Treatment of sleep apnoea (ESRD)
What is obstructive sleep apnoea? CPAP treatment
Obstructive sleep apnoea syndrome is characterised by repeated shortness of breath or complete absence of airflow through the upper airway during sleep. In order to differentiate from central disorders, it is important to find respiratory movements of the chest and abdomen, which indicates preserved respiratory muscle function.
Obstructive sleep apnoea (OSA)
Obstructive sleep apnoea is characterised by repeated episodes of collapse (apnoea) or narrowing of the upper airway (shallow breathing) at the level of the pharynx with preserved (in most cases increased) respiratory muscle function.
The above episodes usually lead to a decrease in arterial blood oxygenation and usually end in awakenings from sleep.
Why Medicus Clinic?
Definitions used in diagnostics
Obstructive apnoea (apnea): a decrease in airflow to the lungs as a result of upper airway obstruction of at least 90% for at least 10 seconds.
Decreased breathing (hypopnoe): a reduction in upper airway flow of at least 30% for at least 10 seconds, accompanied by a drop in saturation of at least 3% or an awakening in the EEG recording.
In contrast, arousals, or unconscious awakenings, cause sleep fragmentation. During normal sleep, the NREM and REM stages alternate to form cycles. In a stressful situation such as apnoea, the nervous system is undoubtedly stimulated and this disrupts the normal sleep stages. Reduced deep sleep and REM sleep, disturbed sleep architecture by respiratory disturbances mean that sleep does not fulfil its functions, even with adequate allocated sleep time. The patient sleeps 7-8 hours and wakes up sleep-deprived, often with a headache and a feeling of chronic fatigue. In addition, sleep is interrupted by visits to the toilet, as apnoea triggers mechanisms that result in more frequent urination during the night.
The cause of respiratory distress in obstructive insomnia syndrome is repeated episodes of airflow limitation through the upper airway. There is no bony or cartilaginous scaffolding at the level of the pharynx, so patency at this section of the airway results from adequate muscle tone. Tongue hypertrophy, elongation of the soft palate, enlargement and elongation of the uvula, hypertrophy of the palatine tonsils, and thickening of the lateral walls of the pharynx promote the collapse of the pharyngeal lumen.
Symptoms of sleep apnoea
Nocturnal symptoms:
Daily symptoms:
Diagnosis of Obstructive Sleep Apnoea
The diagnosis of Obstructive Sleep Apnoea Syndrome is based on the clinical symptoms of the disease and the results of a sleep breathing study (overnight polygraph or polysomnography). The disease is diagnosed if the patient reports at least 1 of the listed symptoms:
and a positive sleep-disordered breathing test is found (RDI/AHI >5/h), or if even the patient reports no symptoms but the sleep-disordered breathing test will be RDI/AHI >15/h .
Most commonly used in diagnosis is the AHI, which indicates the number of apnoeas (Apnea) and shortness of breath (Hypopnea) per hour of sleep or examination. The norm is <5/h.
With polysomnography – a more accurate nocturnal study than polygraphy – it is possible to determine the RDI, which further assesses the number of awakenings related to respiratory distress. The RDI determines the average number of apnoeas, shortness of breath (hypopnea) and respiratory effort-related awakenings (RERA) per hour of sleep. Occurrence of RDI in polysomnographic examination at frequency:
The presence of the above symptoms indicates a diagnosis of ESRD.
A revolutionary approach to CPAP treatment
At Medicus Clinic, we take a comprehensive approach to the treatment of OSA. The whole process is focused on the patient and their comfort. Sleep apnoea treatment specialist Dr n. med. Aneta Kowal , Sleep apnoea treatment specialist Dr. n. med. Aneta Kowal , has created a comprehensive service for our patients, whereby the patient has a tailored therapy safely, under the supervision of a doctor: he can test masks selected by the nurse, and the pressures on the device are set remotely during a several-day pulse oximetry-controlled, cloud-based pressure titration process.
An application for reimbursement on the National Health Service for a CPAP mask is then issued.
At Medicus Clinic, the patient has the opportunity to consult an ENT specialist, bariatrician, maxillofacial surgeon, cardiologist or dietician. It is not uncommon for apnoea to be the result of health complications from another area, so our specialists work together to help the patient to the full extent.
Specialist consultation
An initial consultation is essential to find out what problems the patient is facing.
Matching masks
After the visit, the nurse helps select the appropriate masks for testing.
Hire of CPAP masks and apparatus with pulse oximeter
The patient can test several masks throughout the week that give the most relief. The masks are properly sterilised.
Remote (cloud-based) pressure monitoring and patient contact
Remote monitoring of breathing allows the correct pressure to be selected on the device. The patient is in email contact with the doctor throughout the testing period.
Discussion of further therapy
The patient is given full knowledge of which mask they should buy. At the next visit, the doctor discusses the therapy, issues a request for partial reimbursement to the National Health Service, issues documents from the blood pressure titration and an information sheet with the device settings.