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Khasanov Ulugbek Saidakramovich, Tashkent Medical Academy Vokhidov Ulugbek Nuridinovich, Tashkent State Dental institute
Sharipov Sanjar Salomovich, Tashkent State Dental institute E-mail: [email protected]
USE OF MODERN TECHNOLOGIES IN THE DIAGNOSTICS OF RONCHOPATHY
Abstract: The purpose of this study was to evaluate the results of a polysomnographic study in patients with ronchopathy. We examined 50 patients with ronchopathy who were hospitalized in the ENT department of the 3rd clinic of the Tashkent Medical Academy. All patients underwent an ENT examination, endoscopic examination of the nose and nasopharynx, and polysomnographic study. The study showed that polysomnography is a valuable diagnostic method for patients with ronchopathy, which allows objectifying sleep disorders and timely treatment of ENT diseases for the prevention of obstructive sleep apnea.
Keywords: ronchopathy, endoscopy, sleep disturbance, polysomnography.
Diagnosis and treatment of snoring is a medical and social problem, as evidenced by statistical and epidemiological studies of the spread of snoring and apnea among the population and a large number of publications in both domestic and foreign literature [1; 6; 9; 13; 16].
According to statistics, every fifth person after 30 years of age constantly snores in his sleep. Recent studies have shown that snoring is a precursor and one of the main manifestations of a serious disease - obstructive sleep apnea (OSA) [2; 10; 11; 12]. Under the syndrome of obstructive sleep apnea understand the disease, characterized by the presence of snoring, as a result of periodic subsidence of the upper respiratory tract at the level of the pharynx, cessation of pulmonary ventilation, which is accompanied by a decrease in blood oxygen levels, gross sleep fragmentation and excessive daytime sleepiness [3]. The severity of OSA is determined by the number of episodes of apnea / hypopnea per hour [10]. The disease manifests many symptoms about which the patient often turns to a therapist, cardiologist, neurologist, otorhinolaryngologist, sexologist, psychiatrist, and other specialists, indicating a multi-symptom of the disease and the social aspect of the problem [4; 5].
In Russia over the past 15 years, the problem of snoring and OSA began to pay great attention and isolated it into a separate nosological form - ronchopathy [2]. Ronchopathy is a pathological condition characterized by hyperplastic changes and narrowing of the structures of the upper respiratory tract, soft tissue vibration, the occurrence of an acoustic phenomenon - snoring or snoring [7].
The etiology and pathogenesis of ronchopathy remain not fully understood. It is believed that one of the main causes of snoring is difficulty in nasal breathing [6; 14]. Therefore, most clinicians are convinced that an improvement in nasal breathing
can lead to permanent relief from snoring [7; 15]. In contrast to them, a number ofresearchers argue that the correction ofendo-nasal structures leads to a decrease in the intensity of snoring and the number of episodes of apnea in no more than 20% of cases [6; 7]. There is an opinion that the difficulty of nasal breathing does not have any effect on the occurrence of snoring and OSA [11]. Therefore, the problem of an objective assessment of the respiratory function of the nasal cavity and the determination of the need and extent of endonasal surgery in patients with snoring and OSA takes on a very topical importance.
In recent years, scientific and technological progress has contributed to the emergence and development of new research methods in otorhinolaryngology, including architectonics and the respiratory function of the nasal cavity. Their main advantages are: non-invasive, atraumatic, safe use. Such methods include acoustic rhinometry and anterior active rhi-nomanometry. These diagnostic methods allow to evaluate the architectonics of the nasal cavity and respiratory function, both in normal conditions and in pathology [13].
However, studies of respiratory function in snoring are few or based on a small number of observations [12]. The question of the extent to which nasal obstruction affects the intensity of snoring and the number of episodes of OSA and the effect of the elimination of nasal obstruction on their course has not been sufficiently studied.
So far, a research methodology has not been developed to evaluate the functional and morphological state of the nasal mucosa in normal, with ronchopathy and obstructive sleep apnea at the examination stage, and thus determined in the choice of rational treatment tactics for this pathology.
One of the important achievements in the field of snoring and OSA was the emergence of polysomnography, a fairly
USE OF MODERN TECHNOLOGIES IN THE DIAGNOSTICS OF RONCHOPATHY
objective method of assessing the function of breathing during sleep [16].
The variety of existing methods of treatment of ronchopa-thy indicates a lack of effectiveness of each of them, which leads to the need for further research of this problem.
The development of otorhinolaryngology and insurance medicine dictate the need to objectively substantiate the indications for surgery and evaluate the results of surgical intervention. Objective methods of examination are necessary for understanding the norms and pathologies ofthe nasal cavity when making a diagnosis and evaluating the outcome of operations. Therefore, the search for objective methods of studying the functional state of the nasal cavity and the standardization of the results of the study of nasal breathing remains an urgent problem of otorhino-laryngology, which determined the purpose of this study.
