Syndrome sleepy - the sleep disorder accompanied with episodes of a stop of nosorotovy breath lasting not less than 10 seconds. At a syndrome sleepy can be registered from 5 to 60 and more short-term respiratory standstill. Also snore, an uneasy night dream, day drowsiness, decrease in working capacity is noted. Existence of a syndrome sleepy comes to light when carrying out a polisomnografiya, and its reason – during otorinolaringologichesky inspection. For treatment of a syndrome sleepy the medicamentous and surgical methods directed to elimination of a cause of infringement are used non-drug (special oral devices, a kislorodoterapiya).
Syndrome sleepy (night) – the disorder of respiratory function which is characterized by periodic respiratory standstill in a dream. Except night respiratory standstill constant severe snore and the expressed day drowsiness are characteristic of a syndrome sleepy . Respiratory standstill in a dream is potentially life-threatening state which is followed by haemo dynamic frustration and unstable warm activity.
Respiratory pauses lasting 10 seconds at a syndrome sleepy cause a hypoxia (a lack of oxygen) and the gipoksemiya (increase in carbonic acid) stimulating a brain that leads to frequent awakenings and renewal of breath. After new falling asleep short-term respiratory standstill and awakening follows again. The quantity of episodes depends on weight of violations and can repeat from 5 to 100 times an hour, developing in the general duration of respiratory pauses till 3-4 o'clock in a night. Development of a syndrome sleepy breaks normal physiology of a dream, doing it faltering, superficial, uncomfortable.
Statistically from a syndrome sleepy 4% of men and 2% of women of middle age suffer, with age the probability increases. Women are most subject to development in the period of a menopause. Close to respiratory dysfunction is – reduction of volume of a respiratory stream by 30% and more in comparison with usual for 10 seconds, leading to decrease in perfusion of oxygen more than for 4%. At healthy faces meets physiological - the short, periodically arising respiratory standstill in a dream lasting not more than 10 seconds and frequency no more than 5 at one o'clock, the norms which are considered as option and not menacing to health. The solution demands integration of efforts and knowledge in the field of otorhinolaryngology, pulmonology, a somnologiya.
Classification of a syndrome sleepy
On the pathogenetic mechanism of development of a syndrome sleepy allocate its central, obstructive and mixed forms. The syndrome central sleepy develops as a result of violation of the central mechanisms of regulation of breath owing to organic damages of a brain or primary insufficiency of the respiratory center. in a dream at the central form of a syndrome it is caused by the termination of receipt to respiratory muscles of nervous impulses. The same mechanism of development is the cornerstone of periodic breath of Cheyn-Stokes which is characterized by alternation of superficial and rare respiratory movements with frequent and deep, passing then in .
The syndrome obstructive sleepy develops owing to fall or occlusion of the top airways at preservation of respiratory regulation from TsNS and activity of respiratory muscles. Some authors include a syndrome obstructive sleepy in a syndromic complex obstructive apnoe-gipnoe to which a number of the respiratory dysfunctions developing in a dream also belongs:
- The hypoventilation syndrome – is characterized by steady decrease in ventilation of lungs and perfusions of blood oxygen.
- Syndrome of pathological snore
- Obesity hypoventilation syndrome – the gas exchange violations which are developing against the background of excess increase in body weight and followed by permanent decrease in perfusion of blood oxygen with day and night gipoksemiya.
- Syndrome of the combined obstruction of respiratory ways – a combination of violations of passability top (at the level of a throat) and lower (at the level of bronchial tubes) airways, the gipoksemiya leading to development.
The syndrome mixed sleepy includes a combination of mechanisms of the central and obstructive form. By quantity of episodes severity of a current of a syndrome sleepy is established:
- to 5 episodes in an hour (or to 15 apnoe-gipopnoe) - there is no syndrome sleepy ;
- from 5 to 15 in an hour (or from 15 to 30 apnoe-gipopnoe) – a syndrome sleepy easy degree;
- from 15 to 30 in an hour (or from 30 to 60 apnoe-gipopnoe) - a syndrome sleepy average degree;
- over 30 in an hour (or more than 60 apnoe-gipnoe) - a syndrome sleepy heavy degree.
