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Yo ronco, vos roncas… ¿todos roncamos?

111

El sueño es esencial para la biología humana, siendo imprescindible para múltiples funciones, como las del sistema inmunológico, endocrinológico y cardio-metabólico. Además, mejora las funciones cognitivas y permite ajustes en la conducta adaptativa y en el bienestar emocional.

Uno de los disturbios del sueño son los ronquidos, que alteran el descanso no sólo del roncador sino también del acompañante de cama.

¿Cuándo hay ronquidos?

Los ronquidos ocurren por la relajación de la musculatura de la vía aérea que determina una limitación a la entrada de aire, un flujo turbulento y vibración de los tejidos generando el ruido. Se produce exclusivamente durante el sueño, en la mayoría de los casos durante la inspiración, es decir cuando entra el aire.

En algunos casos el ronquido se presenta de forma aislada, denominándose roncopatía simple, mientras que en otros se acompaña de pausas respiratorias conocidas como hipopneas-apneas, bajada de oxígeno en sangre y/o despertares-microdespertares frecuentes. Estas pausas ocurren cuando el colapso de la vía aérea es mayor, incluso total y representan un cuadro de apneas obstructivas del sueño.

La roncopatía simple es el comienzo del espectro de disturbios respiratorios del sueño que finaliza con el cuadro de apneas obstructivas del sueño. Este espectro se correlaciona con el aumento gradual de la obstrucción de la vía aérea.

Siendo el ronquido un síntoma cardinal del cuadro de Apneas Obstructivas del sueño, lo que tenemos que hacer es valorar la presencia de otros síntomas para determinar si el ronquido es un fenómeno aislado o en realidad tenemos que tratar otra patología. 

Para ello es importante saber que, los síntomas que acompañan a las apneas son pausas respiratorias y ahogos durante el sueño, levantarse al baño varias veces por la noche, presentar dolor de cabeza al despertar, somnolencia durante el día, menor rendimiento laboral/escolar e irritabilidad. 

La principal causa del ronquido es la patología nasal, otros factores que intervienen son el sobrepeso/obesidad, uso de fármacos hipnóticos o miorrelajantes, consumo de alcohol, dormir en posición supina, el sexo masculino, la postmenopausia y la hipertrofia de amígdalas. Este último principalmente en niños.

Las consecuencias del espectro de disturbios respiratorios de sueño aumentan a medida que la limitación a la entrada de aire se hace cada vez más importante. Las principales consecuencias son aumento del riesgo cardiovascular con mayor probabilidad de presentar hipertensión arterial, enfermedades cardíacas, diabetes, aumento de peso, disturbios cognitivos y alteraciones del humor.

Un dato interesante es que el 40% aproximadamente de la población ronca durante el sueño y la mitad de este grupo además presenta pausas respiratorias durante el sueño. 

Se sugiere la consulta para el correcto diagnóstico de los ronquidos y así prevenir el desarrollo de apneas obstructivas o iniciar el tratamiento lo más rápido posible. 

Se aconseja, en caso de ser factible, que en el interrogatorio participe la pareja o los padres dado que brindarán información clave ya que el roncador no es consciente de la sintomatología y muchas veces lo minimiza.

Dentro de las opciones terapéuticas se encuentran corticoides tópicos o antihistamínicos orales en caso de rinitis alérgica, bajar de peso, evitar uso de hipnóticos/miorrelajantes y consumo de alcohol, uso de dilatadores nasales, cirugía nasal y/o de faringe, uso de dispositivos de avance mandibular que se colocan en la boca y traccionan la mandíbula hacia adelante aumentando el espacio en la vía aérea y terapia miofuncional con ejercicios fonatorios y de la musculatura facial. 

Como son varias las opciones terapéuticas, es importante realizar un exhaustivo examen otorrinolaringológico para identificar la causa y de esa forma seleccionar el mejor tratamiento. Es decir, el tratamiento debe ser un traje a medida para cada paciente.

 

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