Sleep Disorders in Children and Adults

The sleep disorders Are a deficit of the normal pattern of sleep that occur when there is a Sleep deprivation, A desynchronization or there is a poor repairing and poor quality sleep. They can occur in infants, children, adults and elderly people.

In recent decades, sleep disorders and especially apnea or hypopnea syndrome have generated increasing interest in the medical and scientific community (National Consensus on Sleep Apnea-Hypopnea Syndrome, 2005).

sleep disorders

Sleep is a basic need, both for children and adults, such as eating, drinking or breathing. Therefore, sleep is a vital function and will be essential to an optimal state of health and well-being throughout life (National Heart, Lung and Blodd Institute, 2012).

When any type of pathology or alteration occurs, a severe alteration of normal sleep pattern will occur. Therefore, it will produce Significant functional consequences that will have a strong impact on the individual's quality of life, To suffer other types of pathologies: problems of physical, mental, and even risk of death.

Dream: Concept and stages

Sleep is usually divided into two basic phases: REM (rapid eye movement) and non-REM sleep (National Heart, Lung and Blodd Institute, 2012

While the non-REM phase refers primarily to the deep sleep or slow wave stage, the REM phase is a lighter sleep phase in the That dreams usually appear. Both phases, usually occur, are formed regularly following a pattern of 3 to 5 cycles of 90 min.

Our"biological"clock, that is, circadian rhythms, will allow our body to correctly regulate the phases of sleep and wakefulness. 24 hours a day.

Types of sleep disorders most common

In the classification of sleep disorders, it is usually used the proposal by the Association of Seleep Disorders Centers, called Classification Of Sleep Disorders (ICSD), (Peraita-Adrados, 2005).

Sleep disorders are usually divided into:

  • Dysomnias.
  • Parasomnias.
  • Disorders associated with medical or psychiatric pathologies.

Disomnias

It refers to the difficulties that appear in the beginning and the maintenance of the dream (insomnia) or the presence of daytime sleepiness (Hypersomnias).

Insomnia manifests itself as the perception of an insufficient sleep, difficult to achieve or a little repair. Generally, the individual will feel Tiredness during the day, attention problems, concentration, memory, irritability or depressive mood.

The term Hypersomnia Refers to a state of persistent daytime drowsiness that predisposes to sleep in unintentional or inappropriate situations. East Type of pathology will have important repercussions at school, work, family, social, etc.

Parasomnias

In the case of parasomnias, there will be episodic phenomena that will disturb nocturnal sleep, without the control mechanisms or the phase of Vigil is involved. There is going to be an activation of the nervous system.

Disorders of the sleep-wake transition (rhythmic sleep movements, hypnotic jerks, sleepiness, nocturnal cramps) may occur. Disturbances on awakening (confusional awakening, night terrors or somnambulism), disturbed deep sleep (nightmares, sleep paralysis, Painful erections).

Another type of secondary parasomnias may also appear, related to enuresis, bruxism or paroxysmal dystonia.

Disorders Associated with Medical Pathologies

Among the most frequent disorders associated with pathologies of medical type are the Snoring , the Sleep apnea wave Narcolepsy .

Sleep apnea or apnea-hypnea syndrome is one of the most prevalent disorders and with more functional consequences for the individual who suffers from it And are undervalued on many occasions.

Sleep Apnea: Apnea-Hypopnea Syndrome

The apnea-hypopnea syndrome is classified as respiratory sleep disorders and in it, there is an alteration of the respiratory pattern, Breathing short for short periods of time.

Breathing is a vital function. When we are sleeping, breathing control becomes an automatically regulated activity (Culebras, 2006). The neuomotaxic nerve centers assume control and respiratory function (Culebras, 2003).

If there is an interruption of this regulation, the individual may die. Therefore, when it occurs, the nervous system generates a measure of Safety resulting in the awakening of the person, thus ensuring the continuity of respiratory function (Culebras, 2003).

The continuous and persistent irruption of the respiratory pattern produces a remarkable decrease in the sleep quality . This fact will be associated with a serious Daytime drowsiness and therefore the quality of life of the person who suffers it will be affected.

Data derived from different medical research have shown that sleep apnea is associated with the presence of arterial hypertension , development of cardiovascular diseases , Stroke , An increase in the prevalence of traffic accidents and a significant deterioration of the quality of life In general (National Consensus on Sleep Apnea-Hypopnea Syndrome, 2005).

Prevalence of sleep disorders

The prevalence of sleep apnea-hypopnea is estimated at approximately 2% in women and 4% in men (Culebras, 2006).

The national consensus on sleep apnea-hypopnea syndrome (2005) shows that different epidemiological studies conducted in the USA and Europe Have estimated the prevalence of this syndrome between 4-6% of men and 2.4% of women in the general adult population.

In the case of the pediatric population, the presence of snoring (as a usual sign of increased airway resistance to the normal passage of Oxygen) is estimated at 10%. There is a peak between 2 and 3 years of age, and then after 9 years a decline Of their presence (Sans-Capdevila and Gonzal, 2008).

However, sleep apnea syndrome often remains undiagnosed (National Heart, Lung, and Blood Institute, 2012). Most of the People who wake up, they wake up partially during the sleep phase to recover their breath but in the morning they are not usually aware of These events (National Institute of Neurological Disorders and Stroke, 2014).

In Spain, there are between 1,200,000 and 2,150,00 subjects suffering from an important sleep apnea syndrome, therefore, susceptible to be treated. Do not However, only 5-9% of this population has been diagnosed and treated (National Consensus on Sleep Apnea-Hypopnea Syndrome, 2005).

