A method for the diagnosis and correction of disorders of breathing during sleep

 

(57) Abstract:

The invention relates to the field of medicine. The invention is characterized by the fact that the results of the survey and limnologically registration with the previously installed base symptoms markers of the disease and the boundary values of significance polimorfismo indicators are gradation of symptoms and verical sonographically parameters that determine the severity of respiratory disorders and depending on the latest therapeutic, dental or surgical correction, and with very severe disease - non-invasive ventilation. Assessment of the severity of the disease and extent of surgical and/or dental perform impact speed by changing the amount of exposure according to the level therapeutic level. The method involves identifying criteria for the appropriateness of the assignment and the assessment of the effectiveness of non-invasive ventilation, surgical treatment, dental correction. The proposed method can improve the effectiveness of treatment failure from expensive equipment for non-invasive ventilation in two groups of patients at lower side is astice respiratory disorders during sleep and emergency conditions in pulmonology and their correction.

Known methods of diagnosing respiratory disorders during sleep. They are based on an assessment of a number of values received in the course of questioning, the patient, and indicators obtained during polysomnography [1].

Known methods of correction of respiratory disorders, consisting in non-invasive ventilation in the mode of continuous positive airway pressure applying apparatus for supporting intranasal ventilation method positive pressure [2].

The disadvantages of these methods are the lack of an integrated stepwise approach to diagnosis of respiratory disorders and the use of expensive equipment for non-invasive ventilation.

The proposed method is free from the above disadvantages. The technical goal of the invention consists in determining the severity of respiratory disorders and volume of therapeutic and surgical treatment.

The claimed technical result is achieved that establish the basic symptoms-markers of disease and boundary value relevance of indicators polysomnographically parameters; the results limnologische ankeney; establish the severity of respiratory and insomniacal disorders.

Depending on the severity of the disease are dental and surgical correction, and extremely heavy during non - invasive ventilation. Assessment of the severity of the disease perform manual, changing the volume of medical, dental and surgical treatment according to stages of the treatment level. The method is based on the stepped perform basic diagnostic and therapeutic stages. Jagged complete method allows to avoid diagnostic errors, to clearly establish the existing markers of disease, to assess the degree of severity of the disease by providing symptom of breathing disorders during sleep.

The method is performed as follows. Breathing pattern during sleep and the state of pathological disorders of breathing during sleep (apnea-hypopnea sleep - SOAGS) is determined by evaluating the range of values obtained in the course of specialized personal tests ('questionnaires) and indicators obtained during polysomnography. To assess the respiratory pattern of the patient during sleep and definition of the basic stamp is ysenia arterial blood oxygen, an indirect indicator of the gas exchange function of the lungs, which reflects the degree of saturation of hemoglobin with oxygen and oxygen transport from the blood into the tissues. OK this value is 95-98%.

Tg/AB (LBI) is the degree of correlation excursion characteristics of chest excursions of the abdominal wall, the indicator characterizing the phenomenon of thoracoabdominal paradox breathing, which reflects the degree of efficiency of the respiratory muscles. OK this value is equal to one dimensionless unit.

AHI index, apnea-hypopnea sleep, the average frequency of pathologic apnea-related desaturation of arterial blood for 60 minutes sleep, reflecting the severity of respiratory sleep disorders. OK this value does not exceed 15 dimensionless units. This index is one of the main sonographically parameters characterizing the respiratory pattern of the patient.

Currently there is no single criterion to assess the degree and severity of respiratory disorders in General. A comprehensive evaluation of all these parameters is especially important in the study of the respiratory pattern in patients with razlichnyye called "tissue hypoxia". State in which a reduced amount of oxygen delivered by the blood to the tissues, is defined as "hypoxemia". Obviously, it is impossible to identify tissue hypoxia and hypoxemia, because the shift of dissociation curve of oxyhemoglobin changes the value of oxygen consumption by the tissues. It is necessary to distinguish between two States: hypoxemia fabric normoxia and hypoxemia with tissue hypoxia. Understanding phenomena allows to assess significance of respiratory disorders, leading to the development of conditions of hypoxia and hypercapnia in patients with different lung diseases.

Thus, in order to realistically assess respiratory sleep patterns and discover a state of pathological disorders of breathing during sleep (apnea-hypopnea sleep) to evaluate the range of values obtained in the course of specialized tests ('questionnaires) and holding polysomnography.

Logistics method.

Used polysomnographically system "ALICE-3" (HealthDyne Devision of Respironics, USA) registration certificate MSMPR 97/1402 from 02.12.97, the certificate of conformity 3301046 valid until 05.2000 issued by the authority on certificados positive pressure "Tranquility" (HealthDyne Division of Respironics, USA) registration certificate MSMPR 97/471 from 13.05.97, the certificate of conformity 3301047 valid until 05.2000 issued by the certification body for medical devices ANO "CCME-VNIIMP".

Diagnostic markers of symptoms SOAKS on questionnaire survey.

On the basis of "special survey" revealed the main symptoms and markers of the disease (table 1).

The combination of "2 symptoms+3 token" or "3 symptom+2 token" (rule of five characteristic set of symptoms and markers SOAGS is considered positive.

The phenomenon of excessive daytime sleepiness - sleep in case the situation against their will - is a sign of having a significantly high degree of correlation (p<0,001) with SOAGS. Diagnostics "daytime sleepiness" is on a scale of "Daytime Sleepiness" (table 2).

Possible grade ball marks from 0 to 24. Values normal values are in the range of from 4 to 8. Manifestations of sleepiness in the range of 8-16 characteristic of SOAGS, drowsiness within 14-21 characteristic of narcolepsy. The response in the range of 8-16 points gives a positive result when testing.

