First of all, yes, this is a tongue twister, I had to try a few times before pronouncing it correctly, not to mention it sounds like a scary zombie disease! So what does it really mean? To break it down quite simply: Paroxymal means a sudden outburst or attack; nocturnal means night and dyspnea is shortness of breath. Collectively, paroxysmal nocturnal dyspnea (PND) is the sensation of oxygen deficiency during sleep, a lack of oxygen causes a person to cough and wheeze, which significantly increases diastolic pressure.
So it’s not a zombie disease, but most would say it’s scary. PND is a common symptom of congestive heart failure. A person suffering from PND will need urgent medical attention; Calling an ambulance is the immediate first step, however, other treatments to quell the episode might include taking nitroglycerin and diuretics.
PND has symptoms very similar to obstructive sleep apnea syndrome (OSA), however, it is not a separate independent disease. PND is very different, it is a severe clinical syndrome directly related to acute heart failure.
People with obstructive sleep apnea syndrome have a significant decrease in the muscle tone of their airways during sleep, leading to airway obstruction. This causes episodes of apnea in which breathing stops completely.
During such pauses, the oxygen content of the blood falls 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 a 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 sleeper’s breathing remains frequent and deep. At this time, the person also experiences shortness of breath, although they may not wake up.
Causes of paroxysmal nocturnal dyspnea?
Paroxysmal nocturnal dyspnea is common among older people with heart problems, however, it can still happen to anyone who suffers from:
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left ventricular failure in a period of exacerbation;
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acute myocardial infarction;
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acute myocarditis;
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heart aneurysms;
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postpartum cardiomyopathy;
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cardiosclerosis;
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mitral stenosis;
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aortic regurgitation;
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the presence of a large intracardiac thrombus or tumor.
The exacerbating factors that can cause the PND episode in a person with the medical problems listed above are:
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pneumonia;
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Kidney damage;
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cerebral circulation disorders;
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emotional overwork;
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great dinner in the evening;
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hypervolemia;
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Quick change from vertical to horizontal body position.
What are the symptoms of paroxysmal nocturnal dyspnea?
The most common symptoms of PND are as follows:
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intermittent sleep;
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dyspnea with physical exercises;
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nocturnal dyspnea in lying position, but relieving in sitting position;
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wheezing cough;
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sputum production, sometimes bloody;
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whistling in the lungs;
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a constant feeling of shortness of breath;
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Chest pain;
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arrhythmia;
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swelling of the feet;
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fatigue and drowsiness.
Usually an episode occurs as follows: a person wakes up from a nightmare dream, feels chest tightness and the desire to sit up, his breathing is deep and difficult. The narrowing of the bronchioles creates shortness of breath, making it difficult for the person to speak. When seated, the person tends to lean forward slightly. Their skin turns pale due to spasm of the superficial vessels, and sometimes they begin to sweat. PND can start suddenly and stop just as quickly in half an hour. The person may still suffer from breathlessness in the morning when they wake up.
Why does paroxysmal nocturnal dyspnea cause these symptoms?
During sleep, in a person with heart problems, body fluid begins to redistribute from the tissues to the blood, which during the day accumulates in the legs or in the abdominal cavity. This process does not happen quickly, 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 force, so the small circle of blood circulation cannot cope with the extra volume of fluid. This volume remains in the excess vessels of the lungs. This additional volume then moves from the vessels into the lung tissue, leading to the development of interstitial lung edema.
The most serious 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. Typical symptoms of pulmonary edema are acute shortness of breath, wet wheezing, and bloody sputum. Acute pulmonary edema can quickly lead to death.
How to treat paroxysmal nocturnal dyspnea?
Before treatment, a thorough medical evaluation is essential to determine the cause of paroxysmal nocturnal dyspnea. A proper examination, examination of the medical history, chest X-ray, ECG, ultrasound of the heart and Doppler of the heart are crucial for an accurate diagnosis.
During the episode of acute paroxysmal nocturnal dyspnea, it is vital to call an ambulance due to the high risk of developing pulmonary edema. First aid for the person includes staying 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 medicine every 5 to 10 minutes. If the attack is accompanied by pain and dyspnea, pain relievers could also be used. Additional therapy may be performed depending on the cause of the disease.
The general recommendation to prevent paroxysmal nocturnal dyspnea is to stop smoking, lose weight in obese people, and normalize blood pressure levels. A strict diet rich in fresh fruits and vegetables and avoiding very salty foods is also recommended. Oxygen therapy is an effective means of managing disease, for use not only in the hospital but also at home.
Prevention of the disease consists in the timely treatment of chronic coronary disease and heart failure, high blood pressure, adherence to the water-salt regime, the prevention of infectious diseases.
A thorough medical evaluation should be done to ensure the correct syndrome is diagnosed, so if you think you have symptoms of obstructive sleep apnea, it could be PND, so you should properly consult with a doctor.