Reasons and mechanism of development of a syndrome sleepy
Violations of regulation of respiratory function from TsNS at a syndrome central sleepy can be caused by injuries, sdavleniye of stem department of a brain and a back cranial pole, damages of a brain at a syndrome of Altsgeyma-Pika, postentsefalitichesky parkinsonism. Primary insufficiency of the respiratory center causing a syndrome of alveolar hypoventilation at which the tsianotichnost of integuments, episodes in a dream in the absence of pulmonary or kardialny pathology is observed occurs at children.
The syndrome obstructive sleepy meets at the persons having obesity, endocrine frustration subject to frequent stresses more often. Anatomic features of the top airways contribute to development of an obstructive syndrome in a dream: a short thick neck, the narrow nasal courses, the increased soft palate, almonds or a palatal uvula. In development of a syndrome sleepy the hereditary factor matters.
Development of a syndrome obstructive sleepy results from the faringealny collapse arising in the course of a deep sleep. Fall of pneumatic ways at the level of pharyngeal department during each episode causes the conditions of a hypoxia and a giperkapniya signaling a brain about need of awakening. During awakening pneumatic function and ventilation of lungs are restored. Violations of passability of the top pneumatic ways can develop behind a soft palate or a root of language, between a back wall of a throat and a hoanama - internal nasal openings, at the level of a nadgortannik.
Symptoms of a syndrome sleepy
Often patients with a syndrome sleepy do not suspect about the disease and learn about it from those who sleep nearby. As the main manifestations of a syndrome sleepy serve snore, an uneasy and faltering dream with frequent awakenings, episodes of respiratory standstill in a dream (according to the persons surrounding the patient), excessive physical activity in a dream.
As a result of a defective dream at patients the neurophysiological violations which are shown headaches in the mornings, weakness, excess day drowsiness, decrease in working capacity, irritability, fatigue during the day, decrease in memory and concentration of attention develop.
Over time at the patients suffering from a syndrome sleepy body weight increases, sexual dysfunction develops. The syndrome sleepy negatively influences warm function, promoting development of arrhythmias, heart failure, stenocardia attacks. A half of patients with a syndrome sleepy has an accompanying pathology (an arterial hypertension, IBS, bronchial asthma, a chronic obstructive pulmonary disease, etc.) which considerably is making heavier a current of a syndrome. Development in a dream quite often meets at Pikvikk's syndrome – the disease combining insufficiency of the right departments of heart, obesity and day drowsiness.
At children the night and day incontience of urine, excessive perspiration in a dream, drowsiness and sluggishness, behavioural violations, a dream in unusual poses, snore can testify to a syndrome sleepy breath through a mouth in the afternoon.
Consequences and complications of a syndrome sleepy
Sleep disorders at a syndrome sleepy can hard affect quality of life. Decrease in concentration of attention increases risk of traumatism and industrial accidents, in life and daily activity in the afternoon.
Increase in frequency of episodes directly influences increase in level of morning arterial pressure. During respiratory pauses violation of a warm rhythm can develop. Even more often the syndrome sleepy is called the reason of development of a stroke in young men, ischemia and myocardial infarction at patients with atherosclerosis. The syndrome sleepy makes heavier a current and the forecast of chronic pulmonary pathology: HOBL, bronchial asthma, chronic obstructive bronchitis etc.
Diagnostics of a syndrome sleepy
In recognition of a syndrome sleepy the contact with relatives of the patient and their participation in establishment of the fact of respiratory standstill in a dream is important. For diagnostics of a syndrome sleepy in out-patient practice V. I. Rovinsky's method is used: one of relatives of the patient marks during sleep by means of hours with a second hand duration of respiratory pauses.
