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Obstructive sleep apnea, also known as sleep apnea, contributes to the development of serious diseases. But by the time heart trouble, high blood pressure or diabetes develops, you will lose your energy and spirit, and satisfying sex will be forgotten. We talk with Prof. dr. n. med. Antoni Krzeski, head of the Otorhinolaryngology Clinic of the Medical University of Warsaw at the Czerniakowski Hospital in Warsaw.
Obstructive sleep apneais still reduced in Poland by many people to "ordinary" snoring and disregarded, both by patients (becausesnoring can not be dangerous) and, unfortunately, by doctors. And in the USA and Western Europe, more and more emphasis is placed on sleep medicine and the diagnosis and treatment of obstructive sleep apnea. Why? Because its proper diagnosis and treatment allows you to avoid the development of many serious cardiovascular diseases, heart diseases, strokes or diabetes, and also, which few people know, allows you to reduce the number of road accidents. How obstructive sleep apnea affects our lives, says Prof. dr. n. med. Antoni Krzeski, head of the Otorhinolaryngology Clinic of the Medical University of Warsaw at the Czerniakowski Hospital in Warsaw.
- Professor, snoring, when it concerns a man, is usually a cause for joking, in the case of women, at most a reason to be ashamed. However, it is not a reason for most of us to make an appointment with a doctor. Meanwhile, specialists around the world are sounding the alarm because of him. Why?
It's very simple. Because snoring very often, but not always, is one of the symptoms of obstructive sleep apnea. It is certainly so if in a bedroom dominated by loud snoring there are shorter or longer periods of poignant silence that result from a break in breathing during sleep in the snorer. Awakened by the silence, the partner begins to listen if the snoring victim is still alive. And the aforementioned sleep apnea, resulting from airway obstruction, leads to the development of many life-threatening diseases - in the initial stage to hypertension, cardiac arrhythmias, chronic fatigue, andsometimes to the development of diabetes, myocardial infarction and stroke. In addition, sleep apnea can be one of the causes of many car accidents, such as head-on collisions that occur in the middle of the day, in fine weather, on a straight road. This is why EU regulations for the treatment of apnea in drivers have been introduced. But these are not all the misfortunes caused by breathing disorders during sleep. Sleep apnea can take away the joy of life also in many other ways, not always in the literal sense.
- What do you mean, professor?
Even the joy of sex. We rarely talk about it, often we do not associate facts, but sleep apnea, caused by obstruction of the airways, affects quite, seemingly distant areas of life, such as mood in the morning or sex. Standing up with your left foot, arguing, or waking up only after the third cup of coffee may indicate problems with breathing at night. Or just imagine a long, blocked-nosed kiss or the level of libido where you haven't slept all night well since time immemorial. My patients thanked me several times that after the laryngological procedures I performed, they became women again - for them it meant the opportunity to kiss passionately. It also happened that the patient's wife asked what I had done to her husband that made him horny, as in his youth.
- You mentioned a blocked nose. Is this the main cause of both snoring and sleep apnea?
Abnormalities in the structure of the upper respiratory tract are the most common, but not the only, cause of obstructive sleep apnea. Obesity, smoking, alcohol and overeating before going to bed also contribute to it.
- If I snore, do I have apnea?
Not necessarily. But according to the medical science of apnea today, apnea should be ruled out first and then treated after snoring, usually by surgically removing the underlying obstruction. If we do not check at the very beginning whether snoring is accompanied by apnea, it may turn out that we all have the wrong sense of a well-fulfilled mission, because there is silence in the bedroom. And the apnea will continue, but quietly, they will ruin your he alth.
- Since not every snorer has apnea and not everyone with apnea is snoring, what else should be worrying?
Morning fatigue. It is so characteristic that even an overworked young manager should realize that something is wrong. Cause when obstructive sleep apnea occurs,he is always sleepy, even on vacation, even when he sleeps 10 hours for several days. Symptoms typical of a stuffy nose are dry, chapped lips in the morning (this is mainly complained of by women), morning dry mouth, recurrent pharyngitis. On the other hand, the characteristic symptoms accompanying obstructive sleep apnea are i.a. sudden waking up in the middle of the night, getting up at night to wet your throat on the way to or from the toilet. It is also worth considering apnea when a young person, e.g. a 30-year-old, is diagnosed with elevated blood pressure. Usually, we blame the unhygienic lifestyle, and often it is in the apnea. Frequent breaks in breathing during sleep reduce the level of oxygen in the blood and put the whole body at attention because it suffocates - the heart begins to beat faster, adrenaline rushes out, and such loads must not leave a trace. Some people even hypothesize that it is the cause of obstructive sleep apnea that most heart attacks or strokes occur in the morning.
