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How is sleep apnea manifested?

by Josephine Andrews
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Sleep apnea (sleep apnea syndrome) is a sleep-related breathing disorder: those affected suffer breathing pauses during sleep. The sounds that occur are particularly loud and irregular compared to normal snoring (also a sleep-related breathing disorder). Sleep apnea particularly affects men who have too many pounds on their ribs. Here you can read everything you need to know about sleep apnea.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

P28 R06 G47

Sleep apnea: description

Snoring is a common phenomenon that increases with age. Almost every second person produces the nocturnal noises:

During sleep, the mouth and throat muscles relax, the airways narrow, and the typical fluttering sound of the uvula and soft palate occurs – but this usually does not result in a short-term cessation of breathing.

It’s different with sleep apnea: Here the snorer’s breath stops briefly again and again. The term “sleep apnea” comes from the Greek: “A-Pnoe” means something like “without breath”.

Sleep apnea disrupts sleep and prevents those affected from waking up in the morning. This often also applies to the bed neighbors who feel disturbed by the particularly loud and irregular snoring with the breathing pauses. Sleep apnea syndrome is dangerous because the brief pauses in breathing during sleep can expand into longer, threatening apnea.

Sleep apnea and normal snoring are among the sleep-related breathing disorders (SDBS). These breathing disorders occur exclusively or primarily during sleep.

Sleep apnea: frequency

There are no exact figures on how often sleep apnea actually occurs – not every “snorer” goes to the doctor. According to the International Classification of Sleep Disorders (ICSD), around two to seven percent of the total adult population has sleep apnea. Overweight people are particularly affected: around two-thirds of patients with sleep apnea syndrome are overweight.

In addition, the frequency of sleep apnea increases with age.

forms of sleep apnea

Doctors distinguish between obstructive and central sleep apnea:

Obstructive Sleep Apnea (OSAS)

Obstructive sleep apnea syndrome is the most common form of sleep apnea. During sleep, the muscles of the soft palate relax. As a result, in people with obstructive sleep apnea, the negative pressure generated when inhaling causes the trachea to collapse at various points in the upper respiratory tract. The air can then no longer flow freely – the sleeping person cannot breathe for a short time.

This respiratory arrest causes the oxygen content in the blood to drop (hypoxemia) and there is a deficiency in the supply to the tissue. This causes the body to “wake up”: It abruptly activates the breathing muscles of the diaphragm and chest, the heart also increases its output and blood pressure rises. The sleeper usually wakes up briefly. Doctors call this waking up caused by sleep apnea “arousal”. When breathing starts again, several deep breaths usually follow.

The brief pauses in breathing associated with obstructive sleep apnea can occur up to 100 times a night. The next morning, the affected person usually can no longer remember that he woke up again and again at night due to lack of oxygen.

Central sleep apnea

The second type of sleep apnea is central sleep apnea. This form is triggered by a malfunction in the central nervous system (CNS). Here the upper airways remain open, but the breathing muscles of the chest and diaphragm do not move sufficiently. As a result, the affected person breathes too little and not deeply enough. The resulting lack of oxygen alerts the brain , which immediately ensures that deep breaths are taken.

Central sleep apnea mainly affects older people. It is often harmless and usually does not need to be treated – unless it occurs in combination with cardiac insufficiency or nerve disorders. Then those affected should go to the doctor.

Sleep apnea: symptoms

Typical symptoms of sleep apnea are repeated pauses in breathing during sleep . The apnea lasts between 10 and 120 seconds and occurs more than five times per hour. This is followed by phases of excessive breathing (hyperventilation) and loud and irregular snoring (when the patient takes a deep breath). In addition to the snoring, partners and relatives often notice the pauses in breathing during the night, while they are not aware of the person concerned.

Consequences of sleep apnea

Sleep apnea has consequences. In general, sleep is disturbed, so that those affected suffer from a chronic lack of sleep and tiredness during the day. They are also forgetful and have trouble concentrating. This also increases the risk of accidents on the road.

Some people with sleep apnea also experience anxiety or depression. In part, the breathing disorder leads to headaches (especially in the morning hours) and reduced sexual desire. Erectile dysfunction can occur in men.

sleep apnea in children

Children can also be affected by obstructive sleep apnea syndrome (OSAS). According to experts, breathing disorders may also play a role in sudden infant death syndrome.

Older children with OSAS often appear sluggish and sluggish. They often stand out in school because of their poor performance.

