Disturbed Patency of the Upper Airway and Its Consequences

Abstract

Every ENT (Ear, Nose and Throat) surgeon meets many patients, both adults and children, suffering from disturbances of upper airway patency. Usually the obstruction is at the level of the nose, nosopharynx or pharynx (Guilleminault et al.,1976). Disturbed patency of the upper airway due to the hypertrophy of tonsills or adenoid is discussed in another paper (Skartyhski et al., this volume). Separate discussion is needed, concerning the problem of nasal airway compromise in patients with sleep apnea syndrome. In this paper we present the consequences of chronic upper airway compromise. A typical patient with mild obstruction of the airflow in the upper respiratory routes presents himself to an otolaryngologist after many years of unsuccessful treatment performed by cardiologists, neurologists or psychiatrists. Not before the authors working on the problem of disturbances of breathing during sleep have proposed a new syndrome in otorhinolaryngology, such patients were fully diagnosed and treated (Simmons and Hill, 1974). The basic examination is an all-night monitoring of many parameters of the blood and functions of the organism — a polysomnographic study (PSG). In patients with upper airway compromise PSG reveals many pathologies in circulatory system function (Orr and Shappell, 1975; Lugaresi et al., 1980) namely the increase in blood pressure and lung circulation, disturbances of the heart rhythm and significant changes in ST — T in ECG examination. Retrospective epidemiologic studies confirmed more frequent pathology in circulatory system in the patients with apneas during sleep. It is possible that sleep apnea may be one of the etiologic factors of the hypertension and of some of the heart diseases (Lugaresi et al., 1980; Miller, 1982).