Untreated breathing disorders during sleep can cause or exacerbate the course of other diseases, including hypertension, ischemic heart disease (the so-called coronary disease). They may also be responsible for more frequent strokes. Untreated people with OSA of a significant degree, due to significant drowsiness, a feeling of constant fatigue, lack of sleep, are unable to function normally. It is also extremely important that patients with OSA may be the perpetrators of traffic accidents due to falling asleep at the wheel much more often than others.

Basic information on the prevalence of breathing disorders during sleep.

Disorders of breathing during sleep as a separate disease entity – OSA and OSA or OSAS appeared in the second half of the last century. However, if you look closely at the belles-lettres, already in the case of Dionysios of Heraklea, who lived in the 4th century BC, one would suspect the existence of OBPS. Greed led Dionysius to unprecedented obesity and daytime sleepiness, and to wake him from deep sleep, doctors used long needles inserted into the skin of his abdomen or chest. King Magas, described by Athenae in 258 BCE, suffered similar ailments. For many years, patients with a high degree of obesity and daytime sleepiness are commonly referred to as Pickwick’s syndrome. The literary prototype of such a character is Joe – the stable boy, from the novel “Pickwick’s Club” by Charles Dickens. He was an obese boy who was snoring extremely loudly, and he was able to fall asleep even while standing.

In the medical literature, you can find a lot of studies analyzing the incidence of breathing disorders during sleep. It seems, however, that the most valuable is the analysis by the authors at the University of Wisconsin. Prof. T. Young and colleagues, conducting research on a group of 602 people aged between 30 and 60 years, showed that 2% of women and 4% of men can be diagnosed with OSA. If we take into account the number of inhabitants of Poland, it can be expected that there are currently around 450,000 in Poland. people affected by these problems. Even if one accepts the existence of fundamental differences between the American and Polish populations (resulting, for example, from a different incidence of obesity), it is a lot. The sheer number of patients with these disorders is very large, it is also necessary to realize that there is no indication that this problem could be solved or even reduced in the near future. Studies on OSA patients have been conducted in our country for a little over 10 years, until quite recently, the largest number of patients across the country was seen in two laboratories: one at the Institute of Tuberculosis and Lung Diseases, and the other at the Pneumonology Clinic of the Medical University, both centers operating in the area of Of Warsaw. These are undoubtedly the centers with the greatest experience in this field, starting from the first half of the 1990s, new centers dealing with the diagnosis and treatment of OSA have developed, and now patients living also in Wrocław, Katowice, Bydgoszcz, Poznań, Lubin have easier access to diagnostics and treatment in suspected breathing disorders during sleep.

Why do some people stop breathing at night?

OSA is a disease in which breathing interruptions occur during sleep, known as apnea. According to the medical definition, apnea is when there is no flow through the airways. The immediate cause of apnea in OSAS patients is the collapse of the soft parts of the throat; the patient’s soft palate collapses, the tongue retracts into the throat, and other parts of the throat may also collapse. The end result is initially a reduction and then complete closure of the lumen of this section of the airways, which is manifested by apnea. Despite many studies conducted so far, it has not been possible to clearly establish the cause that leads to the development of disorders. First of all, 2 groups of factors are taken into account:

• anatomical abnormalities at the level of the throat and / or nose. In a large proportion of OSA patients, nasal septum deviation, enlargement of the palatine tonsils and the tongue can be found. Obesity is an important factor that may also affect the patency of the throat, which leads to fat deposition in the throat and neck area.
• disorders of the nervous regulation of the muscles that supply the throat. Immediately after falling asleep, the muscle tone of the tongue, soft palate and throat is lowered. This phenomenon does not bring any abnormal consequences in healthy people, but in OSAS patients, if there is also a curvature of the nasal septum or very enlarged palatine tonsils, it leads to apnea.