Two positive response - symptoms-markers and daytime sleepiness - vyyavleny identify objective indicators of SOAGS.

If you have less than 2 positive responses when tested using somnologica questionnaires impossible to establish objective indications for polysomnography.

Polysomnographically survey

Polysomnographically the survey is conducted at night time with the use of specialized systems - polysomnographically installations that allow us to determine the main indicators of carotid flow process (cyclic sleep, sleep, sleep efficiency, frequency of awakenings) and accompanying sleep state, such as gipoksemicescuu disorders, hypoventilation, respiratory arrest, etc. Received during polysomnography indicators are objective, are numeric in nature and allow to objectify picture of the pathologic condition (Fig.1, 2).

THE INDEX, APNEA-HYPOPNEA SLEEP (AHI).

Is the main parameter to assess the degree of respiratory disorders, in which it may be split by severity:

- if the index is 5 < AHI < 15 to talk about disorders of breathing during sleep in if there are phenomena of persistent hypoxemia with numbers Sat2< 80%. Such disorders trojstvo of breathing during sleep mild severity.

- 30 index < AHI < 50 to talk about disorders of breathing during sleep moderate severity.

- if the index is 50 < AHI < 100, to talk about disorders of breathing during sleep severe.

- if the index is 100 < AHI to talk about disorders of breathing during sleep is extremely heavy flow, in which the patient needs to conduct emergency activities for health reasons, because the risk of sudden death during sleep in these patients is extremely high.

THE INDEX OF SATURATION OF ARTERIAL BLOOD WITH OXYGEN (SATO2).

Is the main parameter for evaluating the degree of oxygenation of arterial blood, by which it is possible to separate the breathing degrees of hypoxia:

- with an average index value of 80%<Sat2<95% say about moderate hypoxia accompanying respiratory disorders.

- with an average value of the indexmSat2<80% say about severe hypoxia that accompanies respiratory disorders.

Special singles out a rule enhance the severity of the condition defined bymSatO2: indexmSat2<80% that accompanies existing respiratory disorder, is fine.).

INDEX THORACOABDOMINAL PARADOX BREATHING (TR/AB OR LBI).

Is the main parameter to assess the degree of discoordination respiratory effort, by which it is possible to separate the breathing degrees thoracoabdominal paradox:

- with an average index value of 1 <mLBI < 3 it is customary to speak about moderate thoracoabdominal paradox that accompanies respiratory disorder.

- with an average index value of 3 <mLBI to talk about severe thoracoabdominal paradox that accompanies respiratory disorder.

Special singles out a rule enhance the severity of the condition defined mLBI: index mLBI > 3, accompanying the existing respiratory disorder, increases the severity on the same level. (Example: AN=25,mLBI=3,5 - respiratory distress severe.)

It should be noted that with increasing gravity must be remembered that regardless of the combination of indexes that increase the severity, the gain is only one step. (Example: EN,mSat2=77%, mLBI=3,5 - respiratory distress severe.)

Therapeutic correction method SOAKS.

constor CPAP). The selection of one of the above types of therapy or their combination provides for the strengthening of therapeutic effects and the ineffectiveness of the previous level (table 3).

After conducting polysomnographical survey reveals the severity of SOAGS. At the easy course of SOAGS first attempted surgical correction of structural abnormalities in oropharyngeal region or dental correction in the form of retropositional repositioning the lower jaw in the night time with the help of the oral applicator. At the same time carries out a range of measures to reduce the weight of patients, increase their activity and diet therapy. Monitoring patients on an outpatient basis for at least 9 months, during which the estimated dynamics martaban with the evaluation of basic parameters for 9 months. The patient is considered as having SOAKS moderate flow. Low effectiveness of therapy and the presence of side effects retrying polysomnographically examination and extended investigations to determine the causes and comorbidities. Possible additional surgery for oropharyngeal region or integrated treatment (a combination of CPAP and applicator). Such patients are considered to have SOAGS heavy flow and are subject to a mandatory 5-year observation with regular 6-monthly polysomnographically surveys. Thus, the evaluation of the severity of the disease and breadth of therapeutic effects occur stepwise according to the available views about the dynamic flow of SOAGS.

The evaluation of the severity, you can reduce the degree and breadth of therapeutic effects, it is necessary to produce in the range of 6-9 months from the time of diagnosis. The criteria will be positive dynamics of symptoms and markers of disease, compliance of the patient to therapy, no side effects and possible complications.

The efficiency of the method.

The introduction of this method, as in pulmonary and General therapeutic practice will allow doctors to conduct a qualitative diagnosis of SOAGS, choose the best methods for correction of morbid state clearly identify whether the destination as drug therapy, and medical practices in the treatment of patients with respiratory disorders during sleep.

2. Sullivan, S. E., Jssa F. Q., Berton-Jones m, Eves L. Reversal of obstructive sleep apnea by continuous positive pressure applied through the nares. // Lancet, 1981; v.1-862-865.

1. A method for the diagnosis and correction of disorders of respiration by polysomnographically registration with the determination of the degree of apnea-hypopnea sleep and non-invasive ventilation, characterized in that it further when polysomnographically register determine the degree of oxygenation of the blood and the degree of respiratory paradox, at the same time exercise questionnaire and the data obtained establish the severity of the disease and the scope and sequence of correction, the last carried out comprehensively, using surgical, dental, and therapeutic effects.

2. The method according to p. 1, characterized in that the dental correction is to change the location of the upper jaw relative to the bottom using non-invasive removable devices, such as oral applicators.

3. The method according to p. 1, characterized in that surgical correction is the elimination of malformations of the skeleton of the face and oropharyngeal tissue region with mild disease methods of invasive and non-invasive chelust the

 

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