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Obstructive an apnoea in a dream

Table of contents
Obstructive an apnoea in a dream
The diagnosis of respiratory frustration during a dream
Treatment

Respiratory frustration during a dream — set of the syndromes of various etiology which are shown an apnoea during a dream.

Apnoea during a dream — potentially life-threatening the patient the state which is characterized by apnoeas lasting more than 10 seconds with a frequency more than 5 events an hour, leading to significant falling of saturation of hemoglobin oxygen.

Epidemiology

Total number of patients with respiratory frustration during a dream> 350 000 000 persons. Data of the international researches of the last years show that from 9 to 12% of people suffer from these frustration, is more often — men (in the ratio 8:10) than working-age. In Russia of large-scale epidemiological researches it was not carried out.

Genetic predisposition to respiratory frustration during a dream:
• anomalies of a structure of a maxillofacial zone of family character;
• the family frustration of a metabolism leading to obesity; Pikvik's syndrome;
• the allergic diseases of parents and close relatives leading to long sinusitis and rhinitises.

Classification

Allocate obstructive and central an apnoea during a dream. The apnoea of the central genesis meets much less often obstructive and in this chapter is not considered.
Depending on etiological factors distinguish four main clinical forms of respiratory frustration during a dream of obstructive genesis:
• syndrome of pathological snore;
• dream apnoea-gipopnoe syndrome;
• obesity hypoventilation syndrome;
• a syndrome of the combined obstruction during a dream.

Weight of a course of respiratory frustration during a dream

Severity

Average SaO2 value

Minimum SaO2 value

Easy current

> 90%

> 69%

Medium-weight current

> 90%

<69%

 

70 — 89%

> 69%

Heavy current

70 — 89%

<69%

Extremely heavy current

<69%

<69%

Etiology and pathogeny of a disease

The disease pathogeny is studied a little so far.
Allocate 4 groups of factors which are capable to lead to fall of upper respiratory tracts and, as a result, an apnoea during a dream:
• the obesity of various degree leading to emergence of cervical "fatty pillows" and change of nature of excursion of a thorax and a front abdominal wall during breath;
• the hypertrophy of fabrics of a stomatopharynx or anomaly of a structure of maxillofacial area which are characterized by increase of resistance of respiratory tracts to the carried-out air flow;
• obstructive diseases of lungs of varying severity at which the ventilating and perfused relations change the elastic energy of lungs worsens, resistance of respiratory tracts to the carried-out air flow increases;
• at SAGS the factors described above are less significant. Major importance belongs to reduction of a tone of muscles of a stomatopharynx at approach of a dream which is in most cases caused by decrease of the activity of motor-neurons. Mechanisms of this process still are definitely not defined now.

During a dream control of a respiratory center and cortical departments over breath decreases, in these conditions the above described disturbances lead to pulmonary hypoventilation.

Clinical signs and symptoms of an illness

The clinical picture of respiratory frustration during a dream is defined by symptoms of a current of 4 main syndromes.
Symptoms, general for all forms:
• increase in body weight (body weight index> of 29 kg/sq.m);
• excess day drowsiness;
• complaints to loud night snore or feeling of "the respiratory gate" during a dream.
SPH is characterized:
• hypertrophy of fabrics or anomalies of a structure of a maxillofacial zone;
• a non-constant short apnoea during a dream;
• the expressed vibration of oropharyngeal structures, with an inherent sound phenomenon — snore;
• frequent awakenings in a night span.

Clinical signs of SOG:
irregular apnoea during a dream; frequent awakenings in a night span;
the expressed restriction of excursion of a thorax and abdominal wall with development of paradoxical breath (during a breath the stomach is pulled in inside, and at an exhalation it is stuck out outside);
gross obesity.

Of SSO it is characteristic:

combination to obstruction of the lower respiratory tracts; frequent awakenings in a night span.

SAGS symptoms:

regular apnoea and gipopnoe during a dream;
• snore owing to decrease in a tone of muscles of a stomatopharynx;
• frequent awakenings in a night span.
At respiratory frustration during a dream the following systems can be involved in pathological process, in addition to respiratory tracts:
• cardiovascular:
— persistent arterial hypertension early morning hours;
— night ischemia of a myocardium;
• endocrine:
— diabetes mellitus;
— metabolic syndrome;
• organs of sight:
— retinopathy;
• psychoemotional sphere:
— depression.

Frequency of manifestation and expressiveness of symptoms depend on extent of decrease in SaO2 during the periods of an apnoea, a form and character of a course of a disease.
Allocate two options of a course of respiratory frustration during a dream:
• intermittent — is characterized by the gradual increase of symptoms moderated by risk of development to life of the threatening states (forms within a decade);
• persistent — is characterized by fast increase of symptoms, high risk of development to life of the threatening states (forms within several years).

Risk factors of sudden death during a dream:
• heavy arterial hypertension;
• the had myocardial infarction or a stroke;
• it is long the existing ventricular arrhythmias.



 
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