Types of Sleep Apnea

The person who suffers from this type of pathologies performs one or several breaths (apnea) or has superficial and diminished respirations at the same time. Throughout the night (hypopnea).

The breathing pauses usually occur for a short period, seconds or several minutes and can be given around 30 times or more per hour (National Heart, Lung, and Blood Institute, 2012).

According to the National Consensus on Sleep Apnea-Hypopnea Syndrome (2005), it defines apnea-hypopnea syndrome as follows:

It is characterized by the appearance of recurrent episodes in what occurs a limitation of the passage of air and oxygen as a consequence of an alteration Anatomical or functional of the airways. A collapse occurs which implies a decrease in the saturation of Oxyhemoglobin And micro-awakenings that give rise to A poor sleep, excessive drowsiness, psychiatric, respiratory and cardiac disorders.

On the other hand, American Academy of Sleep (AASM), American Academy of Sleep Medicine), makes a classification of the types of apneas that can Appear in respiratory sleep disorders (Culebras, 2006):

  • Obstructive apnea : A suspension of airflow occurs for a minimum period of 10 seconds. It is obstructive your persists the effort
    respiratory.
  • Central apnea : A suspension of airflow occurs for a minimum period of 10 seconds. It is central if during the episode there is no effort respiratory.
  • Mixed Apnea : A suspension of airflow occurs for a minimum period of 10 seconds. It is mixed if the episode begins as central but at Respiratory effort appears.
  • Hypopnea : A normalized respiratory episode occurs, with a reduction of at least 30% of the thoracoabdominal movement, or airflow, Lasting at least 10 seconds or more and with a decrease in oxygen saturation of 4% or more.
  • Awakening related to respiratory effort : A respiratory pattern with an exponential increase in respiratory effort leads to a
    wake.

Consequences

The apnea-hypopnea syndrome causes an increase in blood pressure, increases the risk of suffering from cardiovascular diseases and accidents Cerebrovascular disease, causes excessive drowsiness and significantly diminishes patients' quality of life (Culebras, 2006).

  • Cardiovascular risk : Apnea has important repercussions on the cardio-vascular system. Snoring and Awakenings Persistent is associated with hypertension, cardiac ischemia and cardiac hemodynamics, among others. Night awakenings Can raise blood pressure to reach 200/100 mmHg, although its duration is brief, episodes repeated, hundreds of times Each night, will cause a sustained increase in blood pressure. Thus, sleep apnea causes various cardiac pathologies, such as arrhythmias, blockage Atrioventricular, atrial fibrillation, etc. Studies have shown that 20% of myocardial infarctions and 15% of sudden deaths occur Between midnight and six in the morning (Culebras, 2006).
  • Cerebrovascular risk : Due to altered heart rate, a decrease in blood flow velocity may appear cerebral. Therefore, this persistent alteration may involve cerebral regions with little hemodynamic reserve and therefore contribute to the increase Of the risk of stroke episodes (Culebras, 2006).
  • Daytime sleepiness : It is a subjective or objective tendency to fall asleep. The consequences are the Quality of life, cognitive and behavioral disorders, psychosocial decline, traffic and labor accidents, etc. (Snakes, 2003).
  • Decreased quality of life : The continued tendency to fall asleep and the effort to stay awake during the day, Result in a subjective decrease in quality of life. The individual is usually uncomfortable and their social and family contacts tend to decrease (Snakes, 2003).
  • Cognitive behavioral disorder : Individuals will report complaints of poor memory, reduced attention and concentration, lack of Initiative, passivity, depression and even impotence. As a consequence, there will be a significant psychosocial decline, labor productivity Reduced labor layoffs, school failure or family pathologies (snakes, 2003).
  • Accidents : Different statistical data show that in the US, more than 100,000 traffic accidents per year are caused by drowsiness. At least 23% of drivers acknowledge having fallen asleep behind the wheel. Of these accidents, 1,500 individuals die and another 71,000 Presented lesions (snakes, 2003).

Treatment

Depending on the clinical history and the severity of the disease, several treatments may be used.

Mainly, at the beginning, modifications are made to the habits of life: avoiding alcohol consumption, relaxing medications, weight reduction and give up smoking.

Many individuals improve with basic adaptations such as special pillows, sleep deprivation devices, or oral appliances Which keep the airways open (National Heart, Lung and Blodd Institute, 2012).

On the other hand, when some of the aforementioned methods are not effective, many specialists recommend a continuous pressure (CPAP), the individual must wear a mask attached to a tube and a machine that sends air to keep the road open.

They can also Surgical procedures to remove tissues or expand the airway (National Heart, Lung and Blodd Institute, 2012).

CONCLUSIONS

There are a large number of cases that are never diagnosed, since in many cases it is not known that there is a therapeutic approach or We simply underestimate the long-term consequences of such pathologies.

Providing treatment and counseling for sleep disorders is essential to curb the medical and social consequences that may individual.

References

  1. (GES), G. E. (2005). National Consensus Document on Sleep Apnea-Hypopnea Syndrome (SAHS).
  2. Culebras, A. (2003). Repercussion of sleep apnea in neurology. Rev Neurol, 36 (1), 67-70.
  3. [Links] Sleep apnea syndrome: short-term solutions and long-term cerebraovascular risk. Rev Neurol, 42 (1), 34-41.
  4. Natioinal Heart, L. a. (2012). Retrieved from"What Is Sleep Apnea?": Http://www.nhlbi.nih.gov/health.
  5. Peraita-Adrados, R. (2005). Analysis in the study of sleep disorders. Rev Neurol, 40 (8), 485-491.
  6. Sans-Capdevila, O., & Gonzal, D. (2008). Neurobiological consequences of childhood sleep apnea syndrome. Rev Neurol, 47 (12), 695-664.


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