Izimbangela Nezokwelashwa Zihluke Kokuvimbela Ukulala Kwama-apnea
I-apnea yokulala ingaba yinkimbinkimbi ukuqonda, ikakhulukazi ngenxa yamagama anzima aphonswa nxazonke. Ngeshwa, ngisho nabahlinzeki abathile bezokwelapha bangakwazi ukuqonda kahle izincazelo zezifo ezihlukahlukene zokuxilonga. Lokhu kungaholela ekuhlolweni okubizayo nokungadingekile kanye nokwelapha. Kubaluleke kakhulu ukuqonda izimpawu kanye nezibonakaliso zodwa okuxilongwa ngokukhethekile: i-apnea yokulala eyinkimbinkimbi.
Iyini i-apnea yokulala eyinkimbinkimbi noma eyingozi? Funda ngalezi zimo, izici nezimbangela, ukuthi kutholakala kanjani, futhi ukwelashwa okuphumelelayo kakhulu (futhi uma ukwelashwa kudingekile).
Sibutsetelo
I-apnea yokulala yokucindezeleka ibuye ibizwe ngokuthi i-apnea yokulala yokulala ephuthumayo, futhi lokhu empeleni kuyindlela ewusizo yalesi simo. I-apnea yokulala ebunzima ikhona lapho umuntu owake waba ne-apnea yokuvimbela ubuthongo eba ne-apnea yokulala ebusweni ngenxa yokusebenzisa ukwelashwa ngokucindezela okuqhubekayo kwe-airway (CPAP) . Lokhu kuyiningi lokukhipha, ngakho-ke ake sihlukanise amagama lapha.
Okokuqala, i-apnea yokulala yokuvimbela ingozi uma kwenzeka lapho umoya ophezulu (noma umphimbo) wehla ngesikhathi sokulala. Lokhu kungabangela amaconsi emazingeni e-oksijeni yegazi kanye nokuvuswa noma ukuvuswa kokulala. Ngokususelwa kwisifundo sokulala sokuhlonza okuthiwa i- polysomnogram , lesi simo sikhona uma kunemicimbi emihlanu noma ngaphezulu yokuvimbela eyenzeka ngehora lokulala.
Lezi zigodi zingase zihambe ngamagama ahlukahlukene, kuhlanganise nama-apneas obstructive, ama-apneas ahlanganisiwe, ama-hypopneas, nokuvusa okuhlobene nokuphefumula (ama-RERA).
Uma ukuphazamiseka kwe-apnea yokulala okuphazamisayo kubonakala, ukwelashwa okuvame kakhulu futhi okuphumelelayo ukusetshenziswa kwe-CPAP therapy. Lokhu ukwelashwa kunika ukugeleza okuqhubekayo emoyeni ngokusebenzisa imaski yobuso.
Lolu moya olwengeziwe lugcina indlela yokuhamba emoyeni ingabhidli, noma ivinjise, iphinde ixazulule. Kwezinye izimo, kungase kubangele izinguquko ekuphefumuleni okubangelwa ukuphefumula, isimo esibizwa ngokuthi i-apnea yokulala ephakathi.
Ngencazelo, i-apnea eyinkimbinkimbi yokulala ikhona ngokusebenzisa ukwelashwa kwe-CPAP. Imicimbi yokuvimbela ukuxazululwa kwemicimbi kanye nemikhakha esemaphakathi ye-apnea ivela noma iqhubeke nokuphilisa. Lezi zenzakalo eziphambili ze-apnea kumele zenzeke okungenani izikhathi ezinhlanu ngehora futhi kufanele zenze okungaphezu kwama-50% wezingqikithi eziningi ze-apnea ne-hypopnea imicimbi. Ngakho-ke, uma unayo yonke imicimbi eyi-apnea eyi-100 ephawulwe ngenkathi usebenzisa ukwelashwa kwe-CPAP, kanti kuphela 49 (noma cishe kuncane) yizehlakalo eziphambili ze-apnea, awunayo i-apnea yokulala ebunzima. Kuyinto evamile kakhulu ukuthi iminye imicimbi ye-apnea ephakathi ivela, kodwa kungenzeka ingadingi ukungenelela okwengeziwe ngaphezu kwesikhathi.
Ukuvama
I-apnea yokulala ebunzima ingaba yinto evamile ngesikhathi sokuqala kokwelapha nge-CPAP noma ngisho nokwelashwa kwe-bilevel . Lezi zenzakalo eziphambili ze-apnea azichazwa kangcono ngokusebenzisa imithi (njengezinambuzane noma imithi yobuhlungu be-opioid) futhi akubangelwa ukuhluleka kwenhliziyo noma isifo sohlangothi. Kungase kube nenani eliphakeme lokuvusa kusuka ebuthongweni futhi ukuvuka ngakunye kungalandelwa yi-central post-stimousal.
Lezi zenzakalo zivame ukubonakala ebuthongweni be-non-REM futhi zingathuthukisa kancane esiteji sesi-3 noma i-slow-wave sleep.
Kuvamile kangakanani ukuphefumula okuphambene nokulala? Lokhu empeleni umbuzo onzima ukuphendula. Isimo sangempela nesilinganiso sokuphikelela akuchazwa kahle, ngenxa yokuthi ixazulula ngokungafani ukuthi ukwelashwa kwe-PAP kuyaqhubeka. Kucatshangwa ukuthi kuthinte kusuka ku-2% ukuya ku-20% wabantu njengoba beqala ukusebenzisa ukwelashwa kwe-CPAP futhi kungabonakala kaningi ngobusuku bokuqala noma obusuku bokusetshenziswa. Ngakho-ke, kungase kuvezwe kabanzi njengengxenye yesifundo se-titration esikhungweni sokulala. Ngenhlanhla, iphikelela kuphela ukwelapha kubantu abangaba ngu-2% wabantu.
