.G., Hensley M.J., King M.T., Allen K.M., Saunders N.A. A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea // Am. Rev. Respir. Dis. — 1993. — Vol. 147. — P. 50—53.
15. Keenan S.P., Burt H., Ryan C.F., Fleetham J.A. Long-term survival of patients with obstructive sleep apnea treated by uvulapalatopharyngoplasty or nasal CPAP // Chest. — 1994. — Vol. 105. — P. 155.
16. Schmidt-Nowara W., Lowe A., Wiengand L. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review // Sleep. — 1995. — Vol. 18, № 7. — P. 501—510.
17. Tousignant P., Cosio M.G., Levy R.D., Groome P.A. Quality adjusted life years added by treatment of obstructive sleep apnea // Ibid. — 1994. — Vol. 17. — P. 52—60.
18. Phillips B.A., Schmitt F.A., Berry D.T.R., Lamb D.G., Amin M., Cook Y.R. Treatment of obstructive sleep apnea: a preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA // Chest. — 1990. — Vol. 98. — P. 325—330.
Review
For citations:
Babak S.L., Belov A.M., Stebletsov S.V., Grigoriants R.A. Clinical aspects of sleep apnoe syndrome. PULMONOLOGIYA. 1996;(3):41-46. (In Russ.)
Views:
215
Email this article 