What is sleep apnea?
Sleep apnea (short for sleep apnea syndrome) is a sleep disorder in which during sleep to avoid episodes of apnea or severe respiratory depression.
Background
Everyone has sleep apnea in sleep. One speaks of a sleep apnea syndrome (SAS) in more than five stops per hour. After an interruption in breathing followed by a period of more or less normal breathing again after periods come arrest. These periods of cessation of breathing may be relatively short, and range from 15 to 30 seconds. Periods longer than 30 seconds are also possible. Then insufficient oxygen is absorbed and no carbon dioxide exhaled. The brains give the body a signal to wake up. After awakening, often with a shock, breathing resumes.
The breathing stops can occur very often during sleep. The symptoms the patient can consist of a very restless sleep, not wake up well rested during the day fall asleep in unexpected and extreme fatigue. Mechanical breathing support during sleep causes no breathing stops occur. The diagnosis is made in a so-called sleep center. The research being undertaken is called polysomnography. These various measurements are carried out during the sleep associated with the breathing.
Two syndromes
At the central sleep apnea syndrome (CSAS) is passed during sleep from the respiratory center in the brains of lack of signal to the respiratory muscles, causing the breathing is interrupted.
In obstructive sleep apnea syndrome (OSAS), upper airway flips closed by wall or tongue, causing a blockage (obstruction) in the airway. This happens due to the tonusverlies in the mouth and throat muscles, and therefore the patient is still awake to his deep sleep, slow wave sleep stage reached. Obstructive sleep apnea disrupts sleep in this way, the build-up and causes sleep deprivation.
In most cases, there is a combination of both syndromes.
Obstructive sleep apnea syndrome
The causes of this syndrome may be many and must be sought in tobacco smoking, hereditary factors, a short lower jaw abnormalities in the ear, nose and ear area, lung disorders, a low tone of the mouth and throat muscles example by using sleeping pills or chronic renal failure.
The effects of obstructive sleep apnea-syndrome can manifest itself in violent snoring regularly suddenly wake up with a jolt, abnormal daytime sleepiness, fatigue, irritability, extreme sweating during sleep, muscle by muscle acidification and hypertension. It causes an increased risk of cardiovascular disease and increased insulin requirements. Also, there is a risk of neurocognitive decline in various domains when this condition is left untreated for a long time.
Diagnostics
In a sleep study used different measurements:
- AHI, Apnea Hypopnea Index, some breathing stops per hour (the most decisive measurement)
- AI, apnea index
- DI, gassing Index
- Cumulative night hypoxieduur
- Mean and minimum oxygen saturation value
Current issue
5% of men have apnea (in women are the numbers of slightly less); However, most are not aware of that. The problem is recognized poorly by most GPs. Often people with vague symptoms to the surgery, which are dismissed as burnout symptoms. Rest then gives no solace, but even exacerbates the problem, enters through the social isolation in which the patient.
Sleep apnea treatment options
There are several options for treatment.
- Conservative measures adapting the lifestyle (weight reduction, no alcohol before bedtime, no sleeping tablet).
- Operation: Sometimes it is possible and / or necessary to carry out an operation which aims to improve the airway (with a crooked nasal septum or large tonsils).
- BRACKET: in mild forms of obstructive sleep apnea syndrome is now common at night a bracket (repositioning device mandibulair or MRA) used, which ensures that the tongue can no longer back pockets. This equipment is very similar to some removable brackets (activators) that Orthodontists use. MRAs are in 1987 by the Netherlands introduced H.J. Remmelink in Almelo orthodontist. Over the last ten years, extensive research has shown that many patients with obstructive sleep apnea syndrome with a MRA can be treated. Treatments with a MRA have relatively few disadvantages and side effects. There are currently more than 80 different types of Mras. This means, however, is not suitable for all patients. The MRA-treatment is in Belgium in most cases (partly) refunded by the nihdi.
- Air pressure: in severely obstructive sleep apnea syndrome is positive pressure ventilation, Positive Airway Pressure (PAP), the first choice. Pressure ventilation is not a cure of the sleep disorder, but a (lifetime) treatment.
- CPAP Continuous Positive Airway Pressure,. During sleep are the Airways kept open by a light permanent positive air pressure generated by a pump with a cap on mouth and/or nose is maintained. A CPAP device is prescribed by a (long) doctor, after a sleep study is performed in a hospital. CPAP equipment is now covered by many health insurance (Netherlands) and the nihdi (Belgium, starting from AHI = 20 and ArslI = 30).
- BiPAP, Bilevel positive airway pressure, is a variant of the CPAP. Patients who need a relatively high air pressure to inhale, exhale at the same high pressure may have trouble in. In contrast to the continuous pressure that is issued by a CPAP, BiPAP gives a different air pressure for inhaling and exhaling. This can facilitate the exhale.
- APAP or auto-PAP. This device works just like the CPAP, but depending on the degree of obstruction blows the device with a more or less high pressure.
- Other resources: If the sleep disorder occurs with rugslapen, a tennis ball in the back of the Pajamas are confirmed to prevent slept on the back. Patches or various means such as nose sprays are generally unsuccessful.
Sleep apnea treatment : Surgical options
- The HTP-procedure: the hyoid (hyoid) is moved slightly forward.
- The hyoid-expansion procedure: herewith a titanium prosthesis is placed between the two halves of the hyoid bone, in order to keep the throat while sleeping wider and more open. This technique was developed in the University Hospital Antwerp.
- Other surgical techniques such as UPPP (uvulo-palato-pharyngo-plastic), LAUP (Laser Assisted uvulo plasty) and somnoplastiek are either painful or have moderate to varying degrees of success and are irreversible.
- Stimulation of the upper respiratory tract: researchers testing an implantable neurostimulator (similar to a pacemaker) which, during the night a light pulse to the tongue nerve (hypoglossal nerve), whereby the tongue base itself moves forward, resulting in keeping open the upper respiratory tract. This therapy is being investigated since the 2000s in the UZ Antwerpen and Johns Hopkins University in the us. Recent studies suggest that this technology can reduce the AHI in patients who do not tolerate CPAP. Doctors in the UZ Antwerpen, St. Lucas Andreas Ziekenhuis in Amsterdam and other hospitals in Europe, Australia and the us signs patients in a clinical study to international, the safety and effectiveness of the therapy to investigate.