Obstructive sleep apnoea syndrome
Obstructive sleep apnoea syndrome (OSAS) is a serious sleep-related breathing disorder in which breathing is repeatedly reduced or stopped completely during sleep due to a narrowing of the throat. These pauses in breathing can occur several hundred times a night and last up to minutes. The collapse in the upper respiratory tract leads to a drop in the oxygen concentration in the blood and a reduced supply to the organs. In this case, the brain is the first to be affected and sounds the alarm. This so-called alarm manifests itself in recurring waking reactions, which fragment sleep and lead to non-restorative sleep. The sleep stages are disturbed as a result.
Symptoms of obstructive sleep apnoea
The symptoms of obstructive sleep apnoea syndrome are very variable in their form and intensity. The most common symptoms are irregular loud snoring, non-restorative sleep, constant daytime sleepiness with an increased tendency to fall asleep during the day.
Many people snore while they sleep. Almost half of people over the age of 60 snore. The vibration of the moving parts of the throat causes snoring noises, some of which are very loud, especially when inhaling. This can be very annoying for your bed partner, but can also have serious health consequences as a symptom of obstructive sleep apnoea. Patients with obstructive sleep apnoea report nocturnal pauses in breathing observed by their bed partner. These lead to a drop in oxygen in the blood with a subsequent wake-up reaction and are both frightening for the bed partner and significantly disruptive for the sleep profile of those affected, as restful deep and dream sleep is prevented.
Many patients with obstructive sleep apnoea report pronounced daytime sleepiness. Some report attacks of falling asleep that are difficult to control and occur particularly in monotonous situations (reading the newspaper, watching television, at the theatre, etc.). Microsleep, which occurs when driving, can be particularly dangerous for those affected and those around them and can lead to restrictions in private and professional life. According to a study by insurance companies on fatal accidents on motorways, falling asleep at the wheel is the most common cause of accidents at 24 percent.
Disturbed sleep at night means that the functions and recovery processes that are important for the body and mind can only take place to a limited extent. Many patients report reduced mental and physical performance, poor concentration and sometimes nervousness and irritability. These changes are sometimes particularly noticeable to those around the affected person and significantly reduce their quality of life.
Consequences of obstructive sleep apnoea
The consequences of untreated obstructive sleep apnoea can be serious. They not only worsen the quality of life, but also shorten the lifespan.
Studies have shown that the life expectancy of untreated patients with obstructive sleep apnoea syndrome is significantly shorter than that of healthy people of the same age due to cardiovascular complications. Sleep apnoea can also make it difficult to control blood pressure and lead to cardiac arrhythmia. The risk of heart attack and stroke is three times higher in people with sleep apnoea.
The nocturnal pauses in breathing lead to repeated drops in oxygen levels in the blood, which result in short wake-up reactions. These arousal reactions disrupt the normal sleep profile and can lead to morning headaches, fatigue, sexual dysfunction and even impotence in men. Some sleep apnoeics report that they can no longer cope with the demands of everyday life. This psychological burden should not be underestimated and can lead to depression in some cases.
However, some patients feel that they have no restrictions in everyday life. However, they also have an increased risk of cardiovascular consequences.
Diagnostics
For the diagnosis of "sleep apnoea", it is important to ask the patient about the typical symptoms as part of the medical history and to include the sleeping partner in the sleep history. When you make an appointment in our sleep consultation, we will send you a standardised questionnaire in advance. Here, the typical symptoms of obstructive sleep apnoea are queried and a sleep diary is kept.
If the suspicion of a sleep-related breathing disorder is confirmed during the patient consultation, we will arrange an outpatient polygraphy or an inpatient polysomnography ("sleep laboratory examination").
Ambulatory polygraphy is a small portable device that you can take home and that records your breathing, body position, heart rate and oxygen saturation during the night. The next day, this device can be handed in to your doctor and analysed. This examination can provide a relatively accurate diagnosis of sleep apnoea syndrome.
Night-time sleep is assessed in our sleep laboratory using polysomnography. During the night of measurement, important parameters such as blood pressure, heart rate, nocturnal oxygen saturation, breathing pauses and sleep stages are recorded using EEG and the findings are then analysed for the presence of a sleep-related breathing disorder and the findings and further treatment planning are discussed with you during our sleep consultation.
Our sleep laboratory
Therapy
Once the diagnosis has been made, the individual treatment options are discussed with you during our sleep consultation in accordance with the current DGSM guidelinesand a customised concept is drawn up for you.
The non-surgical treatment options range from recommending weight reduction, abstaining from alcohol, nicotine or sleeping pills, special dental splints and positional training to mask therapy using the CPAP method.
The most common form of therapy is continuous positive airway pressure (CPAP) at night. In this CPAP therapy, air is fed into the airways via a mask. This positive pressure keeps the throat open so that breathing disorders can no longer occur and snoring stops. This pressure is individualised for each patient and is adjusted for you in our sleep laboratory during another night.
Some patients are unable to tolerate the mask despite optimal adjustment in the sleep laboratory. The mask may pinch, leak or not fit the patient's current lifestyle. Before a planned surgical treatment procedure, we inspect the airway as part of a fibreoptic examination and determine the exact constrictions. The entire procedure is carried out in a kind of artificial sleep in our operating theatre and is supervised by our anaesthetists. During this examination, the constriction can be precisely detected and further treatment planning with realistic treatment options can be discussed with you.
In addition to all classic surgical procedures such as tightening of the soft palate combined with tonsillectomy, we also offer modern therapeutic procedures such as so-called "tongue pacemakers" (neurostimulation procedure of the hypoglossal nerve, e.g.Inspire).
A new type of surgical treatment option in Germany is the so-called "tongue pacemaker" (neurostimulation procedure of the hypoglossal nerve, e.g. Inspire). This is a so-called neurostimulation procedure that gently stimulates the lingual nerve (hypoglossal nerve). This nerve activates one of the main airway opener muscles, the genioglossus muscle. This is intended to directly correct the dysfunction of the airway muscles in patients with OSAS. The pacemaker is implanted in the patient during a hospital stay under general anaesthetic. An electrode is placed around the lingual nerve which, when lightly stimulated, pushes the tongue forwards, causing the pharynx to open. A probe continuously measures the breathing rhythm to determine the right time for stimulation during inhalation. The pacemaker is activated at night by the patient using a small remote control. This therapy is used for patients with moderate to severe OSAS. The effectiveness of this therapy was proven in a multi-centre study (STAR study) and published in the New England Journal of Medicine.
For further information, you are welcome to make an appointment at our consultation for snoring/sleep disorders.