Sleep apnea is not always a symptom of the disease, and may also occur in small numbers in healthy people. In order to distinguish normal from disease, the so-called Apnea Index (AI) is calculated, this is the number of apnea per hour of sleep. It is believed that in healthy people it can have a maximum value of 10; which means healthy people can have up to 10 apnea per hour of sleep. It happens, however, in patients that even 400 or 500 apnea are registered during one night. If the duration of particular disorders is given, it is often found that the person does not breathe at all for more than half the sleep time. The duration of the apnea varies, on average it is between 20 and 30 seconds, although apneas lasting even 2-2.5 minutes are noted.

What are the consequences of apnea?

Due to the closure of the airways, one of the most important functions of the respiratory system, air exchange in the lungs, is disturbed. During apnea, the oxygen content is lowered, and thus all organs are hypoxic, including those most sensitive to the reduction of oxygen in the blood, i.e. the brain, heart, kidneys, and liver. A very useful indicator of the oxygenation of the body is the saturation of arterial blood with oxygen: saturation (SaO2). In healthy people, SaO2 is usually in the range of 95-98%, while during apnea, depending, among other things, on its duration, a reduction of SaO2 to less than 50% or even 40% is often observed. To illustrate how serious these disorders are, it can be said that if a healthy person was suddenly moved to the top of Mount Everest, the measured SaO2 value would be about 50%. It should also be noted that at such a high altitude (8,848 m a.s.l.) none of the climbers can climb without a long period of adaptation to high mountain conditions and very few people entered it without the help of an oxygen mask.

In addition to lowering the oxygen content in the blood, a number of other abnormalities occur during apnea: blood pressure rises (systolic pressure may exceed 200 mmHg!), Heart rhythm disturbances occur.

Each apnea must end at some point. It comes about as a result of awakening; the patient wakes up for a period of several seconds, awakening is associated with an increase in muscle tension – the upper respiratory tract opens, the patient takes a few breaths, takes a few breaths, then falls asleep again and in a moment another apnea begins. On the one hand, awakenings play a defensive role – they prevent the patient from suffocating during sleep, but on the other hand, it is difficult to expect a person who wakes up several hundred times each night to be able to function normally during the day. Repeated awakenings after many times lead to the breakdown of the normal structure of sleep, i.e. changes in the duration of individual sleep phases that do not condition adequate rest. In patients with OSA, the duration of deep sleep and REM sleep (fast eye movement sleep – the phase of sleep in which dreams occur) is shortened.

Ailments and symptoms related to breathing disorders during sleep

For easier description, the ailments and symptoms of OSA are divided into those occurring during sleep and during the day. It turns out, however, that the most important problem for patients are the ailments they feel during the day, while the patient’s immediate environment is the most complainant about what happens to the patient during sleep.

Sleep period

• Snore. Snoring sounds have been around for so long that for many years it has been treated as something completely normal and correct. The problem of snoring appeared in the literature for quite a long time, but rather in the aspect of noise, which is often bothersome for the environment, which in the case of people prone to radical problem solving could even be a reason to reach for a weapon; John Wesley Hardin – a famous gunslinger from Texas, shot one night a guest of an adjoining hotel room, who was snoring very loudly while sleeping. Hardin, who reportedly shot more than 30 people during his short life (1853-1895), had to be brought to an end because, as legend has it, he prided himself on never shooting anyone who did not really deserve it.

From a pathophysiological point of view, the snoring sound is produced mainly during the inhalation phase, as a result of vibrating the soft, structures of the upper respiratory tract, devoid of bone or cartilage support. Contrary to previous opinions, the formation of these sounds may involve not only the soft palate and the uvula, but also other elements of the upper respiratory tract – up to the level of the vocal cords. Such a complex etiology, the participation of many different elements means that the development of an effective method of eliminating this ailment is still a huge challenge for medicine. The fact that snoring has been common for a long time, however, an accurate assessment of the frequency of this phenomenon is very difficult. The data from the literature are broadly divergent: 5 to over 80% of men and 2-57% of women are thought to snore regularly. Snoring is an inherent symptom associated with OSA. In highly advanced cases, the patient snores regardless of the sleeping position: sitting, on the stomach, on the back or on one side. Exceptionally loud and irregular snoring is typical of breathing disorders during sleep. It happens, however, that in the initial stage of the disease, snoring disappears or decreases in intensity while sleeping on the stomach or side. Snoring sounds, on the other hand, are significantly intensified after drinking alcohol or taking sleeping pills. They are often so loud that sick spouses are not able to stand either in one bed or even in one room – unfortunately, snoring can also cause serious family problems. Snorers are the bane of holiday or business trips and can astonish or even scare your travel companions by bus, train or plane. Irregular snoring in patients with OSA is associated with periods of apnea – when there is no air flow through the respiratory tract, snoring sounds are also not audible; very loud, even dramatic sounds appear on awakening.

