Diagnosis, Risk Factors, And Management Of Sleep Apnea

Identification of Risk Factors

Sleep apnea is a genuine, possibly perilous condition. It is a breathing issue portrayed by rehashed fall of the upper airway route while taking sleep, with subsequent suspension of relaxing. For all intents and purposes all sleep apnea patients have a background marked by noisy wheezing. They may likewise unconsciously encounter visit feelings of excitement amid the night, bringing about interminable daytime tiredness or on the other hand weakness. Focal and obstructive sleep apnea are the two discrete sorts. Focal sleep apnea, portrayed by an absence of wind current in the nonappearance of ventilatory exertion, is uncommon. Obstructive sleep apnea is considerably more typical and is alluded to as sleep apnea from this point forward. It is described by conclusion of the upper aviation route, bringing about the discontinuance of wind current in spite of relentless ventilator exertion (16). Apnea is characterized as discontinuance of wind current for over 10 seconds. A related occasion, hypopnea, is described by a diminishment in wind current related with an abatement in oxygen immersion. The normal number of apnea, hypopnea occasions every hour of sleep is known as the apnea-hypopnea file (AHI). Grown-ups may encounter up to five occasions for every hour without indications. By and large, as AHI expands, so does the seriousness of indications, an AHI of five or more noteworthy in blend with self-revealed hypersomnolenceis demonstrative of the sleep apnea syndrome (11).

1 Sleep apnea has all the earmarks of being as normal as a few better known sicknesses. It is evaluated that 4 percent of moderately aged men and 2 percent of moderately aged ladies meet negligible criteria for sleep apnea syndrome.

1 this thinks about to a 4.5 percent commonness of asthma in moderately aged adults.

2 Sleep apnea is more common among the hefty, in guys, and in more seasoned individuals.

3 There likewise is by all accounts a higher pervasiveness of sleep apnea in the hypertensive populace

The purpose of this essay is to highlight the identification, diagonosis and numerous types of treatments of the disease.

Identification of risk factors of the patients of Sleep Apnea

The individuals who exhibit frequent signs of sleep apnea exhibit loud and frequent snoring while sleeping. In this context it can be said that when people do not snore frequently they might be under no risk of having sleep apnea (10). On the contrary, people who have been observed to experience apneic events which are characterized by gasping or choking while sleeping can definitely be marked as people who are at risk of sleep apnea. In most occasions the family members identify the people who are at risk of this disease. In many cases obesity plays a major role and particularly obesity in the upper body section of individuals play a significant role to make the individual fall prey of sleep apnea. It has been observed that majority of the sleep apnea patients are obese and the people having more than 120% of the ideal body are seen to have experienced sleep apnea. In many occasions large neck girth in both female and male snorers can be majorly predictive of sleep apnea and in most cases males with circumference of neck of 17 inches or greater than that and females with the next circumference of 15 to 16 inches or more can be tagged as individuals who are at higher risk for experiencing sleep apnea (11).

Diagnosis

There are many other Symptoms and Signs that can help the individuals to identify the patients who are at higher risk for sleep apnea and those are frequent daytime sleepiness hypertension automobile or workplace accidents are having unexplained pulmonary hypertension in individuals that may call in diseases like sleep apnea in a frequent manner. When an individual complaints regarding sleepiness in the times but does not experience are the symptoms and science of sleep apnea A thorough observation of the Sleeping habits audit individual should be useful in that particular scenario (13). For an example the individuals related to the person who complained regarding the sleepiness can check up on the average hours of sleep of that person or the frequently changing sleeping schedules of that person or recent change in the lifestyle of that individual. Not only for the adults but sleep apnea can affect children also and tonsillar hypertrophy is one of the major reason behind that. Children experiencing sleep apnea may show various Symptoms and Signs then the adults exhibit (8).

The existence or the absence of OSA should be determined before the initiation of the treatment. This should be done in order to figure out the failures of those patients who are suffering from the risk of sleep apnea (14). This would act as the first step of guidance for the patients. This is the first steep of developing the baseline to establish the presence of the disease in the patients. The diagnostic criteria for OSA are completely based on the clinical signs and the symptoms that are observed during the sleep of a particular person (3). These are based on the clinical signs and symbols. This is related to the history of the sleep and the physical examination.

Knowing the history of the sleep is the first step toward knowing the disease well that might help in the diagnosis process of the disease. This is divided into three different parts. The first part is the evaluation of the of the routine health checkup (7). The second part is the assessment of the symptoms that forms the major cause of the sleep apnea and that disturbs the sleep. The third part is the wide-ranging evaluation of the patients at high risk for OSA. The patients who have the high risk of having the disease are those who have high risk of heart failure, atrial fibrillation, hypertension, stroke, diabetes nocturnal dysrhythmias and the ones who are evaluated for bariatric surgery. In order to know about the history of the disease certain questions should be asked to the patient regarding the history of snoring and daytime sleepiness and on the existence of obesity or hypertension.

In order to deal with this a serious treatment process should be designed. There are no specific treatment model that can be recommended in order to predict the severity of OSP. In order to fix this objective testing is essential (14). The diagnosis can be recognized by an satisfactory method. The most common method of objective testing are in-laboratory polysomnography and home testing with portable monitors. The particulars on the parameters should be considered with PSG and PM. The patients who have high risk with some amount of nocturnal symptoms of OSA should go through the sleep testing that includes who are obese, the ones who are having diastolic heart failure and the coronary artery disease (16).