The purpose of this study was to evaluate the results of a polysomnographic study in patients with ronhopathy.
The material of this study was 50 patients with ronhopathy who were hospitalized in the ENT department of the 3rd clinic of the Tashkent Medical Academy. The age of patients ranged from 18 to 72 years. All patients underwent an ENT examination, endoscopic examination of the nose and nasopharynx, and polysomnographic study. Based on the classification by ronchopathy, patients were divided into 2 groups. The first group consisted of 30 patients who had a mild degree of ronchopathy. The second group consisted of 20 patients with a moderately severe degree of ronchopathy. Patients with severe ronchopathy were not included in the study. All were surveyed. The questionnaire included complaints, anamnestic data and questions based on the diagnostic criteria for the international classification of sleep disorders. The questionnaire reflected the passport part, place of residence, profession, Table 1. - The results of polysomr
gender, age, height, patient weight and body mass index. If possible, recorded observations of family members who were present at the night snoring of the patient. The control group consisted of 20 healthy volunteers. The research results were statistically processed using Microsoft Excel 2016.
The results of the study. Of the 50 patients, only 16 turned on their own with a complaint of snoring. In 13 of them, the usual snoring was observed for up to 5 years. The remaining 34 patients surveyed filed other complaints, and we received information about snoring as a result of a targeted survey. 32 out of 50 patients had snoring without apnea with a duration of 5-20 years. 3 patients during the survey noted not refreshing and restless sleep, accompanied by dry mouth and headache after waking up. During the working day, they regularly observed drowsiness and low performance.
Examining the ENT organs of patients of the first group showed, that 29% had nasal septum deviation, 25% had vasomotor rhinitis, 13% had polypoid rhinosinusitis, 8% had chronic tonsillitis, and 7% had adenoid vegetation. In the remaining 18% of cases, a mixed pathology of ENT organs was found. Examining the upper respiratory tract of patients of the second group similar data were noted, since 28% had a deviated septum, 20% had vasomotor rhinitis, 15% had polypoid rhinosinusitis, 13% had chronic tonsillitis, 9% had adenoid vegetation. In the remaining 15% of cases, a mixed pathology of ENT organs was found. Inspection data of the upper respiratory tract did not reveal the distinctive features of groups of patients with ronchopathy, which did not affect the results of the polysomnographic study.
To identify the severity of snoring in patients with ronchopathy, a polysomnographic study was conducted. The results of the polysomnographic study are presented in (table 1). raphy in patients with ronhopathy
Indicators Control group n=20 1 group n=80 2 group n=50
Stage 1 of sleep (S1),% 7.0 ± 0.6 17.5 ± 0.8 14.3 ± 0.7
Stage 2 of sleep (S2),% 30.6 39.8 41.4
Delta-sleep (S3+S4),% 36.5 24.5 22.4
Fast sleep phase (REM- phase),% 23.8 14.8 14.4
Wakefulness in a sleep 1.5 2.1 5.8
Apnea/hypopnea index, episodes/hour 0.3 0.3 0.7
SpO2,% 98.5 98.2 98.3
HR, beat/minutes 73 74.1 65.6
The results of the study of snoring intensity in patients of group 1 showed that in 35(43.0%) patients 20-40 dB were noted, in 31(38.6%) patients 41-60 dB, in 14(17.4%) patients 61-80 dB The results of the study of snoring intensity in patients of the 2 groups showed that in 10 (20.0%) patients 20-40 dB were noted, in 2 (50.0%) patients 41-60 dB, in 15
(30.0%) patients 61-80 dB In general, in 45(34.6%) patients 20-40 dB were noted, in 56(43.1%) patients 41-60 dB, in 29(22.3%) patients 61-80 dB. It is necessary to take into account the evidence that the high intensity of snoring can affect people around patients, which increases the negative attitude towards patients with ronhopathy.
In patients of both groups, sleep stage 1 (S1) was elongated compared with the control group, which averaged 15.7%. A decrease in the delta of sleep (S3 + S4) (23.2%) and the fast phase of sleep (REM phase) (14.6%) was also noted. In patients with moderately severe ronhopathy, frequent wakefulness during sleep was detected, which averaged 5.8. In these patients, the apnea / hypopnea index was 0.7. It should be noted that in patients with mild ronhopathy this index did not differ from the data of the control group. This fact indicates
that patients of the 2 groups are most prone to the development of obstructive sleep apnea. Although patients in both groups have snoring and episodes of apnea / hypopnea, oxygen saturation rates remained within the normal range.
Thus, we can conclude that polysomnography is a valuable diagnostic method for patients with ronhopathy, which makes it possible to objectify sleep disorders and conduct timely treatment of ENT diseases for the prevention of obstructive sleep apnea.
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