Izinkinga zokulala zivame kakhulu kubantu abane- arthritis ye-rheumatoid . Ukhathala kubonakala njengenkinga enkulu kulabo abaphila nalesi sifo. Ngesinye isikhathi, kuthiwa akucaci ukuthi ukuphazamiseka kokuphazamiseka kokulala kwe-apnea kwakungathinta isifo samathambo. I-apnea yokulala yokuvimbela ingenye yezinhlobo ezintathu ze-apnea yokulala.
Yini ukucabanga kwamanje? Ingabe kukhona ingozi ephakeme yokuthuthukisa i-apnea yokuvimbela ukulala uma une-arthritis ye-rheumatoid?
Ingabe ukugula okuphazamisa ubuthongo kuyimbangela yokuphazamiseka kokulala nokukhathala okuyizikhalazo ezivamile zabantu abane-arthritis ye-rheumatoid? Ake sicabangele lokho abacwaningi abakwenzile.
I-Rheumatoid Arthritis Basics
I-arthritis ye-rheumatoid iyimithi engapheli, yokuzibulala , yokuvuvukala kwesifo samathambo . Ngenkathi ubuhlungu obuhlangene bomzimba kanye nokulimala okuhlanganyelwe yizici zesifo samathambo, kungenzeka kube nemiphumela yesistimu kanye nokubonakaliswa okungafani. Abantu abangaba yizigidi ezingu-1.5 e-United States bane-arthritis ye-rheumatoid, ngokusho kwamaCenter for Disease Control and Prevention (CDC).
Ukulala nge-Apnea Basics
I-apnea yokulala yimibuzo ejwayelekile kakhulu yokuphefumula ehlobene nokulala. Ngokuphefumula kokuphefumula, ukuphefumula komuntu kuphazanyiswa, noma ngokuyisisekelo ukuyeka, ngesikhathi sokulala. ENyakatho Melika, ukukhula okulinganisiwe-lapho ukuphazamiseka kokuphazamiseka kokulala okuphazamisayo kubhekwa njenge-apnea-hypopnea index (AHI) yemicimbi engaphezulu kuka-5 ngehora njengoba kunqunywe yi-polysonogram-ngamaphesenti angama-20 kuya kwangu-30 kubesilisa namaphesenti angu-10 kuya kwangu-15 phakathi kwabesifazane.
Nakuba i-apnea ibhekisela ekumiswe okwesikhashana kokuphefumula, i-hypopnea ibhekisela ekuphefumuleni okuphuza noma okungajulile. Iziqephu ze-apnea yokulala ziholela ekunciphiseni i-oxygen saturation.
Izingozi ezihlobene ne-apnea yokulala zihlanganisa:
- Ukukhula
- Ubulili besilisa
- Ukukhuluphala
- Izifo ezingavamile ze-tan
Ezinye izici eziyingozi eziye zabonakala zihlanganisa ukubhema, ukungqubuzana komzimba, ukuphuma esikhathini, nomlando womndeni we-apnea yokulala. Izimo ezithile zezokwelapha ziye zahlotshaniswa nesilinganiso esiphezulu sokuphefumula kwesifo sokulala, kuhlanganise nokukhulelwa, isifo sokuqeda isisu sokuphela, isifo senhliziyo esiphumelelayo, isifo esingenasifo samaphaphu nesifo sohlangothi. Abacwaningi bathole ukuxhumana phakathi kwesifo samathambo kanye nengozi eyengeziwe yokuphazamiseka kwezifo zokulala.
I-apnea yokulala ne-Rheumatoid Arthritis ingaxhunyaniswa
Ngokusho kwemiphumela yokucwaninga eyashicilelwe ku-BMJ Open (2016), izinga lokukhubazeka kwe-sleeping obstructive sleep inflation kwaba ngamaphesenti angama-75 aphezulu eqenjini labantu abane-arthritis ye-rheumatoid uma kuqhathaniswa nalabo abangenawo isifo samathambo. Okufunyenwe kutholakala ekutadisheni kokuqala kwamakilasi asetshenzisiwe asetshenziswa idatha yomphakathi wonke. Ucwaningo lwangaphambilini lwe-apnea yokulala kanye nokuhlangana kwalo ne-arthritis ye-rheumatoid lwalusekelwe emibikweni yocala noma ngezifundo zocwaningo ngobukhulu besampula esincane.
