Acute and chronic upper airway obstruction, sleep apnea syndrome

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Upper airway obstruction (UAO) is a partial or complete blockage of the nose, throat, or larynx, causing difficulty breathing, with acute causes like infections (croup, epiglottitis), foreign bodies, trauma, or allergies leading to rapid distress. While chronic UAO, often from sleep apnea, congenital issues (tracheomalacia), growths, or post-intubation scarring, develops slowly, causing symptoms like snoring, sleep disruption, and eventual cardiovascular strain, but can also flare up acutely. Both types reduce airflow, but acute UAO is an immediate emergency requiring rapid assessment and airway management, whereas chronic UAO needs long-term treatment of the underlying cause, like surgery or CPAP (continuous positive airway pressure).

Acute upper airway obstruction[edit | edit source]

Acute upper airway obstruction is often caused by foreign body aspiration, infections (viral or bacterial) - croup, epiglottis, tracheitis, anaphylaxis, burns or trauma. The situation may worsen and develop into a life-threatening emergency (especially in young children)

The symptoms include:

rapid onset of noisy breathing (inspiratory stridor),
drooling,
difficulty swallowing,
hoarse voice,
severe respiratory distress,
cyanosis (blue-toned skin).

In case of emergency, it is essential to find immediate medical attention to secure the airway - examples: oxygen, epinephrine, steroids, intubation or possibly even tracheostomy.

Chronic upper airway obstruction[edit | edit source]

Chronic upper airway obstruction is most commonly caused by obstructive sleep apnea, enlarged tonsils or adenoids, congenital defects (laryngomalacia), subglottic stenosis (scarring from past intubation), growths (tumors, polyps), or vocal cord paralysis.

Typical symptoms include:

subtle start,
snoring,
pauses in breathing during sleep,
daytime sleepiness,
morning headaches,
nasal congestion,
difficulty breathing during exercise.

Chronic obstruction can lead to long-term health issues (e.g. cardiopulmonary compromise) but it may also become acute. In this case, we focus on treating the cause (surgery, CPAP, adenotonsillectomy,...).

Sleep apnea syndrome[edit | edit source]

Sleep apnea syndrome (SAS) is a common and serious condition that puts patients at high risk of developing cardiovascular disease. The prevalence of hypertension in SSA is about 50%. The disease occurs in 4% of men and 2% of women. SSA is more common in individuals with central type obesity.

Risk factors for the development of the disease include being overweight, eating too much food before bedtime, drinking alcohol before bedtime, smoking, using hypnotics, irregular sleep, male gender, and a family history.

According to the causes, we divide it into

obstructive (OSAS) – it is caused by obstruction in the upper airways and respiratory effort is maintained;
central – it has a cause in the CNS, respiratory effort is not present;
mixed – it is caused by a combination of the two previous ones.

Recording of typical snoring during SSA

Symptoms[edit | edit source]

The main symptoms include:

excessive daytime sleepiness and fatigue,
frequent daytime sleepiness and decreased work performance,
gasping, temporary respiratory arrests, repeated awakenings at night,
snoring,
absence of dreams,
dry mouth,
headaches,
symptoms of depression.

Headaches occur much more frequently in SSA than in other sleep disorders; they are reported by approximately 20% of patients. They typically occur in the morning after awakening, are mild, dull, non-pulsatile, diffuse, and usually resolve within an hour. Their intensity does not correlate with the severity of SAS. Respiratory sequelae depend on the degree of hypoxemia and hypercapnia, and in advanced cases pulmonary hypertension, cor pulmonale, polycythemia. Cardiovascular sequelae include hypertension, cardiac arrhythmias, myocardial infarction, and cerebrovascular disorders.

Examination[edit | edit source]

A patient with suspected sleep apnea syndrome should be referred to a sleep laboratory, where a complete polysomnographic (PSG) examination is performed. This test involves attaching sensors to the patient's body to monitor a range of physiological functions during sleep - from brain activity, heart rate, breathing and limb movements to blood oxygen levels. The test also includes video recording, which allows doctors to observe the patient's behavior throughout the night.

Specifically, the following data are monitored:

snoring,
blood oxygen saturation,
ECG, heart rate,
respiratory movements of the chest and abdomen,
airflow during breathing,
EMG - movement of the lower extremities,
electrooculogram,
EEG,
blood pressure.

In some cases, it is possible to use a simpler form of examination - multi-channel sleep monitoring, which does not include EEG, but still allows you to capture key parameters. Alternatively, you can use home sleep monitoring using a borrowed device that records, for example, heart activity, breathing, oxygen saturation, brain activity or eye and limb movements in a natural environment.^[1]

Simpler examination methods are often used – multi-channel sleep monitoring, which lacks EEG. The examination yields an apnea-hypopnea index, which indicates the number of apneas per hour of sleep (the norm is set at five apneas longer than 10 s). More severe stages of the disease are associated with episodes of oxygen saturation dropping to 80% or lower. A disorder of the sleep structure is also typical. Apneic patients spend most of their sleep in the first and second stages, with only 20% in deep sleep (stages three and four) and the REM phase.

Treatment[edit | edit source]

Patient connected to CPAP

Lifestyle modification is necessary, in overweight patients weight reduction, as well as regular physical activity.

The basis of the treatment is CPAP (Continuous Positive Airway Pressure). This device maintains permanent positive pressure in the airways during sleep through a mask that is airtightly placed on the nose. The cooperation of patients with this very effective treatment is 60% due to the discomfort caused by the mask, the noise of the device, drying of the mouth and nose, and irritation of the skin by the mask. In the case of persistent hypertension, the most significant effect is beta blocker atenolol.

Surgical treatment attempts to surgically resolve local airway obstructions. Methods used: nasal surgery, radiofrequency thermotherapy, tracheotomy, uvulopalatopharyngoplasty, laser-assisted uvuloplasty.

Conclusion[edit | edit source]

It can be expected that as doctors become more aware, the number of diagnosed patients suffering from SSA will also increase. It is especially necessary to distinguish patients suffering from primary ronchopathy (snoring) from apnoeics. That is why such an emphasis is placed on PSG examination of patients who complain of snoring. According to data from various authors, among patients who come to the doctor with a single symptom - snoring, about 50% of patients have sleep apnea syndrome.

Links[edit | edit source]

External[edit | edit source]

Edukativní leták FN Olomouc

Literature[edit | edit source]

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  Incomplete publication citation. PLZÁK, J, J KOLZAR and J BETKA2002. pp. 216-220. Also available from <http://nts.prolekare.cz/cls/Ukazclanek2a58e-2.html?clanek=13228&jazyk=&cislo=810>.

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  Incomplete article citation.  PLZÁK, J, J KOLZAR and J BETKA. Obstrukční syndrom spánkové apnoe: diagnóza a léčba. Otorinolaryngologie a foniatrie [online]. 2002, year 2002, well. 4, pp. 216-220, also available from <http://nts.prolekare.cz/cls/Ukazclanek2a58e-2.html?clanek=13228&jazyk=&cislo=810>. ISSN 1210-7867.

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  Incomplete citation of legislative document.  2002. s. 216-220. Also available from URL <http://nts.prolekare.cz/cls/Ukazclanek2a58e-2.html?clanek=13228&jazyk=&cislo=810>. ISSN 1210-7867.

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