Le apnee ostruttive notturne (OSAS) ed il russamento
Obstructive nocturnal apnea (OSAS) and snoring. Snoring indicates a difficult passage of air through the upper airways during sleep. It is caused by the vibration of the soft tissues which causes the typical noise of snoring. During the night, the muscles of the tongue, throat and mouth relax and contribute to obstructing the passage of air. Breathing can become so difficult due to the reduction of the respiratory lumen until it turns into sleep apnea that it causes the absence of breathing for many seconds.
Consequences of sleep apnea (OSAS)
The organs of the body that suffer most from obstructive apnea are the heart and brain because the reduced oxygen saturation can damage them. For this reason, the risks of heart failure, ischemic heart disease, arrhythmias, strokes, neurocognitive deficits increase.
Mortality from stroke and myocardial infarction is significantly higher in people with obstructive sleep apnea than in the general population. Furthermore, due to the excessive daytime sleepiness present in patients with OSA, the risk of road accidents increases considerably. For this reason, many European countries prohibit driving for OSAS patients not on therapy. According to some studies in Italy about 1,600,000 people are affected by OSA but only 3% of cases are diagnosed. From these data it is clear that sleep apnea remains an underestimated pathology.
How are obstructive apneas treated?
C-PAP remains the most effective treatment, especially for severe apneas. C-PAP stands for Continuous Positive Airway Pressure or continuous positive pressure mechanical ventilation and was invented in 1980. PAP mode ventilation is commonly used for patients with severe respiratory failure, including premature babies. In these individuals, PAP ventilation can prevent the need for endotracheal intubation, or it can allow the intubation to be removed more readily. According to the American Academy of Sleep Medicine, mandibular advancement devices are valid alternatives to C-PAP for mild and moderate apneas. Their effectiveness has been amply demonstrated by numerous clinical studies, patients have a better degree of acceptance and wear mandibular advancement devices throughout the night. According to recent statistics from the American Sleep Disorders Association, snoring is reduced in over 94% of cases and completely eliminated in 50%. Their principle of operation is simple, worn before sleep they move the jaw forward and down by increasing the space between the tongue and pharynx, increasing the space for the passage of air.
Why is the airway patency reduced?
Nasal cavities: deviation of the septum, polyps, hypertrophy of the turbinates, mucous congestion
Nasopharynx: adenoid hypertrophy
Isthmus of the jaws: hypertrophy or edema of the palatine tonsils and velopendulus
Oropharynx and hypopharynx: lingual retrusion due to retrognathic micrognathy and macroglossia, lingual tonsil hypertrophy or tongue drop due to excessive loss of muscle tone, lingual tonsil hypertrophy especially in smokers
Fat infill at any level that induces both an increase in tissue thickness with consequent reduction of patency, and greater laxity with consequent less resistance in inspiration, especially forced, and their deformation in the direction of the inspiratory flow which leads them to further reduce the caliber of the airways.
Incoordination of the agonist and antagonist muscles of the upper airways; they are normally responsible for maintaining a patent airway during the respiratory cycle.
Who are the most affected by obstructive apneas?
Subjects with mandibular retrusion Those who have closed nasal cavities due to polyps or the deviation of the nasal septum who, having a sleep already disturbed for other reasons, uses sleeping pills or those who have a deepening of sleep induced by alcohol, tiredness and an exaggerated dinner, with an excessive decrease in muscle tone and therefore also lingual.
APPLIANCE FOR MANDIBULAR ADVANCEMENT
Many orthodontic appliances help in the therapy of OSAS, some are adjustable in mandibular advancement and others are fixed. Of course, depending on the specific case, there will be one device more suitable than others for anti-snoring therapy. Their cost varies from 500 to 2000 euros depending on the characteristics necessary to solve the problem.
- Thornton Adjustable Positioner (TAP)
Other appliances are:
- SomnoMed MAS – Dorsal Fin Appliance
- Respire – Dorsal Fin Appliance
- The SUAD™ Device
- The Temporary SUAD™ Appliance (TSA)
- Herbst Telescopic Appliance
- Quali-Som’s TheraSom Cast
- Tongue Retaining Device (TRD)
- Narval CC
- Nose Breathe Appliance
- Clasp Retained Mandibular Positioner
- Nocturnal Airway Patency Appliance (NAPA)
- TheraSnore Adjustable
- Silent Nite
- The Moses Appliance etc……
If you are a snorer or if you have any doubt that you need to breathe better at night, contact us for information or an appointment.
References: https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/ The Price of Fatigue: The surprising economic cost of unmanaged sleep apnea https://www.ncbi.nlm.nih.gov/pubmed/18250205 https://www.ncbi.nlm.nih.gov/pubmed/25186268 https://aasm.org/rising-prevalence-of-sleep-apnea-in-u-s-threatens-public-health/ https://sleepfoundation.org/sleep-disorders-problems-list/can-kids-get-sleep-apnea https://www.sleepapnea.org/treat/childrens-sleep-apnea/ http://www.nejm.org/doi/full/10.1056/nejm199304293281704 https://www.ncbi.nlm.nih.gov/pubmed/25682233 https://www.ncbi.nlm.nih.gov/pubmed/23589584 https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15372 http://thorax.bmj.com/content/early/2018/02/24/thoraxjnl-2017-210943 http://www.worldcat.org/title/wake-up-america-a-national-sleep-alert-report-of-the-national-commission-on-sleep-disorders-research/oclc/34483350 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3449487/ http://jnnp.bmj.com/content/89/4/418 https://www.ncbi.nlm.nih.gov/pubmed/16335330/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990435/