I-BMJ Open ingxoxo yokutadisha ithi ingozi yokuphefumula okuphazamisa ukulala igxila emadodeni kunabesifazane, kubantu asebekhulile uma kuqhathaniswa nabantu abasha, nakwabantu abanomdlandla. Ingozi yokuphefumula i-apnea eyaziwa ukuthi ihlotshaniswa ne-hypertension, hyperlipidemia, ischemic isifo senhliziyo, nokukhuluphala.
Mayelana ne-arthritis ye-rheumatoid, izici ezithile zibonakala zifaka engozini ephakeme yokuphefumula kokuphefumula, okufaka phakathi i-micrognathia, ukungajwayelekile komgogodla wesibeletho, ukubandakanyeka kokuhlanganiswa kwe-temporomandibular, ukuzibandakanya komjoqo we-cricoarytenoid, nokukhuluphala.
- I-Micrognathia yisimo lapho umhlathi ophansi uncane kunowesijwayelekile. Lokhu kuvame ukulingana ne- arthritis yengane ye-idiopathic . Kungenzeka futhi njenge-micrognathia ekhulile ehlotshaniswa ne-arthritis ye-rheumatoid, kwezinye izimo ngenxa yokuqothulwa kwe-temporomandibular, okuholela ekuvimbelweni kwe-apnea yokulala emoyeni kanye nokuvimbela ukulala.
- Izinkinga zomgogodla zomlomo wesibeletho zingenzeka nge-arthritis ye-rheumatoid, ikakhulukazi, ukungazinzi komhlangano womlomo wesibeletho, ukungalungiswa kwesifunda somlomo wesibeletho, kanye nezinye izinto ezingavamile, njengokungathi ama- osteophyte . Ukungalungiswa komlomo wesibeletho kungabangela ukuhamba kancane kwe-airway, ukunciphisa ubuchopho, futhi kungathinta ubukhulu bokuphefumula kokulala. I-Occipital-cervical (fusion) fusion ingasiza ukulungisa lokho okungavamile nokuthuthukisa i-apnea yokulala.
- Ukubandakanyeka okuhlangene kwe-Temporomandibular-Ukubhujiswa kombuthano we- temporomandibular ohlobene nesifo samathambo anganciphisa ubukhulu be-airway engenhla futhi kubangele ukulala ne-apnea kulabo abathintekayo.
- Ukubandakanyeka okuhlanganyelwe kwe- Cricoarytenoid-Amalungu e-cricoarytenoid ayatholakala phakathi kwezingqimba ze-cricoid kanye nama-paired arytenoid engxenyeni yangaphambili ye-larynx. Amalungu e-cricoarytenoid avulwa, asondele, futhi aqinise izintambo zamagama ngesikhathi sokukhuluma nokuphefumula. Ukungahleleki kungabangela ukuba umuntu alele ekuphefumuleni kubantu abane-arthritis ye-rheumatoid.
Izici ezifuywayo, ukutholakala kwezimo ezithile zemvelo, ezinye izinto zokuziphatha, nokukhetha kokuphila noma ukuziphatha, njengokudla okuncane kakhulu (isib. Ushukela oluningi kakhulu noma amafutha), ukuphuza ngokweqile noma ukubhema, nokuzivocavoca ngokwanele kungase kube negalelo .
Kubuye kwaphakanyiswa ukuthi inhlangano eyaziwayo phakathi kwesifo senhliziyo nesifo samathambo angase, ngenxa yalokho, ingenxa yokuthi i-apnea yokulala. I-apnea yokulala engavinjelwe iboshelwe ukuvuvukala , ukugcoba , nokuphela kokusebenza komzimba . Njengoba izimbangela zenkampani ziye zatholakala, imbangela nomphumela uba sobala futhi isidingo sokuphatha isici ngasinye sisobala.
Izici kufanele zicatshangelwe ngombono wokuthi izifo zesifo se-rheumatic zihlobene kanjani ne-apnea yokulala. Isibonelo, kunqunywe ukuthi abantu abane-apnea yokuvimbela ukulala baye baphakamisa ama-reaction reactants (i- CRP , izinga eliphansi ) kanye nama- cytokines angama -inflammatory. Kubikwe ukuthi ezinye ze-interleukin, ikakhulukazi, i-IL-1, i-IL-2, i-IL-6, i-Il-8, i-IL-18, ne- TNF-alpha ikhuthaza ukulala okungabonakali kwe-REM. I-IL-4, i-IL-10, i-IL-13, ne-TNF-beta ivimbela ukulala okungewona kwe-REM.
