Dr. Elias Fotopoulos, Surgeon ENT, Doctor of the University of Athens, talks to Newsit and Nikos Evangelatos about sleep apnea and modern methods of dealing with it. He analyzes how he treated with ultrasound and when “hybrid” treatments can be applied, while explaining how important it is to change the habits and lifestyle of the sufferer.
What is sleep apnea?
Stopping breathing and oxygenation lasting over 10 seconds is called sleep apnea. Sleep apnea is a very insidious and dangerous condition, as the one who suffers from it usually does not know it. It should be noted that about 3 out of 10 adults have episodes of apnea or sleep in their sleep but most do not know it.
How is apnea linked to snoring? How can snoring be a warning sign?
Snoring and sleep apnea are the two sides of the same coin. Sleep apnea is a very insidious and dangerous condition, as the one who suffers from it usually does not know it. It should be noted that about 3 out of 10 adults have episodes of apnea or sleeping in their sleep but most do not know it. Most of the time the one who snores is sensitized by his/her partner. The first symptom or sign is the strong snoring, over 80dB, which can reach all 100 dB. Snoring may be accompanied by frequent breathing vacation. These breath vacations and consequently oxygenation last from a few seconds to more than 1 minute in severe cases. When they last more than ten seconds we talk about episodes of apnea.
What are the most common symptoms of sleep apnea?
The snoring is accompanied by frequent awakening with a sense of suffocation, which make the patient wake up very tired, and there may be other symptoms: irritability, malice, concentration and attention, decline in efficiency, gastroesophagus -Hypology, arrhythmias, etc. The lack of concentration and severe drowsiness that is frequent during the day, due to a bad sleep is the reason to cause traffic accidents in severe cases.
Why don’t sleep apnea sufferers see dreams?
Because they do not get into the deep phase of sleep, where we see dreams. Due to the fall of oxygen levels, the brain signal for awakening to ventilate the body before falling deep in the dream.
What mechanism do the apnea caused during sleep? What are the causes and predisposing factors;
During the day, the airway is always maintained open thanks to the function of the muscle muscle of the grape and the pharynx. However, during sleep, muscle tone relaxes, resulting in the collapse of the anatomical structures of the pharynx and the coincidence of the walls, leading to partial (suspicion) or complete blockage of the airway (apnea). Thus, in people with anatomical problem, such as nasal diaphragm scoliosis, nasal nasal hypertrophy, hypertrophic adenoid sprouts (meat), oversized almonds, elongated or bulky grape and narrow arches of the palate, more difficult or more, In many cases, the fall of the base of the tongue may be responsible. Of course, there are other, very important predisposing factors such as obesity, smoking, alcohol consumption and heavy meals before bedtime, the use of sedatives, antidepressants or hypnotic substances that relax excessive muscle tone, and even diabetes or diabetes. of sleep.
When should we worry and what suspicious signs should we be very careful about our partner?
Sleep apnea syndrome (SYA) is very insidious and dangerous to the patient, but the sufferer often ignores its existence. The one who initially suspects him is his partner, who is disturbed by his strong snoring (over 80 decibels) and is sensitized.
So if we look at our partner during sleep thrown abruptly with a feeling of suffocation, showing nightly awakening and trying to get air, in this case it is advisable to seek special ENT help or plan to undergo sleep study. Because obstructive sleep apnea syndrome is accompanied by specific signs and symptoms, we must be seriously concerned if our partner shows one or more of the following: Awakening with a sense of suffocation, morning fatigue and drowsiness, malice Cardiovascular complications such as hypertension and arrhythmias. Even if our partner has unusual drowsiness after eating or is in danger of falling asleep on the steering wheel during driving or even during a movie, these signs should raise awareness to think of the possibility of suffering from sleep apnea. Obstructive sleep apnea syndrome is very dangerous and threatening to the sufferer’s life as it may even be responsible for sudden death. That is why its diagnosis and treatment should not be delayed at all.
How is sleep apnea diagnosed?
