Sleep Apnea Treatment

Other sleep-breathing disorders

Increased resistance syndrome of the upper airway (IRSUA)

The concept of upper airway resistance syndrome was initially introduced by Guilleminault for children with a previous diagnosis of idiopathic hypersomnia. The Studies consistently detected the presence of transient awakenings throughout the entire process of sleep, associated with an abnormal increase of the upper airway resistance without oxyhemoglobin desaturation. Subsequent investigations isolated IRSUA as a clinical entity and identified it pathophysiologically to describe subjects without apnea or desaturation suffering electroencephalographic arousals (arousals) repeated as a result of a progressive increase in resistance of the UA. The definition of IRSUA is still very controversial for many authors, who consider it as a prelude to OSAHS symptoms. Somewhere between simple snoring and OSA, as a distinct clinical entity it is still questioned. There is a trend that advocates including IRSUA as a distinct disease entity of SDB, while by another aspect of clinical research it’s considered as a mild manifestation of OSAHS, an initial state of the disease with the same pathophysiological consequences. This syndrome is characterized by recurrent episodes of decreased airflow of the airway in the absence of apneas or hypopneas without oxyhemoglobin desaturation, with respiratory effort related arousals that fragment sleep and generate daytime sleepiness, neurocognitive impairment, deficit of attention and hyperactivity. One of the biggest disadvantage for the clinical diagnosis is that IRSUA is similar to the OSAHS and the resulting symptoms due to overlapping diagnoses.

Central Apnea

In general terms, known as central sleep apnea, the normal breathing pattern disorders during the year, due to negative effects on the nerve centers that control breathing and leads to a cessation of airflow not less than 10 seconds. It is related to dysfunction of the central nervous system centers or lesions in the brain stem that controls breathing. As it is known, by increasing the alveolar PCO2 level the respiratory center is stimulated, the threshold at this level for starting breathing movements is higher during sleep than while awake, so that at the iniciation of sleep the CO2 level is lower compared to required sleep and physiological apneas can ocurr and this is considered as a normal phenomenon, anyhow on people whose sleep quality is low with frequent interruptions, we will see a periodic breathing by idiopathic central apnea, in which the alveolar PCO2 is normal and is known as a non-hypercapnic central sleep apnea. Breathing during waking is controlled by metabolic, behavioral and neural factors, leaving the neural mechanisms of breathing almost exclusively under the influence of metabolic factors, so that structural or functional lesions of the chemoreceptors, autonomic pathways, medullary respiratory centers, motor tracts, anterior horn cells, neuromuscular junction and muscles could lead to central sleep apnea in a broad sense covering both the central and peripheral nervous system. In general, central sleep apnea is far less common than the obstructive variant, however, the interest in the presence of daytime sleepiness, quality of sleep fragmentation and other primary sleep disorders (eg parasomnias, periodic limb movements, etc. .) help to identify this central form of sleep apnea and to avoid presenting a circular mechanism, in which a breathing disorder, could provoke metabolic changes, which for their part disturb the architecture of sleep, aggravating the process. It is distinguished from the OSAHS cause of the absence of ventilatory effort in response to the interruption of breath. In this type of apnea, there are no respiratory efforts (inspiratory) after the collapses or cessations of breathing (apneas). The pathophysiological consequences are similar to the obstructive apnea syndrome.

Mixed apnea syndrome

It is a combination of obstructive apnea and central apnea with a neurological origin and obstructive development. The apnea is diagnosed as mixed, when elements of neurological order coexist with obstructive episodes, provoked by anatomical and functional changes in air route. Generally, mixed apnea episodes are initiated with a central original component but develop respiratory efforts with characteristics of OSA.

Also called periodic or cyclic breathing, is an abnormal breathing pattern consisting of alternating reverse respiratory events. Ventilatory oscillations evolve cyclically from apnea (cessation of breathing), followed by a gradual increase in the frequency and amplitude of breath, tachypnea (rapid breathing but shallow) can often lead to hyperpnea (increased respiratory rate and depth) to return to decrease gradually until the apnea status. This anomaly has its origin in a central nervous system dysfunction and is associated with brain injury and cerebrovascular accidents. The condition may also be present as a common medical evidence at high altitude and amount in patients with heart failure and comas. As in other forms of central apnea, they are not succeeded by ventilatory efforts. The periodic breathing can be a manifestation of an underlying central apnea or appear independently.

Cheyne Stokes breathing pattern (CSBP)

So called periodic or cyclic breathing, is an abnormal breathing pattern consisting of alternating reverse respiratory events. Ventilatory oscillations evolve cyclically from apnea (cessation of breathing), followed by a gradual increase in the frequency and amplitude of breath, tachypnea (rapid breathing but shallow) can often lead to hyperpnea (increased respiratory rate and depth) to return to decrease gradually until the apnea status. This anomaly has its origin in a central nervous system dysfunction and is associated with brain injury and cerebrovascular accidents. The condition may also be present as a common medical evidence at high altitude and amount in patients with heart failure and comas. As in other forms of central apnea, they are not succeeded by ventilatory efforts. The periodic breathing can be a manifestation of an underlying central apnea or appear independently.

 

Congenital central alveolar hypoventilation syndrome or Ondina syndrom

Alveolar hypoventilation syndrome is caused by a fault in the automatic control system of breathing that determines abnormal levels of low blood oxygen (hypoxia) and an excessive concentration of carbon dioxide in the blood. Hypoventilation during sleep is heightened, when the breath control is completely involuntary and persons can not regulate these episodes of hypoxia and hypercapnia with voluntary hypoventilation to normalize their blood gases. Its congenital form occurs in the newborn period or during the first year of life but is a rare entity, the prognosis is grave, with a high mortality rate and a therapeutic dependency for the mechanical ventilation at night. The most frequent clinical manifestations are daytime drowsiness, headaches, and sleep disturbances.

In the Germanic-Scandinavian mythology, water nymphs were called mermaids, of great beauty that lived in lakes, rivers, ponds and fountains. They have their correspondence in the Naiads of Greek mythology. From the 18th century the mermaids protagonized a string of fantastic stories, which became heroines. The evil or curse of the mermaid refers to the legend in which the nymph curses the one with whom she falls in love, for betraying his promises of love. ”You promised me that every last breath out of your mouth would be for me, and I accepted your vote. Then so be it. All the time you stay awake your breath you belong, but if you ever sleep ... your breath will belong to me and you die.”.