By Dr Carlos Glória features@algarveresident.com
Dr Carlos Glória is a specialist in Pneumology and Intensive Care, and responsible for the High Dependency Unit of Hospital Particular do Algarve in Alvor.
Sleep apnoea is an illness characterised by respiratory intervals, of variable duration, during sleep.
There are two types
of sleep apnoea: central and obstructive.
In central apnoea, which is less common, the brain does not send the appropriate signal to the respiratory muscles.
In obstructive apnoea, which is much more frequent, oxygen does not pass through the nasal passage or mouth, in spite of the effort produced by the respiratory muscles.
In a patient with sleep apnoea, the number of respiratory pauses can be 30 or more during one hour of sleep. These pauses are usually interrupted by periods of heavy snoring.
Patients with sleep apnoea do not engage in a deep sleep and, therefore, complain of morning tiredness, excessive drowsiness during the day and often headaches on waking.
Sleep apnoea can occur at any age but is more frequent in people who are overweight. It is estimated that more than half-a-million Portuguese suffer from this illness.
What are the consequences of sleep apnoea?
Due to the alteration in the normal sleep pattern, people with this illness frequently feel sleepy during the day. Concentration periods diminish and this can influence their professional capabilities.
The consequences can vary from purely unpleasant situations to situations that can put one’s life at risk. Symptoms include depression, irritability, sexual dysfunction, learning difficulties and memory loss, falling asleep at work, when on the telephone or when driving.
People with untreated sleep apnoea have three times more chances of having a car accident.
The recognition and treatment of this illness are also important due to the fact that it can be associated with the onset of cardiac arrhythmia, high blood pressure, heart attacks and cerebral thrombosis.
How to reach a diagnosis?
Even though the first evaluation is made by the General Practitioner, the final diagnosis is made by a team of doctors and technicians with specific training, normally by a pneumologist or a neurologist.
A Polissonography is an exam which registers a variety of functions which occur during sleep, such as cerebral electric activity, eye movement, muscular activity, heart beats, movements and respiratory flow, blood oxygen levels and so on.
Observation and analysis of these results then allow for a correct diagnosis of sleep apnoea and also its graveness. In the majority of cases, the patient can undergo a simple screening test at home.
In specific cases, the test can be done during the night in a Sleep Laboratory, available at Hospital Particular do Algarve.
Another type of specialised test the patient can undergo is Teste de Latência Múltipla do Sono, which measures the speed at which a patient falls asleep during the day.
It may be useful to measure the degree of sleepiness and exclude other sleep disorders. This is a test which is performed in the Sleep Laboratory during the day.
What is the treatment for sleep apnoea?
Basic measures: In less serious cases, changing normal habits may be sufficient, such as losing weight or reducing the intake of alcohol. In more serious cases, specialised treatment may be necessary.
CPAP: The use of nasal CPAP (continuous positive airway pressure) is the most common and effective treatment for sleep apnoea.
During the night, the patient wears a nasal mask which is connected to a small ventilator that forces air through the nasalpassages, preventing their collapse as well as respiratory pauses.
Sleep apnoea will reoccur if the patient stops using the ventilator or utilises it incorrectly.
Surgery: Some patients with sleep apnoea may benefit from surgery. This might mean the need for the removal of adenoids and tonsils (especially in children), removal of polyps or of structural abnormalities, such as Uvulopalatopharyngoplasty, which consist in the removal of tissue in the posterior section of the pharynx.
There are treatments available which can eliminate snoring (uvulopalatoplasty by laser or electrocoagulação, sonoplastia por radio), but these do not treat sleep apnoea.
Who should seek help?
People who suffer from excessive sleepiness during the day, heavy snorers or who have respiratory pauses during sleep are probable sufferers of sleep apnoea. This is a treatable illness.
When not treated, it can have serious consequences for the patient as well as others. The patient is advised to consult a doctor to discuss his particular symptoms and preferably seek help in a hospital that has a Sleep Disorder Laboratory or a Centre for Neurological Studies, both available at Hospital Particular do Algarve in Alvor.
Once treated, a patient will have the chance to regain quality of life, which only a proper night’s sleep can provide.
