Obstructive sleep apnea, chronic and costly disease


Sleeping well is essential for the proper functioning of a person. In modern life it is very common to suffer from disorders of the sleep because we live very exposed to artificial light and that is one of the main factors that alters the cycles of sleep.

Here is an interview with the doctor pulmonologist Ramón Toribio, graduated from Valle de Hebrón Hospital, Spain. He provides services in the COM Professional Building and in Cedimat.

What are disorders of the sleep?

These are conditions that alter the cycles of the sleep. It is a multidisciplinary pathology, that is, it involves different medical specialties, depending on the specific symptoms of each patient. For example, insomnia may be a manifestation of a disease psychiatric, either anxiety or depression, but insomnia, sometimes, especially in women, can manifest as a symptom of obstructive apnea the sleepIt is not the most common, but it can be seen.

—Types of disorders sleep and which are the most common:

The disorders of sleep are: insomnia, sleep apnea sleep (obstructive or central), restless legs syndrome, bruxism (teeth grinding), narcolepsy, among others. But, the most common are insomnia and obstructive apnea the sleep (OSA).

What is the obstructive apnea the sleep?

It is a condition that is caused by the collapse, partial or complete, of the upper respiratory tract. Apnea is stopping breathing and is known as one of the respiratory disorders of the sleep. When you stop breathing, you don’t oxygenate well and that produces a microarousal, which generates a lot of brain activity, which will interfere with the normal cycles of the sleep.

Who is at risk for OSA?

People with overweight and obesity, but it does not mean that all people with these conditions suffer from OSA. There are thin people who have OSA because their upper airway, anatomically, is narrow or flaccid. Also, patients with maxillofacial disorders.

Smoking and alcohol consumption are considered a risk factor, because they produce alterations at the level of the muscles of the respiratory tract that makes it weaker, which makes it easier for it to collapse.

OSA is more frequent in men than in women, however, in postmenopausal women the prevalence is even. In general terms, worldwide the prevalence of OSA is estimated at 5%. In República there is no organized study, but from what one consults and comments with colleagues, the behavior is similar to that of the world population.

Can children get OSA?

Yes. In children, it is usually associated with hypertrophy of the tonsils and obesity. If the child loses weight and the tonsils are operated on, the child is cured. In the case of minors, this disease is associated with poor school performance.

What are the symptoms of OSA?

Snoring, observed apneas and nocturnal choking attacks, which can sometimes be confused with a seizure. On the other hand, nocturia (waking up to urinate repeatedly), morning headache, daytime sleepiness and feeling tired. Patients with obstructive apnea the sleep they are people who fall asleep easily wherever they go, which makes OSA a condition that can lead to workplace and other accidents, in the case of drivers.

Most patients usually come to the clinic because the bed partner takes them, be it the woman or the man, because they do not let them sleep because of the snoring, and then they are tormented by the respiratory pauses of the partner.

How is it diagnosed?

It begins with a physical examination of the patient and evaluation of the airway. In addition, analysis to rule out associated diseases (hypothyroidism or diabetes) and identify any cardiovascular alteration. A polysomnogram, which is a recording of the sleep of the patient overnight, either in a laboratory of the sleep or at home, depending on the characteristics of the patient.

What are the risks of having OSA?

Most patients with obstructive apnea the sleep As they do not rest well at night, the next day they usually present with symptoms of drowsiness, fatigue, tiredness. But, at the level of the cardiovascular system, the obstructive apnea the sleep is a risk factor for cardiovascular diseases, because this drop in oxygen saturation produces an increase in heart rate and blood pressure, and this can translate into high blood pressure, if the patient is not, or it can cause the hypertensive patient is not well controlled.

Suffer obstructive apnea the sleep it can also trigger arrhythmia or worsen it, if the patient already has it. At a cerebrovascular level, this is going to become a risk factor for cerebral vascular accidents, etc.

Then, in the very long term, it has been associated with degenerative neurological diseases, such as Alzheimer’s, Parkinson’s or senile dementia. But also in the metabolic system it is associated with insulin resistance, obesity and even cancer, due to the inflammatory state in which the body is.

There are people who can benefit from sleep apnea surgery. sleepis a lower percentage of patients, or maxillofacial surgery, in case the patient has disorders at the maxillofacial level or at the level of the respiratory tract, also with mandibular advancement devices.

How is this condition treated?

The first thing is that if the patient is obese, he must lose weight, second, the patient must improve the hygiene of the sleep. On the other hand, more than 90% of patients are treated with CPAP (Continuous Positive Airway Pressure), an electronic device that administers to the patient, through a mask that covers the nose and mouth, a continuous air pressure that keeps the airway open. The patient must use it every night and it eliminates snoring and apnea.

What do you mean by hygiene? sleep?

They are the bad habits that one usually has such as: going to bed watching television, going to bed with a cell phone or tablet, having dinner close to bedtime and eating copious meals during the night, not having a fixed time to go to bed, not sleeping between 7 and 8 hours, not sleeping in a suitable environment (soundproofed, dark and air-conditioned). If you treat the apnea, but the patient has poor hygiene of the sleepthen you will not achieve the goal.

Is OSA overcome, that is, is it cured?

The obstructive apnea the sleep is a disease chronic and progressive, because as you get older you tend to become more flaccid and gain weight. It could only be cured in some cases, with surgery or if the patient recovers his weight, but that happens in less than 10% of the universe of patients. In most cases it is a disease forever.

What lifestyle adjustments can improve the quality of sleep?

Maintain a proper weight, exercise, keep a fixed time to go to bed, monitor hygiene measures of sleep and eliminate cigarettes, alcohol, stimulant substances or drinks.

A disease expensive

The pulmonologist Ramón Toribio assures that the obstructive apnea the sleep is a disease which is underdiagnosed, at the international and national levels, because access to diagnosis is complex.

“In the Dominican Republic, OSA is a disease for rich. The study to make the diagnosis is expensive, since most medical insurances do not cover it. They are not included in the basic health plans and that means that people cannot undergo the study to confirm the diagnosis and then the treatments are also expensive.”

Source-www.diariolibre.com