It is worth remembering that obstructive sleep apnea occurs at all ages, in young children, adolescents, young adults and adults of all ages.
- I have all these symptoms - which doctor should I see?
To the primary care physician for a referral. And here begins the problem with answering the question: to whom? In many countries, there is a separate section - sleep medicine. There are specialized sleep centers that refer patients with sleep disorders, including those suspected of having obstructive sleep apnea. In such centers, doctors of various speci alties cooperate with each other. We do not have such centers, there are sleep disorders laboratories in which only diagnostic tests are performed. And there are too few of them and you have to wait months for the examination. Sleep apnea is treated by a pulmonologist, but usually a snoring patient is referred to an ENT specialist. And we, ENT specialists, often start to solve the problem surgically right away. The night concerts are ending, but as I said before, it doesn't have to mean the end of apnea. Therefore, it should be a rule to test snoring patients for the presence of apnea. We have tools. In the past, you had to lie down at night surrounded by the equipment in the hospital to perform polysomnography, today the technology allows you to perform this type of examination at home. In addition, before surgery, we perform an endoscopic examination of the upper respiratory tract, and in doubtful cases during pharmacological sleep, to determine at what level the airflow is blocked.
- Likeis treated a patient who underwent ENT surgery, stopped snoring but remained with apnea?
Here, the gold standard is CPAP therapy, so far the most effective in the treatment of obstructive sleep apnea, reimbursed by the National He alth Fund after polysomnography. CPAP is an abbreviation of the English name: continuous positive airway pressure - constant positive airway pressure. Simply put, the patient sleeps in a special mask through which air is supplied at a specific, increased pressure to prevent obstruction. It is not as inconvenient as it may seem. I know because I checked it myself. In addition, depending on the severity of the apnea, special orthodontic appliances are also used in the treatment - unfortunately, they are not popular in our country, in other countries they are used relatively often, especially in the initial stages of the disease. The American Academy of Sleep Medicine recommends it as the first method of choice for mild to moderate stages of the disease, and it is found to be effective in approximately 70 percent of cases.
According to an expertprof. dr hab. med. Antoni Krzeski, head of the Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of WarsawProfessor dr hab. med. Antoni Krzeskiis the head of the Otorhinolaryngology Clinic of the Medical and Dental Faculty of the Medical University of Warsaw, which is located in the Czerniakowski Hospital.
In 1984 he defended his doctoral dissertation on "The results of surgical treatment of chronic otitis media" middle ".
In 1995, he completed his postdoctoral dissertation with the dissertation "The role of the urinary tract complex in the pathogenesis of chronic paranasal sinusitis".
In 2001 he obtained the title of professor.
He studied rhinosurgery with prof. G. Rettinger (Germany) and prof. E. Huizinga (the Netherlands) and with prof. E.B. Kerna (USA). In 1986 he participated in the first European presentation by prof. H. Stammberger in the field of functional endoscopic surgery of the paranasal sinuses, which was presented at the congress of the European Society of Rhinology in Athens (Greece). He was the first to introduce this surgical method into clinical practice in Poland. Currently, he has over 10,000 endoscopic operations on the paranasal sinuses and the base of the skull. He educated many nasal and paranasal sinus surgeons in Poland.
In 2007 he was a lecturer at 19th Biennual Comprehensive Course in Rhinology and Rhinoplast RHINOFEST 2007, Mayo Clinic, Rochester (MN, USA).
It is undoubtedly a leader in the field of rhinology in Poland. It is also highly regarded abroad.
He has been organizing everyone since 2003of the year, the international rinology conference RHINOFORUM, in which the most outstanding world authorities in the field of rhinology participate as lecturers.
Since 2011, he has also been organizing international seminars on "Obstructive Apnea During Sleep in ENT practice" every year.
He is the author of 10 textbooks in the field of rhinology and many publications in this field.
He was a delegate to Poland of the European Society of Rhinology and the European Academy of Facial Plastic Surgery.
In 2008 he was awarded the title of honorary member of PTOLR-ChGiS.
Currently, he is the president of the "Rynologia Polska" Association and the editor-in-chief of "Magazyn Otorynologiczny".
He loves to teach young people whom he uses his knowledge and experience on a daily basis.