I-Anatomy, Indawo Yokulala, Namazinga Okulala Zonke Izidingo Zokucindezela Impembelelo
Uma ngabe kunqunywe ukwelashwa okuqhubekayo okune-airway pressure (CPAP) ukuze uphathe i- apnea yakho yokuvimbela ubuthongo , ungase uzibuze: ingabe ukuqina kwe-apnea yokulala kulinganiswe ukuhambisana kwe-AHI nomfutho we-CPAP odingekayo wokuthola ukwelashwa okuphumelelayo? Funda ukuthi (futhi kanjani) ukuhlelwa kwe-CPAP enqunyiwe kuhlobene nezinga eliphansi lokuphefumula lokuphefumula nokuthi yiziphi ezinye izici ezingase zihileleke ekunqumeni ukwelashwa kwakho okuhle, kufaka phakathi i-anatomy, indawo yokulala, nezigaba zokulala.
Indlela Ubuthongo Be-Apnea Obunzima Okuhlobene Nayo Nokucindezela
Kungokwemvelo ukucabanga ukuthi kuzoba nobuhlobo phakathi kokubekwa kwesimo se-CPAP nesimo se-apnea yokuvimbela ukulala. Uma udinga imithi yengcindezi yegazi, umthamo ophakeme ngokwemvelo uzomphumela omkhulu, akunjalo? Ngeshwa, ubuhlobo abukho ngqo uma uphatha ukuphefumula kokuphefumula.
I-apnea yokulala engavimbelekile (i-OSA) itholakala ukuthi ifundela ubusuku bokulala noma i- home sleep apnea test ehlola inani lezikhathi ngehora lokulala lapho umoya ophezulu uphela khona, okuholela ekuhlahleni kwamazinga e-oksijeni wegazi noma ukuvuswa kokulala. Uma lo moya ugoqa ngokuphelele lokhu kubizwa ngokuthi i-apnea futhi uma ihlukana kancane kancane lokhu kubizwa ngokuthi i-hypopnea. Ingqikithi yalezi zenzakalo ngehora lokulala i- apnea-hypopnea index (AHI) .
I-AHI ivumela ukuhlukaniswa okujwayelekile kokuphefumula kwe-apnea yokulala.
Uma kunemicimbi engaphansi kwezingu-5 ngehora, lokhu kuthathwa njengokujwayelekile. Uma kubhalwe imicimbi emihlanu kuya kwezingu-15 ngehora, lokhu kuyi-OSA emnene. Uma kunezinhlobo ezingaphezu kwezingu-15 kodwa zingaphansi kwezingu-30, lokhu kubhekwa njengesi-OSA esilinganiselwe. Okokugcina, uma izenzakalo ezingaphezu kuka-30 zirekhodwa ngehora lokulala, lokhu kubonakala njenge-OSA enzima.
Ungase ucabange ukuthi i-OSA enamandla idinga ukusetha okuphezulu kwe-CPAP ukuyiphatha. Eqinisweni, lokhu akunjalo ngaso sonke isikhathi njengoba kunezici eziningi ezihilelekile ekunqumeni ukulungiselelwa okudingekayo. Ngokuvamile, ukwelashwa kuqala esimweni esincane futhi kancane kancane kwanda ukuxazulula zonke izenzakalo ze-apnea ne-hypopnea kanye nokuhlehlisa. Ukusethwa okuphansi kunazo zonke kumishini ye-CPAP kungase ibe ngamasentimitha angu-4 kuya ku-5 kwengcindezi yamanzi (isifinyeziwe njenge-cm H20 noma i-CWP). Iningi labantu lidinga ukucindezela okukhulu kunalesi simo esiphezulu kakhulu. Isilungiselelo esiphezulu sihluka ngohlobo lomshini, kodwa singaba phezulu ku-25 noma ku-30 CWP.
Ukunquma Ukucindezeleka Kwe-CPAP Okudingekayo Ukuxazulula Ukulala Kwe-Apnea
Uma ukulungiselelwa kwe-CPAP kunqunywe njengengxenye yocwaningo lokubamba ubusuku ngobusuku ebhodini lokulala , i-polysomnography technologygist izobona amaphethini wokuphefumula futhi ilungise ukuhlelwa phezulu lapho ulele. Lokhu kwenziwa kude ukusuka kwelinye igumbi, ngakho-ke ukuphazanyiswa akukwenzeka. Umgomo ukuqeda i-apnea yokulala nokugubha futhi ubheke ukulala okujulile, kufaka phakathi ukulala kwe-eye ngokushesha (REM) ukulala. Lesi silungiselelo kufanele siphinde senziwe ngcono ngenkathi silele phezulu (ngemuva kwakho), lapho ukuphefumula kokuphefumula kuvame ukonakala.