At survey at patients the body weight index (BWI)> 35 usually is defined that corresponds to the II degree of obesity, the neck circle> 40 cm at women and 43 cm is at men, indicators of arterial pressure exceed 140/90 mm of mercury.
To patients consultation of the otolaryngologist during which pathology of ENT organs quite often comes to light is held with a syndrome sleepy : rhinitis, sinusitis, nose partition curvature, chronic tonsillitis, polyposes, etc. The research of a nasopharynx is supplemented with a faringoskopiya, a laringoskopiya and a rinoskopiya by means of a flexible fibroendoskop.
Reliable picture of existence of a syndrome sleepy allows will establish carrying out a polisomnografichesky research. Polisomnografiya combines long (over 8 hours) simultaneous registration of electric potentials (EEG of a brain, the ECG, the electromyogram, an elektrookulogramma) and respiratory activity (the air streams undergoing through a mouth and a nose, respiratory efforts of muscles of an abdominal and chest cavity, saturation (SaO 2) of blood oxygen, a phenomenon of snore, a body pose during sleep). In the analysis of record of a polisomnografiya the quantity and duration of episodes in a dream and degree of expressiveness of the changes happening at the same time is defined.
Option of a polisomnografiya is the printing research – the night registration of electric potentials of an organism including from 2 to 8 positions: ECG, nasal respiratory stream, chest and belly effort, saturation by oxygen of arterial blood, muscular activity of the lower extremities, sound phenomenon of snore, body position during sleep.
Treatment of a syndrome sleepy
The program of treatment of a syndrome sleepy can include use of non-drug, medicamentous and surgical methods of impact on a cause of illness. The general recommendations at not heavy violations of night breath include a dream with the raised head end of a bed (20 cm higher than usual), a dream exception in situation on a back, an instillation for night of a ksilometazolin (galazolin) in a nose for improvement of nasal breath, rinsing of a throat by solution of essential oils, treatment of pathology of ENT organs (chronic rhinitis, sinusitis), endokrinopatiya, an exception of reception of hypnotic drugs and alcohol, weight reduction.
During sleep use of various oral devices (a vydvigately lower jaw, uderzhivately language) promoting maintenance of a gleam of airways, a kislorodoterapiya is possible.
Use of the chrezmasochny equipment room SIPAP-terapii (SIPAP-ventilyatsii) providing maintenance of constant positive pressure of pneumatic ways allows to normalize night breath and to improve day health of patients with a syndrome sleepy . This method is considered the most perspective and effective today. Purpose of reception of a teofillin not always gives desirable effect at patients with obstructive night . At the central form of a syndrome sleepy the positive effect from acetazoleamide reception is possible.
Surgeries at a syndrome sleepy are considered as auxiliary in cases of the available anomalies and defects in a structure of the top respiratory ways or their chronic diseases. In a row the adenoidektomiya couples, correction of a nasal partition and a tonzillektomiya allow to remove completely the causes of a syndrome sleepy . Operations on a uvulopalatofaringoplastika and a trakheostomiya are carried out at extremely heavy frustration.
Forecast and prevention of a syndrome sleepy
The syndrome sleepy is not harmless frustration. Increase of clinical symptomatology happens to time and can cause heavy degree of disability or a lethal outcome in 40% of patients in the first 5 years of development of a disease, in 50% - for the next 5 years and in 94% of patients with a 15-year experience of a disease.
Death rate indicators at patients with a syndrome sleepy by 4,5 times exceed those in the general population. Application of SRAR-therapy allowed to reduce death rate by 48% and to increase life expectancy for 15 years. However, this method does not make impact on pathogenesis of a syndrome sleepy .
Prevention of possible complications in a dream dictates need of participation in treatment of a syndrome of experts of pulmonologists, otolaryngologists, cardiologists, neurologists. In case of a syndrome sleepy it is possible to speak only about performing the nonspecific prevention including normalization of weight, refusal of smoking, reception of somnolent medicines, alcohol, treatment of diseases of a nasopharynx.