Apnea del sueño


¿Ronca frecuentemente? ¿Se despierta como si no hubiera descansado en toda la noche? ¿Parece que se queda sin respirar durante el sueño? ¿Le duele la cabeza por las mañanas frecuentemente?. Estos son algunos de los síntomas que puede tener si padece apnea obstructiva del sueño.

¿Qué es la apnea obstructiva del sueño?
La apnea obstructiva del sueño es una patología que ocasiona episodios repetidos de obstrucción en la vía aérea superior por el estrechamiento o cierre de la misma. Esto hace que la persona que lo padece presente durante el sueño pausas breves en su respiración.
 
¿Qué factores de riesgo pueden producir la apnea obstructiva del sueño?

  • Ser hombre.Los hombres son entre dos y tres veces más propensos a tener apnea del sueño que las mujeres. Sin embargo, el riesgo aumenta en las mujeres con sobrepeso, y pareciera que el riesgo también aumenta después de la menopausia.
  • La edad.La apnea del sueño ocurre con mucha más frecuencia en adultos mayores.
  • La obesidad aumenta significativamente el riesgo de sufrir apnea del sueño. Los depósitos de grasa alrededor de las vías respiratorias superiores pueden obstruir la respiración.
  • Consumo de alcohol, sedantes o tranquilizantes.Estas sustancias relajan los músculos de la garganta, lo que puede empeorar la apnea obstructiva del sueño.
  • Los fumadores tienen tres veces más posibilidades de padecer apnea obstructiva del sueño que las personas que nunca fumaron. El tabaquismo puede aumentar la inflamación y la retención de líquidos en las vías respiratorias superiores.
  • Antecedentes familiares.Si tienes familiares que padecen apnea del sueño, se puede tener un mayor riesgo.
  • Circunferencia del cuello.Las personas con cuellos más gruesos podrían tener vías respiratorias más estrechas.
  • Vías respiratorias estrechas. Las amígdalas o adenoides también pueden agrandarse y obstruir las vías respiratorias, especialmente en los niños.
  • Congestión nasal.Si tienes dificultad para respirar a través de la nariz, ya sea a causa de un problema anatómico o por alergias, eres más propenso a padecer apnea obstructiva del sueño.

 
¿Qué síntomas puedo tener si tengo apnea obstructiva del sueño?

  • Ronquidos fuertes (generalmente percibidos por los acompañantes).
  • Cansancio durante el día, te puedes sentir poco descansado o aturdido a pesar de haber dormido suficientes horas.
  • Despertares sobresaltados, ahogándose o jadeando.
  • Despertares con frecuencia para orinar.
  • Sueño no reparador, somnolencia durante el día.
  • Dolores de cabeza matutinos.
  • Dificultad para pensar con claridad o recordar cosas.
  • Boca seca o dolor de garganta.

 
¿Qué consecuencias tiene la apnea del sueño?
La apnea del sueño mantenida puede ser peligrosa. Algunas de sus consecuencias son:

  • Relación con mayor riesgo de accidentes: Debido al cansancio y la falta de atención.
  • Más posibilidad de riesgo cardiovascular, puesto que se ha relacionado con mayor frecuencia de hipertensión arterial, arritmias cardíacas, infartos y problemas cardíacos graves.

 
¿Es conveniente que consulte a mi médico?
Sí. En caso de tener los síntomas previos, es aconsejable hacerlo.
 
¿Cómo sabe mi médico de familia que tengo apnea del sueño?
Su médico sospechará que usted tiene esta patología realizándole algunas preguntas en la consulta y explorándole.
Se emplea también la escala de Epworth (pulse aquí para descargarla), en la que una puntuación mayor de 12 indica alta probabilidad.
 
¿Existe alguna prueba que pueda diagnosticarlo?
Ante la sospecha de apnea del sueño, deberá confirmarse mediante una “prueba del sueño” o polisomnografía. Generalmente esta prueba se realiza en el hospital, aunque actualmente también hay investigaciones para realizarla en el domicilio.
Se trata de dormir una noche en el hospital, donde distintos electrodos colocados en su cabeza, pecho y piernas junto a 1 o 2 cinturones en el pecho registran la frecuencia cardíaca, respiración y otras variables.
Con esta prueba se detecta el número de episodios de obstrucción al flujo total (apneas) o parcial (hipopneas) para poder establecer el diagnóstico.
 
¿Cuál es el tratamiento de la apnea del sueño?
Existen medidas higiénico dietéticas que deben ser la base del tratamiento y deben mantenerse todos los días:

  • Procurar no dormir boca arriba, dormir de lado. A veces la apnea del sueño es más frecuente al dormir hacia arriba. Puede probar en colocar almohadas u objetos molestos como pelotas en su espalda, o comprar dispositivos comercializados para este fin.
  • Bajar peso: la apnea del sueño es más frecuente en pacientes con sobrepeso (sobre todo aquellas personas con cuello ancho y corto) y a veces su disminución mejora esta patología.
  • Evitar el alcohol y tabaco, ya que puede empeorar la apnea del sueño.
  • Evitar el uso de sustancias hipnóticas como benzodiacepinas, ya que relajan la musculatura de la vía aérea y originan mayor obstrucción.

Cuando la prueba de sueño o polisomnografía sea positiva, se prescribirá una máquina para dormir denominada CPAP (Continuous Positive Airway Pressure). Existen otras opciones, menos frecuentes puesto que son menos efectivas, como son los dispositivos de avance mandibular o cirugía que ayuda a mantener la vía respiratoria abierta.
 
¿Qué es la CPAP?
Una CPAP es un dispositivo con una mascarilla que mantiene la vía aérea abierta durante el sueño, haciendo que el aire ambiental entre en el organismo a presión positiva mantenida para evitar el colapso de esta.
Este dispositivo debe colocarse siempre que el paciente vaya a dormir y sólo corrige el problema si se usa, aunque sean unas horas.
Puede parecer incómoda al principio, pero es necesario  acostumbrarse y pronto se notará la mejoría de los síntomas mejorando el suelo nocturno y el cansancio diurno.


Verónica García Ramos

MIR Medicina Familiar y Comunitaria, Arturo Eyries, Valladolid.

 
 
 
REFERENCIAS BIBLIOGRÁFICAS:

  • Patient education: Sleep apnea in adults (The Basics). Doctors and editors at UpToDate. Enero 2020.
  • Síndrome de apnea e hypopnea del sueño. Guía fisterra.

 
Revisado: enero 2020.

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