Syndrome of Sleep Apnea

Definitions
At apnea: is the cessation of breathing greater than 10 seconds.
In obstructive apnea: is a cessation of breathing by pharyngeal obstruction related to hypotonia of pharyngeal muscles with persistence of respiratory movements.
A central apnea: is the cessation of respiratory drive with stop motion and respiratory flow.
A hypopnea: it decreased ventilation of about 50%.
A syndrome of sleep apnea: it is from 10 apneas + hypopneas per hour of sleep.
A syndrome of severe sleep apnea: is when the apnea-hypopnea index greater than 30%.

Epidemiology
9 Apnea Syndrome Sleep button:
4 3 to 5% of the male population,
4 1 to 2% of the female population.
9 Risk factor: hypertension, stroke, myocardial infarction, car accidents, social gene.

Screening

  • Polygraphie respiratory recording of nocturnal SaO 2, respiratory movements, respiratory flow, snoring.
  • Polysomnography: respiratory polygraphy + + EEG + EMG electro-occulogramme.



Pathophysiology
Snoring: is the vibration of the posterior wall of pharynx narrowed.
Obstructive:
pharyngeal closure during inspiration in sleep (Promotes alcohol, sedatives, …)
respiratory movements persist when there is a struggle of O 2 desaturation, and bradycardia microréveil, taken with noisy inspiratory tachycardia.

Clinical signs

  • Often a man over 45 years, generally obese
  • Snoring loud sometimes prolonged apnea,
  • restless sleep, wake-up call Apnea
  • Asthenia morning, daytime sleepiness (watching TV, driving, reading a newspaper, …), morning headaches, impaired concentration, impotence, urinary frequency at night.
  • Anomaly anatomical reduction of the soft palate, large uvula, chin back, enlarged tongue, tonsils, deviated nasal septum.

Balance Sheet
nocturnal SaO 2: desaturation “comb”
Polysomnography:
apnea, SaO 2 mean, minimum desaturation snoring, sleep stage IV + REM sleep, microreveils,
superficial sleep, stage I and II, little sleep III and IV and some REM sleep.
Polygraph,
Cephalometry
pulmonary function tests + blood gases: Research pulmonary chronic obstructive associated hypercapnia.

Treatment
A Medical: diet, no alcohol at night, not sleeping pills, light dinner.
A Mechanics:
Pressure continues positive night life, keeps the airways open.
effective pressure from 6 to 14 cm H 2 O
pressure fixed or variable, humidifier.
Education equipment (nasal breathing, prevent leaks, although the address mask, protection of the nasal bridge)
dramatic effect with disappearance of drowsiness,
side effects or unwanted noise, rhinitis, conjunctivitis, …
A Surgical:
uvulo-palato-pharyngoplastie,
tonsillectomy,
vegetation
advancement of the mandible.
A oral prosthesis,
Sometimes adding O 2 on the mask.

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