What Is Paroxysmal Nocturnal Dyspnea?
Firstly, yes, this is a tongue-twister, I had to have a few goes before I pronounced it properly, not to mention that it sounds like a scary zombie disease! So, what does it actually mean? To break it down quite simply- Paroxymal is means a sudden outburst or attack; nocturnal means night and dyspnea is shortness of breath. Together, Paroxysmal Nocturnal Dyspnea (PND) is the sense of oxygen deficiency during sleep, the oxygen deprivation causes a person to cough and wheeze, which significantly increases diastolic pressure.
So it isn’t a zombie disease, but most would say it is scary. PND is a common symptom of congestive heart failure. A person suffering from a PND will need urgent medical attention- calling an ambulance is the first immediate step, however other treatments to appease the episode could include taking nitroglycerin and diuretics.
PND has very similar symptoms to obstructive sleep apnea syndrome (OSA), however is not an independent separate disease. PND is very different, it is a severe clinical syndrome directly related to acute heart failure.
People suffering from obstructive sleep apnea syndrome have a significant decrease in the muscle tone of their respiratory tract during sleep, which leads to obstruction of airways. This causes episodes of apnea where breathing completely stops.
During such pauses, the oxygen content of the blood drops, and signals are received in the respiratory center that the tissues are in a state of hypoxia. After 10-20 seconds, the oxygen level in the blood drops to the minimum, and this finally causes the body to react to the situation. A microstimulation of the brain increases the muscle tone of the upper respiratory tract that helps to inhale. For several seconds after that, the breathing of the sleeper remains frequent and deep. At this time, the person also experiences shortness of breath, although they may not wake up.
Paroxysmal Nocturnal Dyspnea Causes?
Paroxysmal nocturnal dyspnea is common among elderly people with heart problems, however it can still happen to anyone who suffers from:
- left ventricular failure in a period of exacerbation;
- acute myocardial infarction;
- acute myocarditis;
- aneurysms of the heart;
- postpartum cardiomyopathy;
- mitral stenosis;
- aortic insufficiency;
- the presence of a large intracardiac thrombus or tumor.
The exacerbation factors that can cause the PND episode in a person with the medical issues listed above are:
- kidney damage;
- disorders of cerebral circulation;
- emotional overwork;
- big dinner for the night;
- Rapid changing from vertical to horizontal body position.
What are the Symptoms of Paroxysmal Nocturnal Dyspnea?
The most common symptoms of PND are the following:
- intermittent sleep;
- dyspnea with physical exercises;
- dyspnea at night in a lying position, but relieving in a sitting position;
- a cough with wheezing;
- production of sputum, sometimes with blood;
- whistling in the lungs;
- a constant sense of lack of air;
- pain in the chest;
- feet swelling;
- fatigue and drowsiness.
Typically an episode occurs as follows: a person wakes up from a nightmarish dream, feeling tight in the chest and a desire to sit down, their breathing is deep and hard. Narrowing of the bronchioles creates shortness of breath, which makes it hard for the person to speak. When sitting, the person usually leans forward slightly. Their skin becomes pale because of the spasm of surface vessels, and sometimes they break into a sweat. PND can start suddenly and can stop just as suddenly in half an hour. The person may still suffer from dyspnea in the morning when they wake.
Why does Paroxysmal Nocturnal Dyspnea cause these Symptoms?
During sleep in a person with heart problems, body fluid begins to redistribute from tissues into the blood, which during the day accumulated in the legs or abdominal cavity. This process does not happen rapidly so after falling asleep there would be no immediate symptoms. Paroxysmal dyspnea develops slowly after a considerable time after falling asleep.
In people with heart failure, the left side of the heart does not work at full strength, so the small circle of blood circulation cannot cope with the additional volume of fluid. This volume stays in the excess vessels of the lungs. This additional volume then moves from the vessels into the lung tissue, which leads to the development of interstitial pulmonary edema.
The severest form of paroxysmal dyspnea is acute pulmonary edema, which develops as a result of increased pressure in the pulmonary capillaries and leads to alveolar edema. The typical symptoms of pulmonary edema are the acute shortage of air, wet wheezing, and bloody sputum. Acute pulmonary edema can quickly lead to death.
How to Treat Paroxysmal Nocturnal Dyspnea?
Before treatment, it is crucial to perform a thorough medical assessment to determine the cause of the paroxysmal nocturnal dyspnea. An appropriate examination, exploration of medical history, chest X-ray, ECG, ultrasound of the heart and Doppler of the heart is crucial for an accurate diagnosis.
During the acute paroxysmal nocturnal dyspnea episode, it is vital to call an ambulance due to the high risk of developing pulmonary edema. First aid for the person includes remaining calm, placing them in a semi-sitting position, and putting their feet in a hot bath. Give the person nitroglycerin under the tongue and repeat the drug every 5-10 minutes. If the attack is accompanied by pain and dyspnea, analgesics could also be used. Further therapy can be carried out according to the cause of the disease.
The general recommendation for preventing paroxysmal nocturnal dyspnea are stopping smoking, weight reduction in obese persons and normalizing blood pressure levels. A strict diet high in fresh fruits and vegetables and avoiding heavily salted food is also recommended. Oxygen therapy is an effective means of controlling the disease, for use not only in the hospital but also at home.
Prevention of the disease consists in the timely treatment of chronic coronary artery disease and heart failure, arterial hypertension, observance of the water-salt regime, prevention of infectious diseases.
A thorough medical assessment must to be undertaken to ensure the correct syndrome is diagnosed, so if you think you have obstructive sleep apnea symptoms, it could be PND, so get it properly checked out by a doctor.