Abanye abantu bathunyelwa ekhaya nge-self-adjusting machine CPAP, ngezinye izikhathi kuthiwa yi-AutoCPAP noma i-APAP.
Kulesi simo, udokotela ohlinzekela uvumela ukucindezela okuhlukahlukene, nomshini uzoqala phansi futhi ulungise phezulu lapho kudingeka khona ekuphenduleni ukulinganisa kwe-airway (okukhombisa ukuwa okuqhubekayo kwezicubu ezithambile ezifana nesisekelo solimi noma i-palate ephansi emqaleni ). I-CPAP inikeza ukuqhutshwa okuphakathi komfutho we-air extra ukuhlola ukuphikiswa futhi, ngokungeziwe, ngabe umoya ophezulu uyaphela. Uma ngabe umoya womoya uvulekile esimisweni samanje se-CPAP esinikezwe, sigcinwa.
Umfutho we-CPAP odingekayo awuhambisani ngokuqondile nobukhulu bokuphefumula kokulala.
Abanye abantu abane-OSA abanobuhle badinga ukucindezelwa okukhulu kanti abanye abantu abane-OSA enzima badinga ukucindezeleka okulinganiselwe. Lokhu kuthiwa, abantu abane-apnea ebuthongweni obunzima kakhulu bavame ukudinga ukucindezelwa okuphezulu ku-CPAP, noma ngisho nokwelashwa kwe-bilevel . Lokhu kuyiqiniso ikakhulukazi esimisweni sokukhuluphala ngokweqile noma ukuvinjelwa kwesisu. Izingane zingadinga ukucindezelwa okufanayo kubantu abadala, naphezu kobukhulu obuncane bezindiza zabo.
Iziphi izici ezenza ukulungiselelwa kokucindezela kwe-CPAP okudingekayo? I-anatomy ye-airway engenhla kanye nemvelo yendlela yokuvimbela umoya wendiza inendima enkulu. Uma i-apnea yokulala ivela ngenxa yephunga elivinjiwe ngenxa yemithi noma i- septum ephukile , i-palum epholile , noma ulimi oluwela emuva emoyeni, kunezinhlobo ezihlukahlukene zomoya okudingeka zixoshe lezi tissue endleleni.
Ngaphezu kwalokho, ukukhuluphala ngokweqile noma ukugqilaza kungase kukhulise izinto. Eqinisweni, lapho abantu belahlekelwa ngu-10% wesisindo somzimba wabo, kungadingeka ukuthi ulungise izilungiselelo ze-CPAP ngokuzibeka phansi.
Utshwala, imishanguzo ephumula imisipha yomoya (njenge- benzodiazepines ), futhi ukulala ngemuva kwakho kungase kwengeze ngezikhathi ezithile ekudingeni ukucindezela kwakho.
Ekugcineni, i-REM ukulala ekuseni ingahle iphumule imisipha futhi ivuselele ukuphefumula kokuphefumula.
Ukubeka kahle kungase kuxhomeke ekuhlaziyweni kwe-AHI ehlala njalo
Ngakho-ke, njengoba kuchazwe ngenhla, akulula ukuqagela ukuthi yikuphi ukucindezelwa kwe-CPAP okungase kudingeke uphathe izinga lakho lokuphumula lokulala. Kungase kuguquke ngandlela-thile phakathi nobusuku kuncike ekulaleni kwakho nokulala kwesigaba. Uma ingcindezi iphansi kakhulu, i-apnea yakho yokulala ngeke ilawulwe ngokwanele. Uma uphakeme kakhulu, ungase uthole imiphumela emibi njenge-mask ukuvuza noma umoya ugwinya .
Kubalulekile ukuba umshini uhlelwe kahle ngumbono wokulala ukuze uqinisekise isipiliyoni esihle kakhulu kanye nezinzuzo ezinkulu kakhulu. Amadivayisi anamuhla angahlinzeka ngolwazi nge-AHI esalayo futhi lokhu kungasiza ukuqondisa ukulungiswa kwengcindezi. Kungaba isifiso sokusebenzisa umshini we-AutoCPAP okwazi ukulungisa nalezi ezinye iziguquguquko.
Izwi elivela
Uma uqhubeka ube nezimpawu, uphinde uhlolwe udokotela wakho wezokwelashwa oqinisekisiwe ebhodini ukuqinisekisa ukuthi isimo sakho siphathwe ngokwanele ngezilungiselelo zokucindezela umshini wakho. Ungashintshi izilungiselelo wena njengoba ungase ungaqondi ngokugcwele iziguquko ezibangela ubunzima obungase ubhekene nakho.
Umthombo:
Kryger, MH et al . "Izimiso Nemikhuba Yokulala Imithi." Elsevier , edition 6, 2017.