Sleep apnea: causes and risk factors

There are various factors that favor the development of obstructive sleep apnea syndrome. These include, among other things:

Other risk factors are smoking, alcohol, pregnancy and existing diseases such as rheumatism, acromegaly , hypothyroidism or polycystic ovary syndrome . A large tongue, enlarged tonsils, nasal polyps and a lot of fat and connective tissue at the entrance to the airways can also promote sleep apnea. In general, irregular bedtimes can make symptoms worse.

Central sleep apnea is rare and is caused by disorders in the central nervous system (CNS) . Due to neurological damage, the control of the respiratory muscles works poorly.

One possible cause is neuroborreliosis – a disease stage of tick-borne borreliosis. Heart failure patients also often suffer from central (sometimes obstructive) sleep apnea. Central sleep apnea can also occur as a result of chronic kidney weakness (chronic renal insufficiency) or shortly after a stroke.

Sleep apnea: investigations and diagnosis

Anyone who snores (the partner often notices it, but not the person concerned) and suffers from respiratory arrest during sleep should consult an ear, nose and throat (ENT) doctor. The path to diagnosing “sleep apnea” requires several steps – there is not “one” sleep apnea test.

The doctor will first ask you about your medical history (anamnesis), for example:

  • Do you have any previous illnesses?
  • Do you suffer from insomnia?
  • Do you take medication (eg sleeping pills or tranquilizers)?
  • What about your alcohol consumption?
  • Do you take drugs?
  • What are your sleeping habits? (The partner may know better, which is why those affected should ask him or her first – or the partner can come with you to the doctor)

In addition to these questions, the doctor may ask you to fill out a questionnaire. The so-called STOP-BANG questionnaire is very short and contains general questions about sleeping habits, among other things.

This is followed by a physical examination . The ENT doctor looks for anatomical abnormalities in the oral cavity and in the nose and throat area – for example bite abnormalities (position of the jaws to each other), curvature of the nasal septum or nasal and pharyngeal polyps. The paranasal sinuses can be shown well with imaging methods.

The doctor also calculates your body mass index (BMI) from your height and weight.

Sometimes the clarification of sleep disorders and sleep-related breathing disorders also requires polysomnography – an examination and measurement of various parameters during sleep. You usually have to spend one or two nights in a sleep laboratory for this. Doctors analyze your sleep patterns, your breathing during sleep and other factors that indicate sleep disorders (sleep apnea screening). Electrodes attached to the skin help to register the air flow during breathing, the pulse rate, the oxygen content in the blood and the movements of the chest.

Additional sleepiness tests may be required .In the multiple sleep latency test (MSLT), for example, the patient has to take a 20-minute nap several times a day at two-hour intervals. The test records the tendency to fall asleep and the degree of daytime sleepiness.

For some time now, devices have also been available for home use to analyze breath during sleep. They enable recordings similar to those in the sleep laboratory, but do not require straps or nasal cannulas. Instead, the measurement can be taken on the patient’s finger, for example, where a probe measures the smallest changes in the blood vessels and thus draws conclusions about breathing.

Current medical guidelines for sleep-disordered breathing advocate the use of home devices to aid in the diagnosis of sleep apnea.

Smartphones and smartwatches also use this technology, but are usually not approved as medical devices.

Sleep apnea: treatment

You can find out what treatment options are available for sleep apnea in the article Sleep apnea – treatment

Sleep apnea: disease course and prognosis

Obstructive sleep apnea should definitely be treated because it affects health, work and private life:

  • Patients with daytime sleepiness are up to seven times more likely to have an accident on the road.
  • Sleep apnea is associated with high blood pressure, cardiac insufficiency (heart failure), coronary heart disease and cardiac arrhythmia (eg atrial fibrillation).
  • A connection with pulmonary weakness hypertension , diabetes mellitus, kidney (kidney insufficiency) and arteriosclerosis also seems likely.
  • Obstructive sleep apnea syndrome is generally associated with increased mortality.

In people with dementia, treating sleep apnea is also important because the sleep-related breathing disorder further promotes mental decline.

Sleep apnea during pregnancy can harm the unborn child. However, there are currently no controlled studies to recommend therapy for sleep apnea (and other sleep-related breathing disorders) in pregnant women.

Apart from the possible health consequences, snoring and sleep apnea also put a considerable strain on the partnership. 

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