Sleeping (multi-body-quarrel) is done in a special center that requires the patient’s stay for one night. This examination records, in addition to the duration and the number of apnea per hour of sleep (Apine -Subparts), and other parameters such as the drop in oxygen saturation (SAO2), cardiac function, blood pressure, etc. Lastly very useful diagnostic, Sleep counting number (AHI) and durability, snoring intensity and other useful parameters. The important advantage of the method is that the patient does not need to be unraveled, as you can easily do the home.
How is the causes of obstructive apnea diagnose?
Video-rhin-lamboscopy examination with flexible camcorder in specialized OTO-Rinos-Lentology clinic is diagnostic. Endoscopy in the clinic is done very easily, quickly and completely painlessly for the patient. It detects the anatomical obstacles of nose, mouth and throat that cause blockage of the air channel and predispose to apnea. Video -endoscopy can also be combined with drug hypnosis -dise (sleep simulation condition for even greater diagnostic accuracy) in order to recognize the specialist where exactly where to intervene correct the anatomical barrier to the air passage using the most appropriate surgical technique.
What is DISE? Why is its role in diagnosing and treating sleep apnea?
Endoscopic Drug Induced Sleep Endoscopy (DISE) is to examine the choice to diagnose the causes of airway obstruction in patients suffering from obstructive sleep apnea (SLEEP APNEA). Specifically, the patient is given to the patient’s hypnotic substance to create sleep simulation conditions and under the supervision of the anesthesiologist, the entire respiratory tract is crossed with a special high-resolution video-endoscope. In this way, the potential points of the airway blockage during the apnea are highlighted, from the entrance of the nose to the subfruit, the epiglottis and the larynx. The examination takes place in a special center with advanced technology endoscopic equipment and under the supervision of a specialized anesthesiologist. This examination provides even greater diagnostic accuracy and helps the special doctor recognize exactly where to intervene by correcting the anatomical obstacle to the air passage by choosing the most appropriate surgical technique.
If the problem is in the language, then what is the treatment?
If during sleep endoscopy it is clearly evident that the level of obstruction is at the base of the tongue, then the treatment is based on the application of a special oral masculine, which keeps the tongue firm during sleep and prevents it from falling back and closing the airway. This cushion is made of silicone and made by a specialized dentist. And it is only used during sleep and is easily tolerated by the patient.
What is the most common conservative treatment of apnea?
The treatment of election for sleep apnea syndrome is the application of continuous positive airway pressure (CPAP). CPAP is a mask placed above the nose and / or mouth and gently blows air on the airway to keep it open during sleep. Unfortunately they are not easily tolerated by several patients because they cannot easily tolerate continuous air flow.
How is sleep apnea treated with ultrasound? What are their advantages?
The use of surgical ultrasound in the treatment of snoring and obstructive apnea in recent years has given reliable solutions. It is a modern device that produces oscillations of very high frequencies, which are transferred to the ultrasound cutting organ, which directly affects the anatomical obstacle (grape, palate arches, diaphragm, niches, meats, tonsils, etc.) that causes difficulty in the air. Ultrasound treatment is usually done in a specially equipped center and requires a mild and short -term general anesthesia or drunkenness. The method is bloodless, almost painless, with perfect sterilization thanks to high frequency oscillations. All these advantages of ultrasound reduce recovery time and within a few hours the patient can go home. The results are immediately and are first perceived by the patient’s partner in the coming days, and the patient sleeps quietly and free from snoring and apnea.
Lately there is more and more reason for the “hybrid” treatments of sleep apnea. When can they be applied? How effective are they?
By “hybrid” we unite combination therapies, that is, a combination of 1) Surgical treatment with ultrasound or frequencies eg in the nose or pharynx, along with 2) application of orally. They have an ideal indication when sleep endoscopy shows obstruction on more than 1 level. Eg nose and tongue. They have very high therapeutic success rates even in a large number of apnea.
Is it important to change habits and lifestyle the sufferer?
Lifestyle changes are effective ways of mitigation of sleep apnea symptoms: weight loss, avoiding alcohol and of course, smoking cessation. Also, avoiding heavy and fatty meals at night, keeping the hours (3 hours in the last meal before lying down), avoiding mild sleeping, daily aerobic exercise (walking) is generally very important a shift to the healthier lifestyle.
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