Amazinga e-cytokine okuvuthayo ahambisana nokuqina komoya wokulala. Amazinga aphezulu we-TNF-alpha aye ahlotshaniswa nokuphefumula okungaphezulu kokuvimbela ubuthongo ne-hypoxia. Lokhu kungase kuchaze ukuthi kungani abantu abane-rheumatoid arthritis abaphathwa nge- block block TNF bathola ukuthi izinga labo lokukhathala liyathuthuka. Ukutadisha okwengeziwe kuzodingeka ukuthi wenze isiphetho mayelana nomthelela wezokwelapha ezithile ze-arthritis ye-rheumatoid.
Kufanele Kulawulwe Kanjani?
Ukuhlangana kwe-arthritis ye-rheumatoid kanye ne-apnea yokulala kungabangela kakhulu ukukhushulwa nokufa kwabantu kubantu abanezimo zombili. Ukuthi inhlangano ingabangela ingozi yokwandisa izifo zenhliziyo ezigulini ze-rheumatoid arthritis mhlawumbe into ephawulekayo.
Ama-Rheumatologists kufanele abheke izibonakaliso zokuphefumula okuphazamisekile ezigulini zabo lapho bexoxa futhi bezihlola futhi, uma kuboniswe, babhekane nesazi sokulala noma umtholampilo wokulala. I-apnea yokulala ngokuvamile ilawulwa ngokusebenzisa amadivayisi we-CPAP . Ukuhambisana namadivayisi we-CPAP kuyinkinga kwabanye. Kungase kube ngcono kakhulu kuchazwe njenge-cumbersome. Eminye indlela ekhona yokuphathwa kwe-apnea yokulala ihilela isikhundla esithile somzimba ngesikhathi sokulala ukugcina umoya ovulekile, ukulahlekelwa isisindo, nokusetshenziswa kwamadivaysi ukuhambisa i-mandible phambili ngaleyo ndlela ukunciphisa ukuvinjelwa kwamanzi. Ngokuqinisekile, inkinga akufanele inganakwa.
Okubalulekile
Uma umuntu one-arthritis ye-rheumatoid ekhononda kudokotela wabo mayelana nokukhathala, akufanele kuqale ukuxoshwa njengesici esivamile esihambisana nesifo. Akufanele kucatshangwe ukuthi ukukhathala kuhlobene nje nokuphazamiseka kokulala nokulala ukuhlukana okuhambisana nobuhlungu. Nakuba lokho kungase kwenzeke ezimweni eziningi, umsebenzi onzima wokunquma imbangela kufanele wenziwe. I-apnea yokulala kufanele ilawulwe ngaphakathi noma ngaphandle. Imiphumela engaba khona ye-apnea yokulala engalashwa ikhulu kakhulu.
> Imithombo:
> Ataka, H. et al. I-Fusion Occipitocervical Inokuthi Ikwazi Ukuthuthukisa I-Apnea Yokulala Ezigulini Ezinezifo Ze-Arthritis Nezikhukhula Zomlomo Ophezulu. Isiphetho. 2010 Sept 1; 35 (18): E971-5.
> Shen, Te-Shun et al. Ingozi Yokuvimbela I-Apnea Yokulala Ezigulini Ezinezifo Ze-Rheumatoid I-Arthritis: Isifundo Somphakathi Esivela Esizweni Esiphezulu Sabantu Abahlala Emakhaya. I-BMJ Vula. 2016; 6 (11): e013151.
> Shoda, Naoki et al. I-apnea yokulala e-Rheumatoid Arthritis Iziguli ezinezilonda ze-Occipitocervical: Izici ezivame kakhulu nezihlanganisiwe ze-Radiographic. I-European Spine Journal. 2009 Juni; 18 (6): 905-910.
> Strohl, Kingman P MD. Sibutsetelo sokuvimbela i-Apnea yokulala kubantu abadala. Kusesikhathini. Kubuyekezwe ngo-Juni 24, 2016.
> Taylor-Gjevre, Regina M., Nair, uBindu V., noGjevre, uJohn A. Ukuvimbela Ukulala Apnea Ngokuhlobene Nezifo Ze-Rheumatic. I-Rheumatology (2013) 52 (1): 15-21.