{"id":22304,"date":"2016-03-08T00:00:00","date_gmt":"2016-03-08T00:00:00","guid":{"rendered":"https:\/\/sylvainchamberland.com\/sleep-apnea-pathophysiology-signs-and-symptoms\/"},"modified":"2023-08-21T13:33:33","modified_gmt":"2023-08-21T13:33:33","slug":"sleep-apnea-pathophysiology-signs-and-symptoms","status":"publish","type":"post","link":"https:\/\/www.sylvainchamberland.com\/en\/sleep-apnea-pathophysiology-signs-and-symptoms\/","title":{"rendered":"Sleep apnea, pathophysiology, signs and symptoms"},"content":{"rendered":"

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Obstructive sleep apnea is the most frequent problem of breathing disorders related to sleep. It is a known fact that snoring is one of the first symptoms of apnea. 20% to 25% of snorers<\/strong> (1 out of 4) are reported to suffer from obstructive sleep apnea as well.<\/p>\n

A consultation in sleep medicine is strongly recommended for people who snore and who present daytime sleepiness, sleep interruptions (insomnia), hypertension or other cardiovascular problems, a lack of restorative sleep or a lack of concentration (similar to attention deficit disorder).<\/p>\n

Loud and intermittent snoring with periods of silence of more than 10 seconds long should suggest an apnea problem.<\/p>\n

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Definitions<\/h2>\n

Obstructive apnea<\/h3>\n
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Obstructive apnea<\/p><\/div>\n

\u2022 Reduction of respiratory amplitude of more than 90% (\u2265 90%) during episodes of 10 seconds or more (\u2265 10 s).<\/p>\n

Hypopnea<\/h3>\n
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Hypopnea<\/p><\/div>\n

\u2022 Reduction of respiratory amplitude of 50% (\u2265 50%) for more than 10 seconds in duration with a 3% or greater (\u2265 3%) desaturation in oxygen or presence of microarousals.<\/p>\n

Upper airway resistance syndrome (UARS)<\/h3>\n
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Upper airway resistance syndrome<\/p><\/div>\n

\u2022 Increase in the effort to breathe or flattening of the nasal pressure wave of 10 seconds or more in duration and presence of microarousals, increase in heart rate of 5 heart beats or more per minute.<\/p>\n

Central apnea<\/h3>\n
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Central apnea<\/p><\/div>\n

\u2022 More than 3 consecutive cycles of crescendo and decrescendo changes in respiratory amplitude AND<\/strong> 5 or more episodes of central apnea or hypopnea per hour OR<\/strong> crescendo or decrescendo changes for 10 consecutive minutes or more.<\/p>\n

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Symptoms associated with apnea<\/h2>\n

Symptoms associated with sleep apnea are:<\/p>\n

\u2022 Night-time arousal<\/p>\n

\u2022 Diaphoresis or night-time sweating<\/p>\n

\u2022 Choking sensation during the night<\/p>\n

\u2022 Lack of restorative sleep<\/p>\n

\u2022 Enuresis (night-time urination in bed) or nocturia (waking up often to urinate at night)<\/p>\n

\u2022 Abnormal motor activity of legs and arms during sleep<\/p>\n

\u2022 Daytime sleepiness<\/p>\n

\u2022 Cephalgia in the morning when waking up (morning headache)<\/p>\n

\u2022 Poor concentration<\/p>\n

\u2022 Memory loss<\/p>\n

\u2022 Anxiety and depression<\/p>\n

\u2022 Gastroesophageal reflux disease<\/p>\n

\u2022 Impotence<\/p>\n

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Signs of apnea<\/h2>\n

Signs of sleep apnea are:<\/p>\n

\u2022 Obesity<\/p>\n

All patients suffering from apnea are not necessarily obese. However, we can assume, due to epidemiological studies, that 90% of obese patients suffer from apnea.<\/p>\n

\u2022 Increase in neck circumference<\/p>\n

Fat deposits in the neck compress airways in the same way as if we clamp a hose. Less air goes through and the pressure has to be increased to overcome the resistance caused by the narrowing of the airway and obtain the same throughput. The increase in parapharyngeal fat reduces airways.<\/p>\n

\u2022 Increase in waist circumference<\/p>\n

Obesity is associated with a high body mass index (BMI). Among the people who consult in sleep clinics for apnea, 28% have a BMI greater than 30 and 47% have a BMI between 26 and 30. A normal BMI is between 20 and 25.<\/p>\n

\u2022 Retrognathia (recessed jaw or jaw shifted backward)<\/p>\n

Retrognathia can affect the upper jaw only (retrusive maxilla), the lower jaw (mandibular retrognathia) or both jaws.<\/p>\n

\u2022 Maxillary constriction (palate too narrow)<\/p>\n

Lack of width in the maxilla can be explained by the fact that an individual who does not breathe through the nose necessarily breathes through the mouth. Yet, to breathe through the mouth, the tongue must be lowered and must not be in contact with the palate, otherwise air would not pass through. Small child, small tongue, big child, bigger tongue. In a growing patient, the tongue thus lowered almost permanently to facilitate mouth breathing does not participate in the development in width of the palate as the child grows up. Indeed, if a patient breathes normally through the nose and maintains the mouth closed during breathing, chances are that the tongue is in contact with the palate most of the time. As the child grows up, his\/her tongue grows and the palate gets wider to adapt to the development of the tongue.<\/p>\n

\u2022 Overjet and overbite (horizontal and vertical distances between the upper and lower teeth greater than normal)<\/p>\n

\u2022 Tonsil hyperplasia<\/p>\n

\u2022 Macroglossia (large tongue)<\/p>\n

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Airways obstruction area<\/p><\/div>\n

\u2022 Narrow oropharynx<\/p>\n

Airways restriction areas can be located in the nasopharynx, oropharynx<\/a> or laryngopharynx.<\/p>\n

\u2022 Soft palate erythema and edema<\/p>\n

\u2022 Nasal obstruction (deviated nasal septum, turbinate and nasal mucosa hypertrophy following chronic allergies)<\/p>\n

\u2022 Hypertension<\/p>\n

Comorbidities associated with<\/strong> apnea are hypertension, cardiovascular diseases, infarction and thyroid problems.<\/p>\n

Alcohol intake<\/strong> increases the risk of apnea by increasing the nasal and pharyngeal resistance to the passage of air. This is explained by the effect of alcohol on muscular motor function (it is a known fact that muscles of a drunk person are weaker…). The pharynx collapses more easily, which increases the resistance to the passage of air and thus reduces the throughput of inhaled and exhaled air.<\/p>\n

Smoking<\/strong> is a risk factor for apnea. Sleep is unstable by the decrease of nicotine level in the blood during the night. Smokers have 3 times more risks of suffering from apnea than non-smokers.<\/p>\n

The prevalence<\/strong> of apnea is from 4% to 9% of middle-aged men<\/strong> and from 1% to 2% of middle-aged women. The highest prevalence is among men of 40 to 65 years of age<\/strong>.<\/p>\n

The prevalence in children<\/strong> from 2 to 8 years of age is 2%<\/strong>, but consequences can include hypertension, enuresis, growth delay, hyperactivity<\/strong> and cognitive impairment.<\/p>\n

Pediatric apnea<\/h3>\n

Just listen to this baby and you will feel like choking.<\/strong>
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