Medical profile of a patient with obstructive sleep apnea

Background. Snoring and obstructive sleep apnea (OSA) are common problems that frequently bring patients to see an ENT physician. This study focuses on the structural characterization of patients with these complaints, analyzing the anatomical features of the upper airways that may predispose to the development of snoring and OSA. In the practice of otorhinolaryngologists, patients with snoring complaints constitute a significant proportion and require special attention due to the risk of developing a number of severe and life-threatening conditions, including during elective surgical interventions. Successful diagnosis and treatment of these conditions require a careful assessment of the anatomical features of the upper airways. The study considers such parameters as: comprehensive otorhinolaryngologic examination, determination of body mass index (BMI), analysis of general somatic pathology, analysis of cardio-respiratory sleep monitoring and other characteristics.

Aim. To conduct a comprehensive analysis of the structure of patients with complaints of snoring and respiratory arrest during sleep in the clinical practice of an ENT doctor.

Materials and methods. Thirty patients with complaints of snoring, daytime drowsiness, and sleep apnea were examined. A STOP-BANG questionnaire survey, BMI determination, analysis of general somatic pathology, comprehensive otorhinolaryngological examination, cardiorespiratory sleep monitoring, examination of a maxillofacial surgeon, allergist and therapist were conducted.

Results. The mean age of the patients was 44±3 years. The predominance of men among the surveyed subjects was revealed – 90%, against 10% of women. According to the analysis of BMI pre-obesity was found in 13 patients, grade 1 obesity – in 5 patients, grade 2 obesity – in 4 patients, and grade 3 obesity – in 3 examined patients. Hypertension was found in 20% of patients, and pathology of the bronchopulmonary system was found in 10% of patients. Pathology of the maxillary system was detected in 4 (13.3%) patients. Among the diseases of ENT organs, 16% of the examined patients had chronic tonsillitis, 6.6% had hypertrophy of the pharyngeal tonsil. Every 3 patients had nasal septal deformity, chronic maxillary sinusitis in 3 (10%), allergic rhinitis in 6 (20%), vasomotor rhinitis in 8 (26%), and rhinosinusitis with nasal polyps – 3 (10%). History of operations on ENT organs: adenotomies – in 7 (23%) patients, uvulopalotoplasty – in 4 (13%) patients with an unsatisfactory result, injuries nose surgery was performed – in 9 (30%) patients, tonsillectomy – 5 (16%), septoplasty previously performed – 2 (6.6%). Survey: according to the STOP-BANG questionnaire, a low risk of OSA was found in 22% of patients, while an average risk and a high risk were detected equally in 39% of the examined patients. Respiratory monitoring during sleep revealed the following: 16.7% of patients had position-dependent snoring (associated with ENT pathology in 40% of cases), 60% had severe OSA (IGA 56±8/h), mainly due to obesity or hypertrophy of the palatine tonsils, which required CPAP therapy or surgical treatment, and the remaining patients had mild/moderate forms of apnea that were corrected using various treatment methods.

Conclusion. The results obtained in this study demonstrate the widespread pathology of ENT organs and a high comorbid background in patients with complaints of snoring and confirm the relevance of assessing the state of the upper respiratory tract by a ENT doctor, and also emphasize the need for a comprehensive examination of this category of patients within the framework of a multidisciplinary team.