Patients or family members often ask if snoring (commonly known as snoring) is a disease. Some people say it is not a disease, and even say that snoring is a good symbol of a sound sleep; others counter that snoring is a disease, and emphasize that people who snore a lot must seek medical attention quickly to avoid accidents in their sleep. There are different opinions on who is right, and let me give you a statement as follows. Through the two cases of snoring-induced hypertension and atherosclerotic massive cerebral hemorrhage that we rescued with great difficulty at the beginning of this year and rejected our prior prevention advice, and another case of snoring-induced hypertension and atherosclerotic massive myocardial infarction at 6:00 a.m. yesterday (July 9), it is necessary to give a warning to people with severe snoring (especially with frequent apnea) that they must not It is necessary to remind people with severe snoring (especially with frequent apnea) not to be paralyzed and take snoring seriously, but to seek medical attention and strengthen preventive measures to ensure safety.
I. Mechanism of snoring and its harm
As we all know, the muscles of the pharynx (such as the soft palate, tongue and uvula) can still maintain a certain degree of tension and smoothness after a normal person falls asleep, and the air can freely and unhinderedly pass through the pharynx and enter and leave the lungs without or only with a very slight sound. Snorers, however, are different. The muscles of the pharynx become relaxed during sleep (the more mature the sleep, the more relaxed they become), prompting the ventilation opening of the upper airway to be narrower than normal, and the inhaled airflow passing through the narrow upper airway pharynx causes a snoring sound due to the vibration of the soft tissues of the pharynx. This can also explain the reason why a normal person who is overly tired and a person who takes sleeping pills can have different degrees of snoring after a deep sleep.
If the upper respiratory tract is blocked to different degrees or even completely due to serious snoring, the gas cannot pass through the pharynx and enter and exit the lungs adequately and normally, which will cause obstructive apnea and lead to the lack of oxygen and carbon dioxide retention in the body. It will not only cause and aggravate hypertension, pulmonary heart disease, coronary heart disease, myocardial infarction, diabetes, ischemic or hemorrhagic stroke, brain atrophy, dementia and other diseases after accumulation. Severe cases can also cause sudden cardiogenic or cerebral death such as the three cases we mentioned above. Therefore, long-term snoring with obstructive apnea should be regarded as a disease and should never be ignored and paralyzed.
The clinical symptoms and signs of snoring and obstructive sleep apnea are non-specific, so the diagnosis cannot be made only on the basis of the following symptoms and signs, but the more you have the following symptoms, the more likely you are to have the disease.
Daytime clinical symptoms
(1) Fatigue and drowsiness: the most common symptoms. The lighter the symptoms, the more sleepy, easily tired and inattentive; the more serious, the more sleepy you can be during meals, conversations and even while watching TV. Driving or work may also fall asleep and lead to work-related injuries or traffic accidents.
(2) Wake up often feel a thousand throat bitter mouth bad breath: is also a common symptom. Due to snoring during sleep, the pharynx becomes more congested and edematous, bacteria multiply, and the tongue root becomes yellow and thick;
(3) Dizziness and headache: There are often different degrees of dizziness and lightheadedness after waking up. The headache is the most common and can last from a few minutes to two hours, sometimes requiring painkillers to relieve;
(4) Personality changes: mood is often impatient, irritable and anxious, emotional depression and depression. (4) Personality changes: irritability, anxiety, depression and depression. Older people are often prone to dementia;
(5) Sexual dysfunction: symptoms such as loss of libido, sexual apathy, impotence and premature ejaculation may occur.
(6) Puffiness: the face is often puffy and the bulbous conjunctiva is congested and edematous in the morning, the hands and feet are swollen and numb, and even the whole body is sore.
2. Clinical symptoms at night
(1) Snoring during sleep: It is the main unique symptom, the snoring sound is sometimes high and sometimes low, sometimes big and sometimes small, irregular. The alternating phenomenon of snoring – breath-holding = gasping – snoring often occurs, and the average airflow interruption time is about 10-30 seconds; in severe cases, it can be more than 200 seconds, at which time the patient can show obvious symptoms of hypoxia such as cyanosis and open-mouth breathing;
(2) Repeated breath-holding, waking up and frequent turning over during sleep: often the patient is pushed awake because the co-sleeper or co-sleeper is worried that the patient cannot recover breathing, and the solo sleeper is often woken up by breath-holding or by loud self-snoring. After waking up, the snoring stops and can be repeated after going to sleep. After waking up, you often feel panic, chest tightness and discomfort in the precordial area;
(3) Excessive sweating and polyuria: There is an obvious increase in sweating in the head, neck and upper chest. The volume and frequency of urination increases at night (should be distinguished from the frequency and urgency of urination in prostate enlargement);
(4) Insomnia and dreaminess: Some patients show difficulty in falling asleep, easy to wake up and wake up early, dreamy after sleep, and no relief after sleep, etc.
The diagnosis of snoring and obstructive sleep apnea should be made based on medical history, combined with physical examination and multi-channel sleep monitor examination results.
1.Monitoring by multi-channel sleep monitor: It is the gold standard for diagnosing snoring and obstructive apnea. Through the examination, not only can you be diagnosed whether you have snoring and obstructive apnea, but also can understand its condition and degree. We have now carried out a more convenient and accurate home-based remote detection technique, which reduces the need for patients to sleep through the night in the hospital:
2, blood oxygen monitoring: you can continuously monitor the situation and changes in your blood oxygen saturation and its degree of harm. It is more accurate for patients who are seriously ill:
3, ECG and EEG monitoring: can detect whether the heart and brain are hypoxic and the degree of hypoxia at that time, which is more important for the prevention and treatment of sudden cardiac death:
4, diagnostic criteria: sleep apnea more than 5 times / hour, and each time more than 10 seconds to confirm the diagnosis. Those with 5~15 times/hour are mild, those with 15~30 times/hour are moderate, and those with more than 30 times/hour are severe.
Prevention and treatment of snoring and obstructive sleep apnea
1.Lifestyle change.
Weight loss, low pillow, avoid drinking alcohol, lying alone and taking sedative sleeping pills, quit smoking, and keep side sleeping position.
2.Non-surgical treatment
(1) Oral orthodontic appliances or dental pads, a variety of devices are available for patients with simple snoring and mild obstructive sleep apnea. The former can cause discomfort such as mild pain in the temporomandibular joint in the morning.
(2) Transnasal or oronasal continuous positive airway pressure ventilator treatment: It is the most effective, safe and reliable treatment method for patients with mild to moderate severe snoring and sleep apnea, and has been widely used and received good results in Europe and the United States and other countries. Since the pressure required to keep the upper airway open is different for each patient, the doctor needs to determine the specific pressure required according to the specific condition and examination of each patient.
3.Surgical treatment
(1) Nasal surgery: patients with enlarged turbinates, deviated septum and nasal polyps should have their nasal obstruction surgically removed.
(2) Laser-assisted uvulopalatopharyngoplasty and radiofrequency ablation: usually only suitable for the treatment of patients with simple snoring.
(3) Tonsil and adenoidectomy: suitable for patients with sleep snoring and obstructive apnea in children caused by enlarged tonsils and adenoids, which can often be cured after surgery.