Izimbangela
Izimbangela eziqondile ze-apnea eziyinkimbinkimbi zokulala aziqondi ngokugcwele. Kungenzeka kube neminikelo eminingi kulowo mkhuba, futhi akuzona zonke ezibangelwa ukwelashwa kwe-CPAP. Abanye abantu bangase babhekane nesimo ngenxa yokungazinzi ekulawuleni kwabo ukuphefumula. Kungenzeka kaningi phakathi kwalabo abanenkinga yokugcina ubuthongo, njengokulala. Kubonakala sengathi kubangelwa amazinga aphansi e-carbon dioxide kwezinye. Uma umuntu eqala ukuphefumula kakhudlwana kokulala (nge- AHI ephakeme) noma enezigameko ezingaphezulu ze-apnea ezivezwe ngaphambi kokwelashwa, lokhu kungandisa ingozi. Kubonakala sengathi kwenzeka nakakhulu emadodeni.
Kuyathakazelisa ukuphawula ukuthi ezinye izindlela zokwelashwa zokuphefumula ukulala nazo zibonakala zandisa ingozi yokuthuthukisa i-apnea yokulala eyinkimbinkimbi. Ukuhlinzwa kanye nokusetshenziswa komshini womlomo kuye kwabikwa kokubili ukudala i-apnea yokulala ephakathi. Kungenzeka futhi uma izingcindezi zosizo lwe-PAP ziphakeme kakhulu noma ziphansi kakhulu, njengoba zibekwe ngesikhathi sokufunda isifundo noma ekusetshenzisweni kwekhaya okulandelayo.
Imiphumela kanye nokwelapha
Ngisho noma i-apnea eyinkimbinkimbi yokulala ijwayele ukuxazulula isikhathi, kunabantu abangamaphesenti amabili (2%) abantu abahlala kulo mkhuba futhi kungase kube neminye imiphumela. Abanye balaba bantu bangadinga ezinye izindlela zokwelapha ukuxazulula lesi sifo.
I-apnea yokulala yokuncintisana ingase iqaphele ukuphikelela ekulayisheni okujwayelekile kwedatha yokuhambisana ne-PAP. Lokhu kuzovame ukuvela ekuqokweni okulandelwayo okulandelwayo kanye nesazi sakho sokulala ezinyangeni ezintathu zokuqala zokusetshenziswa. Uma kwenzeka izenzakalo ezingaphezu kwezingu-5 ze-apnea eziphakathi ngehora, naphezu kwezenzakalo zokuvimbela ukulala kwe-apnea ekuvimbeleni, lokhu kungase kushukumise izinguquko. Kungani lokhu kungase kudingeke?
Ukuphefumula okunamandla okuqhubekayo kokulala okuhambisana ne-AHI ephezulu ehlala phansi kungabangela ukuqhuma okuqhubekayo kokulala nokushiswa kwe-oxygen. Lokhu kungaholela ekulele ubusuku neminye imiphumela yezempilo yesikhathi eside. Okubaluleke kakhulu, lokhu kungase kuphazamise ukwelashwa kwe-PAP: umsebenzisi angase abike kancane inzuzo futhi abe nokunamathela okwesikhashana isikhathi eside ekwelapheni.
Kubalulekile ukuqaphela ukuthi kungenzeka kube nokuhlukahluka kwamabili ebusuku. Esimeni sesimo sakho sokuqala, ezinye iziphakamiso ku-AHI zingase zibekezeleleke uma impendulo yonke yokwelapha ihamba kahle. Yize amadivaysi anganikeza imingcele emincane ye-apnea imicimbi, lezi aziphelelanga, futhi lokhu kungahlolwa kangcono nge-polysomnogram ejwayelekile.
Ukuxazululwa kwe-apnea yokulala obunzima kungase kuxhomeke ekubhekaneni nezimbangela eziyinhloko. Isibonelo, uma izingcindezi ezisetshenzisiwe ziphezulu kakhulu (noma, kancane kancane, ziphansi kakhulu), ukulungiswa okulula kungalungisa lolu daba. Uma ukuvuvukala kwenzeka ngenxa yokuvuza imfucuza, ukufaneleka okufanele kungasiza. Kwezinye izimo, kungadingeka ukuthi ushintshele kwi-ST ye-Blevel (ngesilinganiso sokuphefumula esifike isikhathi esingasikelwa ngesikhathi sokuphefumula) noma ukwelashwa kwe-ASV. Lezi zindlela zokwelapha ngokuvamile zizodinga isifundo se-titration ukuthola izilungiselelo zedivayisi ezilungile.
Ukwelashwa okunengqondo kakhulu kuvame ukuphumelela kakhulu: isikhathi. I-apnea yokulala ebunzima iyakwazi ukuthuthukisa ngamacala angu-98% njengoba ukwelashwa kuqhubeka. Kungase kungadingi ukungenelela okungaphezulu ngaphandle kokulinda nokubuka imicimbi esele ixazulula eyedwa.
Imithombo:
I-American Academy ye-Sleep Medicine. Ukuhlukaniswa kwamazwe ngamazwe okuphazamiseka kokulala , 3 rd ed. Darien, IL: i-American Academy of Sleep Medicine, 2014.
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