History and Physical Examination

This is an effective process that can be used to evaluate OSA that requires the recording the signals that are related to the electroencephalogram, electrooculogram, chin electromyogram, airflow, oxygen saturation, respiratory effort and electrocardiogram or heart rate (5).

Portable Monitors for diagnosis of OSA should be performed only in the conjunction with a complete sleep evaluation. The clinical sleep evaluations that use PM must be evaluated and supervised by the practitioner with the broad certification in sleep medicine or an individual who fulfils the eligibility criteria for the sleep medicine certification examination (15).

In many instances the multiple sleep latency test is not routinely indicated in the initial evaluation and the diagnosis of OSA or in an assessment of change that is followed by the treatment with nasal CPAP.

Figure 1: diagnosis sleep apnea

Source: (6)

Sleep apnea can be initially diagnosed at a sleep centre or at the clinic lab. This can be done when a patient sleeps overnight. This study is called the study of, “polysomnogram”. The study of the sleep charts the important signs like heart beat, breathing and brain waves (2).

This includes continuous positive airway pressure (CPAP). This is considered to be a positive and moderate form of treatment. It is used in the severe cases of OSA and it is considered to be a better option for the mild sleep apnea. It was first introduced in the year, 1981. It provides a steady stream of pressurized air to patients through a mask that they wear during their sleep. The airflow keeps the airway open, this prevents the pauses in the3 breathing and restoring the normal levels of oxygen (8). The new models of CPAP are small and light and they are they are virtually silent. The patients are given the choice of innumerable sizes of mask and different styles in order to achieve a good fit. In order to contribute to the comforts of the patient the heated humidifiers are connected to the CPAP units.

The other form is the oral appliances. The oral appliance is a useful option of treatment for the people having mild issues, in order to reasonable OSA to the ones who actually prefer CPAP or they are not able to successfully comply with the therapy of CPAP. The oral appliances appear as sports mouth guards, which assist in maintaining an unobstructed and open airway by stabilizing or repositioning the lower jaw, the soft palate, the tongue and the uvula. Some of them are designed mostly for the purpose of snoring and the sleep apnea. However, they need to be fitted by those dentists who should be trained in giving sleep medicines.

The other process is the process of surgery. This option can be applied when the problem involves anatomic deformity. This can be corrected in order to alleviate the breathing problem. On the other hand this has a severe risk. The surgical option most often addresses the issue by removing or reducing the tissue from soft palate, tonsils, uvula, adenoids and the tongue. The surgical method can be performed only with the help of an operation (7). The biggest risk is that it contains is the fact that it is not certain that the result will be positive. The surgical removal of the tonsil and adenoids is treated as the most common option for treating the children.

Objective Testing

The other includes the behavioural changes. It has been observed in many cases that the persons who are overweight suffer from sleep apnea. In such case weight loss is the best option.99 This option might be effective one for those who might develop the habit of changing from back-sleeping to side-sleeping. This might bring results for those who are suffering from the mild cases of OSA (9).

Apart from this the other treatments include the over-the-counter remedies. There are certain sprays that might reduce the snoring like internal nasal dilators, external dilator strips and lubricant sprays (4). However it has been proved that there is no such evidence that these remedies might even reduce the problems of loud snoring. The snoring created loud sound that is regarded as the warning sign for this disorder. The most common treatment that is used for the snoring patients is the change of the position of the sleep. The patients are generally advised to stay off the back during sleeping and raise their heads of the bed in order to reduce these symptoms.

It is a matter of fact that quality sleep for a long period of time helps to maintain a good balance in life and if an individual gets deprived of sound sleep that can potentially affect the productivity and can bring in numerous troubles for that particular person. It has been seen that the lack of sleep aggravates anxiety, reduced quality of daily life, increases stress level and harms the daily course of life of that individual (10). First and foremost lack of sleep destroys the patterns of electric inside human brain and reorganizes cognitive functions. Continuous lack of sleep can cause various disorders with cognitive impairments (3). Not only that, it can definitely be said that sleep apnea results in a major negative impact on the individual alertness, attention, learning ability and significantly harms the productivity of that person (12). One should not only look for the physical factors of sleep apnea but also look for the associated psychological factors of the disease. It is a matter of fact that the psychological roots can be found based on emotional factors, attitudes that concerns sleep and some dysfunctional beliefs along with many other behavioural factors like inadequate sleep hygiene (13).  

It has been seen that when a person who is fighting with sleep apnea after getting professional help gets out of the trauma they exhibited sorts of depression and fatigue while performing daily activities(3).  It is a matter of fact that the patients of sleep apnea should be handled with proper care and under professional supervision in order to eradicate these issues (14).

Conclusion

Thus to coclude, it can surely be said that the diseases like sleep apnea can surely be treated with proper care and by utilizing cognitive behavioural therapy in order to enhance the sleep quality, disorders of sleep and many more. It Is a matter of fact that diseases like sleep apnea initially may look simple and easy to get rid of but negligence can cost a lot as with lesser productivity and increased stress and depression of the patients, the matter becomes pretty serious and the patients who are fighting with this odd, may find themselves cornered.

Polysomnography

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