Sleep medicine / pulmonology

Due to the interplay between the heart, lungs and brain, a wide variety of heart and lung diseases can lead to unhealthy breathing pauses caused by a lack of oxygen during sleep. It has been proven that nocturnal breathing disorders, which are often accompanied by heavy snoring, sudden waking from sleep or persistent daytime sleepiness with morning headaches and high blood pressure, increase the risk of cardiovascular disease fivefold.

In the normal population, the frequency of the most common obstructive sleep apnoea syndrome (OSAS) is 6-12%. Screening for sleep apnoea is therefore already part of the investigation in the case of high blood pressure and any other form of heart or lung disease. For this purpose, our patients are given a so-called polygraphy device, which they take home with them and put on for one night during one of the following nights after prior instruction. The parameters collected are then forwarded to us via an app and analysed.

Our patient therefore does not have to visit the German Specialist Centre again. In mild cases, these can be eliminated by preventing the patient from lying on their back or by using a mandibular advancement splint. In moderate or even severe forms of sleep apnoea, the patient should be seen in a sleep laboratory for adjustment to nocturnal mask ventilation.

COPD is the third most common cause of death after heart disease and stroke. It is a chronic, progressive lung disease characterised by irreversible airway constriction.

Because the airways are narrowed and the function of the fine cilia in the bronchial tubes is impaired, there is an increased build-up of secretions in the periphery of the lungs. This allows bacteria to multiply more quickly, leading to bronchitis and, in the worst case, pneumonia.

Over time, the increased airway resistance leads to over-inflation of the air sacs (alveoli) and thus to emphysema.

What is asthma?

Asthma is a disease of the airways. In asthma, the airways are chronically inflamed and therefore constricted. Chronic means that the disease is permanent.

The cause of asthma is not yet fully understood. It is known that people with asthma have hypersensitive airways. They react to various triggers with inflammation of the airways. The mucous membrane of the bronchial tubes swells and thick mucus forms. The muscles of the bronchi also spasm. Experts call this bronchospasm. As a result, the airways constrict and you can no longer breathe in and out freely. Exhaling in particular is often difficult and takes a long time. You have to inhale more quickly and become short of breath. Breathing becomes strenuous. Shortness of breath and a sudden asthma attack can occur.

The symptoms may worsen suddenly or gradually. Lung function can also decrease. If these deteriorations go beyond the usual level, this is referred to as an exacerbation. In this case, the patient requires more medication or higher doses for several days. There are mild and severe exacerbations. An asthma attack also counts as an exacerbation.

• Pronounced daytime sleepiness
• General exhaustion
• Limited performance during the day
• Morning headaches on waking

Nocturnal symptoms such as loud snoring and pauses in breathing are often not noticeable to the patients themselves.

Questionnaire on daytime sleepiness (german)

The typical permanent signs (symptoms) of COPD are:

• Cough, often with sputum, especially in the morning
• Shortness of breath, especially on exertion

Frequent in moderate and severe disease:

• Noises when breathing (wheezing, whistling, humming), occasional tightness in the chest
• Hyperinflation of the lungs (barrel chest)
• Water retention in the legs or arms

In advanced stages of the disease, weight loss may occur.

Typical symptoms of asthma are:

• Shortness of breath that occurs repeatedly in attacks, often at night
• Whistling breathing noise
• Tightness in the chest
• Coughing with or without mucus production

The symptoms can sometimes be stronger and sometimes weaker. There are also periods without symptoms.