A diario más gente consulta por problemas de sueño, y cada vez estamos diagnosticando más casos de apnea. Lo primero que refieren es la presencia de cansancio, dificultad para realizar actividades habituales y, sobre todo, la ausencia de un sueño reparador, que está asociado a graves problemas de salud, si no lo tratamos a tiempo. Y además se trata de un problema multidisciplinar, es decir, que atañe a muchos especialistas (cardiólogos, neumólogos, otorrinos, internistas, neurólogos, neurofisiólogos, etc)
¿Qué síntomas son típicos de la apnea del sueño?
- Apnea, es decir, paradas o pausas en la respiración, dejar de respirar súbitamente y durante varios segundos (más de 10 segundos), acompañado de un sueño no reparador independientemente de la duración del sueño
- Ronquidos, a veces muy sonoros, irregulares y molestos para quien comparte cama contigo, incluso en otras habitaciones.
- Rechinar de dientes o bruxismo, como forma de descargar la tensión acumulada de todo el día.
- Dolor de cabeza, molestias a lo largo de todo el día que hace difícil concentrarse, y tener problemas de memoria.
- Sueño a lo largo del día, en cualquier sitio se dormirían, incluso conduciendo, lo cual es un riesgo muy alto para ti y para los demás.
- Cansancio marcado, no tienen ganas de hacer nada, el día se hace tedioso y largo. Refieren aumento de la fatiga incluso siendo de perfil sedentario.
- Irritabilidad importante, no aguantan nada, se suman los problemas y no hay fuerzas para continuar las tareas diarias. Finalmente, refieren presencia de estrés y depresión, día a día rinden menos y el nivel de energía está bajo mínimos, se suman en la tristeza y entran en un círculo vicioso muy peligroso.
- Nicturia, es decir, se levantan a orinar mas de lo habitual por la noche.
- Boca seca al despertar, debido al empleo de respiración por boca en vez de nasal.
- Habitualmente obesidad o sobrepeso, aunque uno puede padecer de apneas con un peso adecuado o ligeramente elevado. Sí que es típico que haya un aumento de la circunferencia del cuello (hombres> 43.2 cm; mujeres,> 38,1 cm).
Existen, fundamentalmente, tres tipos de apneas:
- Obstructiva: Ocurren a nivel faríngeo. Durante el sueño, disminuye el tono muscular e incluso desaparece durante la fase activa, con diferencias entre la actividad muscular del diafragma y de vías respiratorias superiores, e inestabilidad de dichas vías. La obstrucción nasal parcial que induce apnea obstructiva a nivel faríngeo, con congestión de la mucosa nasal y de secreciones acumuladas.
- Central: ausencia de señal respiratoria y ausencia de esfuerzo respiratorio (no se detectan movimientos toraco-abdominales). El sistema nervioso deja de enviar estímulos a los músculos respiratorios.
- Mixta: apnea que habitualmente comienza como central y termina con un componente obstructivo. El 50% de los episodios de apnea son de este tipo.
¿Hay solución? Lo primero es hacer un diagnóstico a través de una prueba que se conoce con el nombre de POLISOMNOGRAFIA NOCTURNA. El paciente se lleva un pequeño equipo a su domicilio para dormir con el y detectar las apneas.
Si los resultados confirman que hay una apnea del sueño, y de origen obstructivo, la solución es emplear una CPAP, un equipo que emplea una Presión Positiva Continua en la vía aérea, muy sencillo y fácil manejar, que se considera una terapia de primera línea para la apnea obstructiva del sueño sintomática o moderada a severa. El equipo realmente es un compresor, que genera una presión de aire que se transmite a través de un tubo hasta una mascarilla que, al tener una presión positiva, vence la obstrucción o cierre de la vía respiratoria y evita las pausas respiratorias o apneas.
¿Cómo medimos las apneas o hipoapneas? El número de apneas e hipopneas por hora de sueño se denomina índice de apnea-hipopnea (IAH), en el que la presencia de apnea obstructiva del sueño se define como un IAH de 5 o más eventos por hora. El IAH se usa para clasificar la gravedad de la enfermedad; Se considera que las personas con un IAH de 5 a 15 tienen una apnea leve, de 16 a 30 de grado moderado, o más de 30 eventos por hora tienen apnea obstructiva del sueño grave.
¿Hay otras terapias? El uso de terapias alternativas (dispositivos de férulas mandibulares y opciones quirúrgicas) para pacientes que rechazan o no pueden usar CPAP debe considerarse de forma personalizada, con respecto a la naturaleza de la obstrucción, los factores específicos del paciente y las preferencias del paciente.
Debemos resaltar la necesidad de realizar modificaciones en el estilo de vida incluyen asesoramiento sobre pérdida de peso en pacientes con sobrepeso y obesidad, evitando medicamentos y sustancias que promueven la relajación de la vía aérea superior (p. ej., Alcohol, benzodiacepinas y analgésicos opiáceos).
¿Y por qué es importante tratar la apnea del sueño? Se ha comprobado que se asocia con un mayor riesgo de enfermedad cardiovascular. Las personas con este problema son más propensas a padecer hipertensión, accidente cerebrovascular, problemas coronarios o insuficiencia cardíaca, también tienen un mayor riesgo de arritmias relacionadas con el sueño (p. ej., bradicardia sinusal y bloqueo auriculoventricular), fibrilación auricular y taquicardia ventricular no sostenida.
Así pues, si sospechas que puedes tener este problema, ¡acude al médico porque tiene solución!
REFERENCIA
Obstructive Sleep Apnea in Adults.
Veasey SC, Rosen IL.
N Engl J Med 2019; 380:1442-1449.
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