Sleep Apnea Treatment

Clinical profile of patients with sleep apnea

If we were to draw a standard profile of a patient OSAHS, we would describe a man of middle age, between 40 and 65 years, habitual snoring (with long histories of snoring that usually began in childhood), overweight, hypertensive and referring excessive daytime sleepiness. Usually the OSAHS patient is an obese man, though this feature is not exclusive cause it is also presented also in women, especially postmenopausal women and young men with or without overweight. Clinical manifestations of sleep apnea syndrome are the result of the interaction of anatomical, neural and genetic converging on the development of pathology.

Obesity
Obesity is a major risk factor for OSA, but it is also true that it is the only reversible condition. A body mass index (BMI) greater than 28 kg/m2 is more related to anthropometric indicators of sleep breathing disorders. Excess weight is present in 60-90% of patients diagnosed with OSAHS. Overweight and fat distribution are factors associated with risk of respiratory disorders. The waist circumference, fat deposits on the pharyngeal walls and the size of the circumference of the neck are data, that have to be considered in OSAHS diagnosis. This linkage is demonstrated by the fact, that many patients with a high rate of apnea/ hypopnea improve after achieving a substantial reduction in weight. OSAHS relationship with obesity is justified by the fact, that an increase in the scope of the neck with local deposits of fat decrease the permeability of the UP radius, combined with lung volume reduction in obese persons with fatty deposits at the abdomen.

BMI: Current Weight / (height2). Considering the current weight in kilograms and height in meters. 25 to 30 are overweight notes. Between 30 and 35 is considered "mild obesity 'or first grade. Between 35 and 40 is considered "moderately obese" or second grade and above 40 is considered "morbidly obese" or third degree. Levels below 20 viewed under weight. The ideal index therefore lies between 20 and 25 kg/m2.

Genre
The majority of male prevalence in epidemiologic surveys of OSAHS is constant and population studies establish that the ratio between men to women is roughly 3:1. These percentages are matched, whereas the age advance and the OSAHS incidence of menopausal women is similar to those of men. The greater willingness of men to develop OSAHS has no clear explanation, and is another of these clinical lacks of knowledge, that discovers the pathophysiology of this syndrome. Anatomically, women have a shorter pharynx than men and again develop three times less OSAHS than men. On the other hand, studies show, that men have greater deposits of fat in the upper airway. Currently there is no sufficient literature to justify the differences of gender function.

Age
There are epidemiological evidences, that the presence of sleep breathing disorders in the elderly population is well above the levels in young and middle-aged population. The frequency of OSA increases with age also experiencing a sharp increase after the 65th age.

Family genetic component, family relation
Studies of interference in the family component of sleep breathing disorders have become increasingly important with recent population studies. The identification by genetic inheritance was noted by Redline et al. in 1995, who found out, that the risk of ORSD increases from 2 to 4 times in ORSD families. The medical records reflect also a familiary ORSD background and link in a large number of patients.

Other diseases
There are diseases associated clinically to an OSAHS condition, such as renal failure or metabolic or endocrine disorders, such as acromegaly, hypothyroidism or diabetes type II.

Toxics and drugs
Alcohol plays an aggravating role of OSA, the consumption of alcohol in the hours before sleep increases the number of respiratory events (apneas and hypopneas) in both snorers and in patients with OSAHS. There is evidence, that many drugs as sedatives or barbiturates encourage the occurrence of apneas, as well as snuff or other substances for their irritant effect on the mucosa of the upper airway.

Position of the head and neck
Body position during sleep is burdening as it affects the diameter of the upper airway. The dorsal supine position due to the reduction of the radius of the UA and a predisposition to oral breathing. When subjects sleep in the supine position, moving the tongue and soft palate causing a reduction of the UA. Modifications in the neck flexion changes the position of the hyoid delaying it back causing changes in the resistance to airflow. In healthy patients this position may be the reason of occasional episodes in apnea and in cases of OSAHS, already ocurred, aggravate the condition.

Posture: The posture aspect and neuromuscular balance of the head, spine, hips, legs and foot support, is closely related to masticatory function, occlusal and is an aspect to observe. Changes in neck flexion resulting in different positions of the hyoid, which can cause changes in airflow resistance in the pharynx. The TMJ connect the jaw to the skull, it is the articulation guide for the body to adopt a good posture and is one of the important factors in getting the balance. When the balance is broken dental mandibular condyle will acquire a different position from the usual within the fossa glenoid.

Mouth breathing
Nasal breathing is the ideal and any alterations, which prevent such problems with allergic rhinitis, deviated septum, enlarged adenoids, nasal obstruction or polyps, subdues the patient to oral breathing, which predisposes to collapse. The open mouth undertakes the action of the pharyngeal dilator muscles, that move dorsally to their insertion, causing a decrease in its length and a reduction in the generated force.