“Mr. Pickwick’s apartment was disturbed by an incessant roar. As soon as the door was opened, the figure of an unusually fat boy was seen standing with his eyes closed, as if he were asleep due to his calm and peaceful expression. When asked why he had come, he said nothing, only nodded, as if snoring slightly; repeating the question three times produced no response. Just as he was about to close the door, he abruptly opened his eyes, blinked several times, and raised his hand to knock again.
This magnificent production of the writer Charles Dickens in chapter 54 of his work Posthumous papers of the Pickwick Club It entered the history of medicine as the original description of obstructive sleep apnea syndrome (OSAS). Fat Joe, a plump, ruddy, sleepy, slow boy (bradypsychia in medical terminology), exaggerates and summarizes the main clinical manifestations of this widespread disease.
Widespread but poorly diagnosed: Although it is estimated to affect 5% to 8% of the population, there are many cases that go undiagnosed. And those affected can suffer serious consequences, as other diseases (comorbidities) such as diabetes and cardiovascular disease are associated with it.
And how can we know if we have OSAS? We must be alert for such signs: heavy and irregular snoring, which alternates with respiratory pauses (apnea) due to the collapse of the airways; sleep is restless and usually interrupted by multiple awakenings; excessive sleepiness during the day; formulates thoughts and ideas slowly, as happened to Fat Joe; difficulty concentrating and remembering; headaches, mostly in the morning; and nocturia, which is the need to get up to urinate several times a night.
OSA and obesity: chicken or egg?
Numerous epidemiological studies suggest a link between sleep disorders (including lack of rest) and obesity, which is one of the epidemics of the 21st century. It is logical to assume that OSAS is the most common type of obesity associated with sleep disorders.
But the relationship seems to be bidirectional. On the one hand, in obese patients, especially those suffering from so-called central obesity (with a pear-shaped or pear-shaped morphotype, like in Fat Joe), the percentage of OSA exceeds 50%; on the other hand, 60-70% of people with OSAS have this overweight problem, and patients with sleep disorders are more likely to develop it.
This appears to be due to the hormonal and metabolic disorder that causes sleep apnea. Due to these interruptions in breathing, the production of leptin (a hormone that causes a feeling of satiety and enhances thermogenesis or heat production) decreases and the production of ghrelin increases, which stimulates appetite and the formation of adipocytes, fat cells.
That is, under these circumstances, the brain establishes a procedure for To save money energy, perhaps in the wrong way. Added to this is an increase in the consumption of foods rich in fats and sugars, and a decrease in physical activity.
And as if that weren’t enough, the metabolism of OSA patients can develop resistance to the action of insulin, leading in many cases to diabetes.
vascular disorders
Another consequence of sleep apnea is a periodic drop in the level of oxygen in the blood caused by obstructive phenomena. This causes brain activation with micro-awakenings of the brain, which we have been able to observe in the studies we are doing in the sleep lab.
We sleepologists interpret these micro-awakenings, in which the person is not fully awake, to represent the sleeping brain’s defense mechanism against attack. Produced by the release of catecholamines (adrenaline), in the long term they increase the risk of hypertension, angina pectoris, myocardial infarction, stroke, sudden death…
It should be clear that early detection of OSAS and effective treatment are powerful weapons for the prevention of cardiovascular and cerebrovascular disorders. A simple overnight test at the patient’s home, such as a respiratory polygraph, can confirm or rule out a diagnosis.
Daytime sleepiness: risk of accident
The poor quality of nighttime rest in sleep apnea patients has another fundamental connotation. Fragmentary, superficial sleep with multiple micro-awakenings and short awakenings, to which nocturia should be added, means that this sleep is not restful, followed by excessive sleepiness during the day.
The consequence of this is low intellectual performance, with difficulties in the ability to concentrate, remember, solve problems, etc. And if those sleep attacks Hurry up with us behind the wheel, there is a serious risk of getting into a traffic accident.
In fact, the Highway Traffic Authority links daytime sleepiness to up to 30% of crashes. They are also usually the most severe as they occur at high speed, without pre-braking and in a frontal impact. Suffering from sleep apnea increases your chances of being in a traffic accident by 3 to 7 times, an estimate that increases by up to 11 times if alcohol is also taken.
As expected, OSA also increases the risk of accidents at home and at work. In the latter case, it increases by at least 50%, which means that the diagnosis and treatment of obstructive sleep apnea will prevent 18,000 to 25,000 occupational accidents per year.
Mechanical means to remove the obstacle
And how can it be treated? The main method of treating moderate and severe severity of the disease is based on the use of a night ventilation system using a compressor and a put-on mask through which purified air is blown (CPAP-BIPAP devices). This puts positive pressure on the airways and allows the obstruction to be cleared during sleep. Some individual cases can also be resolved with surgery.
However, it should be noted that the best treatment for OSAS is weight loss, a healthy lifestyle, and basic sleep hygiene.
Juan José Ortega Albas, somnologist, Fisabio
This article was originally published on The Conversation. Read the original.
Source: RPP
I’m Liza Grey, an experienced news writer and author at the Buna Times. I specialize in writing about economic issues, with a focus on uncovering stories that have a positive impact on society. With over seven years of experience in the news industry, I am highly knowledgeable about current events and the ways in which they affect our daily lives.