• Apneas observed by household members. The patient usually learns about sleep apnea from people who observe him during sleep. It sometimes happens that it is the concerned spouses who lead the sick to the doctor because they have noticed that the husband stops breathing every now and then. It is almost a rule that the frequency and duration of apnea increases markedly after consuming alcohol at bedtime.
• Restless sleep. Patients with OSA sleep very restlessly – they wave their arms, move their legs, twist, which can cause serious injuries to their spouses. Usually, they are completely unaware of their behavior and learn about it from members of their immediate family. They often wake up at night with a feeling of breathlessness, choking, and a stuffy throat. Such ailments are often the cause of nervousness, fear and even fear of suffocation or even death.
• Frequent urination at night. This is an extremely troublesome symptom that occurs in many patients, sometimes they are forced to get up every hour to urinate. It should be noted, however, that the increased frequency of urination at night may also accompany other diseases, e.g. heart failure, kidney disease or prostatic enlargement. If the problem of breathing disorders during sleep concerns young children, involuntary urination may also occur – in the group of adults it happens much less frequently.
• Awakening. As previously mentioned, each apnea ends in awakening, but most of them do not remember the next day. It happens, however, that after some apnea patients wake up a little longer, often it is related to the feeling of fear, anxiety, shortness of breath, a feeling of increased heartbeat. It also happens that patients experience apnea immediately after falling asleep as difficulties in falling asleep and therefore seek medical help.
• Excessive sweating is another unpleasant ailment associated with breathing disorders during sleep. In the morning, patients often wake up with sweat, quite often complain that the pillow is completely wet and the pajamas can only be washed.

SYMPTOMS APPEARING DURING THE DAY

• The feeling of lack of sleep is one of the most frequently reported ailments, patients often complain that regardless of whether they sleep 6, 8 or 10 hours, in the morning they wake up tired, sleepy, and the only thing they want to do is go to sleep. Some people wake up as tired as after doing some very strenuous physical exertion. Such a feeling of fatigue and weariness accompanies most patients throughout the day.
• Excessive daytime sleepiness. This is the most common condition associated with OSA. A patient with OSA can fall asleep regardless of the situation in which he finds himself: while reading the newspaper or watching TV, it also happens that untreated people fall asleep while talking on the phone or even at the table during lunch or dinner. Excessive sleepiness and falling asleep during the day is not only an embarrassing ailment but can also be very dangerous, not only for the patient himself. Patients with OBPS can also fall asleep while driving a car or other motor vehicles. One of the patients of the Warsaw laboratory of breathing disorders fell asleep while waiting for the traffic lights to change at the intersection. The spiciness of this authentic story is added by the nature of the work he did – he was a professional driver who, a few months before establishing the proper diagnosis, was distributing petrol in tankers all over Poland. Another patient who came for the examination was a professional military pilot …… Falling asleep while driving is a huge problem, still not fully understood and, what is worse, underestimated. Symptoms derived from excessive sleepiness, constant fatigue and lack of sleep are difficulties with concentration, problems with remembering, memory impairment. Some patients are also prone to depressive reactions.
• Morning headaches are probably related to the increased concentration of carbon dioxide in the blood during sleep, which has the ability to widen the blood vessels of the brain, which can lead to headaches. However, it cannot be ruled out that they are also caused by cyclic changes in blood pressure associated with apnea. Ailments begin as soon as you wake up and usually tend to subside during the day.
• Potency disorders. Decreased sexual performance, decreased libido may affect up to about one third of men with breathing disorders during sleep. This leads to an increase in the anxiety and frustration of the sick, and is also responsible for the breakdown of marriages.