Severe fatigue and its association with the presence of obstructive sleep apnea syndrome

A common cause of chronic fatigue is obstructive sleep apnea. In this disease, fatigue and drowsiness during the daytime are the result of impaired breathing during sleep. During sleep, patients experience snoring and respiratory arrest.

When patients come to the therapist with complaints of lethargy, fatigue, drowsiness, irritability, memory disorders, and difficulty concentrating, the doctor usually associates this with somatic (that is, bodily) diseases or mental disorders. The above “set” is a classic symptomatology of many diseases. The patient is advised to consult a neurologist, he takes certain drugs, but this does not bring the expected effect, because the main cause is not eliminated. If fatigue and so on is caused by sleep apnea, then the cause of complaints is a violation of breathing during sleep.

Sleep in obstructive sleep apnea is constantly interrupted due to micro -arousals of the brain during episodes of respiratory arrest. At these moments, pronounced disturbances in gas exchange are noted – hypoxemia (oxygen starvation) and hypercapnia (excess carbon dioxide in the blood). These disorders cause the human brain to wake up and resume breathing. Since apnea episodes can occur 300-400 times per night, the normal structure of sleep is significantly disturbed. As a result, a person wakes up after a heavy unrefreshing sleep and feels depressed, tired and lethargic all day.

This situation is repeated every night, and as a result, the patient has a chronic lack of sleep. Not surprisingly, many patients close their eyes from physical fatigue, and they can fall asleep in the most inopportune place. Patients with obstructive sleep apnea sometimes fall asleep during a conversation, dinner, or meeting. As a rule, patients complain not only of constant fatigue, but also of poor memory, absent-mindedness, and reduced performance. They are at risk of developing anxiety, mood swings and depression. Constant fatigue can cause various mental problems.

The constant need for sleep also has an adverse effect on professional performance: a person cannot perform actions that require increased concentration of attention, which leads to a decrease in the quality of work and a high risk of injury at work.

Patients with obstructive sleep apnea, feeling very tired, do not control their condition and often fall asleep while driving, becoming participants in traffic accidents. If you feel tired and fall asleep while driving , then for safety, stop, take a break to rest.

Watch the video of Dr. med. Sciences, Professor Buzunov R.V. about the frequency of road accidents among drivers with obstructive sleep apnea syndrome

The foregoing indicates that increased fatigue and daytime sleepiness are a medical and socioeconomic problem. There is a need to actively identify and treat the disease causing these conditions. Patients complaining of poor sleep, snoring, increased fatigue, weakness should consult a somnologist to identify their breathing disorders during sleep. To diagnose the disease and determine its severity, a polysomnographic study is performed .

Treatment for sleep apnea depends on the underlying cause. In the presence of congenital or acquired anatomical defects of the nasopharynx, surgical intervention is indicated. In other cases, if indicated, CPAP therapy is used . With this treatment, during sleep, the patient breathes air, which is supplied through a mask of a special apparatus under a slight therapeutic pressure. For treatment, 2 types of devices can be used: with manual adjustment of therapeutic pressure and Auto-CPAP, which does not require manual adjustment of therapeutic pressure. The latter automatically changes the pressure value depending on the parameters of the patient’s breathing. Prisma 20A and its predecessor Somnobalance E from Weinmann – Loewenstein (Germany) can serve as an example of such devices .

Clinical example . The patient came to the Center for Sleep Medicine because of severe daytime sleepiness, which he had been suffering from for a long time. Polysomnography was performed and a severe degree of obstructive sleep apnea was diagnosed. The patient stopped breathing for 1.5 minutes and in total there was no breathing up to 80% of the night’s sleep. According to the results of CPAP therapy, the patient notes that he began to get enough sleep, his working capacity increased greatly, daytime sleepiness and “swimming” of consciousness while driving a car disappeared.

Another clinical example The man suffered from sleep disorders and severe fatigue for many years. Due to systematic problems with sleep, he could fall asleep during the day at the most inopportune moments: while driving a car, during a meeting, etc. To solve the problem, he turned to our Center for Sleep Medicine. The first results appeared already at the stage of the treatment program . Excess weight began to decrease, vital energy and strength appeared, the need for daytime sleep disappeared.

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