Focus on sleep health and quality

  About 1/3 of a person’s life is spent in sleep, and Shakespeare once compared sleep to the “tonic” at the banquet of life. Adequate sleep, balanced diet and proper exercise are the three internationally recognized health standards. As a necessary process of life, sleep is an important part of the body’s recovery, integration and memory consolidation, and is an indispensable component of health. However, there is a general lack of awareness of the importance of sleep. According to the World Health Organization survey, 27% of people have different degrees of sleep problems, and the incidence of insomnia among Chinese adults is 38.2%, which is higher than that of developed countries. Sleep disorders have become a prominent problem that threatens public health around the world.  In 2001, the International Foundation for Mental Health and Neuroscience launched a global sleep and health program to raise awareness of the importance of sleep and designated March 21 as “World Sleep Day”. “World Sleep Day was officially introduced to China in 2003. “The purpose of World Sleep Day is to draw attention to the importance and quality of sleep and to remind us to pay attention to sleep health and quality. The theme of this year’s World Sleep Day is “Get an extra hour of sleep”.  There are three main criteria for good sleep quality: 1. Sleep takes no more than half an hour; 2.  A sleep disorder occurs when a person’s sleep does not meet more than 1 of these 3 criteria on a consistent basis (more than 3 days per week, more than 2 weeks per month). Sleep disorders are abnormalities in the quantity of sleep and abnormalities in the quality of sleep or the occurrence of certain clinical symptoms during sleep. Classification of sleep disorders: A, endogenous sleep disorders (episodic sleeping sickness, post-traumatic narcolepsy, obstructive sleep apnea syndrome, central sleep apnea syndrome, restless legs syndrome, etc.); B, exogenous sleep disorders; C, daily rhythm sleep disorders. Among them, obstructive sleep apnea syndrome is one of the most common diseases. According to the authoritative survey data, the prevalence of obstructive sleep apnea syndrome (OSAHS) with snoring as the main symptom is 2-4% in China, and the prevalence of people over 65 years old is as high as 20% to 40%.  Snoring is a common phenomenon for many people, and people used to think that snoring is a sign of “good sleep”. However, with the development of medicine, in the past decade or so, it has been gradually recognized as a possible disease – sleep apnea hypoventilation syndrome (SAHS). Thus, it is recognized that snoring is not only a potentially dangerous symptom, but also the most common symptom of SAHS.  Snoring is the sound made by the airflow produced by a person’s breathing during sleep, vibrating the soft tissues around the pharyngeal cavity. When the upper airway collapses completely and airflow is blocked from passing, the patient suffocates or suffocates during sleep, a condition called obstructive sleep apnea syndrome (OSAHS), also known as snoring. The louder the snoring during sleep, the more powerful the obstruction of airflow during sleep, and the more harmful it is. Some people may “die of sleep” due to prolonged oxygen deprivation and asphyxiation, and about 3,000 people die suddenly due to snoring every day around the world.  OSAHS is defined as 30 or more recurrent episodes of apnea or sleep apnea hypoventilation index (AHI) ≥5 times/hour during 7 hours of sleep per night with clinical symptoms such as drowsiness. AHI is the number of apnea plus hypoventilation per hour of sleep time.  OSAHS is characterized by alternating loud snoring, brief shortness of breath and apnea lasting more than 10 seconds during sleep. The apnea can cause the patient to feel suffocated and sometimes wake up suddenly, and he can fall back to sleep after breathing resumes. EEG reveals that the patient’s sleep continuity is interrupted at night, with no deep sleep but only light sleep throughout the night, and the quality of sleep is thus severely affected.  Repeated episodes of apnea and hypoventilation can lead to recurrent hypoxemia or hypercapnia, and the health hazards are manifested as follows: 1. In severe cases, the brain dysfunction can cause morning dizziness, headache, daytime drowsiness, sleepiness, lack of concentration, memory loss, or induce personality changes, loss of libido, and other manifestations, and even cause accidents.  2, long-term repeated hypoxemia or hypercarbia, will damage a variety of organs and organs, and the gradual development will lead to complications of the cardiovascular system, respiratory system, nervous system, endocrine system, urinary system, etc.. Damage to the heart, lungs and cerebrovascular will lead to nocturnal arrhythmias, angina attacks, and frequent panic, chest tightness and discomfort in the precordial area after waking up from suffocation. It has been found that nocturnal sleep apnea is an independent risk factor for the development of hypertension, coronary heart disease, myocardial infarction, and stroke. Since obstructive breathing disorders can cause increased negative chest pressure, it leads to esophageal reflux and perpetuates gastrointestinal disorders. Hypoxia can also cause renal tubular reabsorption dysfunction and increased nocturnal urination.  Snoring is only for adults? Actually, it is not, children can also. The prevalence of snoring in children is as high as 2%, and the age of prevalence is 2-5 years old, and it is very easy to be misdiagnosed and missed. These “fatty” children may have active lymphatic system, tonsil and adenoid hypertrophy, resulting in upper airway blockage, intellectual developmental disorders, hearing loss, facial changes, etc.  OSAHS is caused by many factors, the following people should be especially careful: 1, upper respiratory tract obstruction is the main cause of OSAHS, including tonsil hypertrophy, adenoid hypertrophy, small jaw deformity, sinusitis, nasal polyps, nasal septum deviation, tongue hypertrophy, tongue root lymphoid tissue hyperplasia, etc. 2, obese people, so that the pharyngeal cavity tissue increased, making the pharynx easy to obstruct. 3, usually more common in men than women. The incidence increases in women after menopause and is close to the male level.4. The risk of morbidity increases with age.5. The risk of morbidity is correspondingly greater in those with family history.6. Long-term heavy smokers, smoking can stimulate pharyngeal inflammation and cause edematous narrowing of the pharynx.7. Long-term heavy drinkers and sedative-hypnotic drug users, alcohol can make the muscles relax and the tongue root fall back, thus aggravating the obstruction.8. Certain Patients with systemic diseases, including hypothyroidism, acromegaly, hypopituitarism, amyloidosis, vocal cord paralysis, post-polio or other neuromuscular disorders (such as Parkinson’s disease), long-term gastroesophageal reflux, etc.; chronic bronchitis with carbon dioxide retention, emphysema and other respiratory diseases are also a high-risk group.  Sleep breathing monitoring with polysomnography (PSG) is the best monitoring method to diagnose sleep breathing disorder. Through monitoring, we can not only understand the severity of sleep breathing disorder and hypoxemia, but also the cause and type of sleep breathing disorder.  Now there is an independent sleep monitoring room with one bed in the ward of respiratory medicine of our hospital, equipped with monitoring equipment such as polysomnography and portable sleep monitor, which can carry out sleep monitoring work for inpatients and outpatients in all departments of the hospital every night. The sleep monitoring room has senior doctors and nurses with rich clinical experience. The advanced sleep and respiratory monitoring equipment will provide patients with scientific and accurate diagnosis, and will select the most suitable individualized treatment plan for patients, so that they can enjoy quality medical services naturally.  OSAHS should be treated for the cause of the disease. Treatment should be based on a combination of the patient’s severity, the location of the lesion, and the doctor’s experience. Only when the right treatment method is chosen, the treatment effect can reach the most satisfactory level.  1.Etiological treatment: Correct the underlying disease that causes or aggravates OSAHS, such as applying thyroxine to treat hypothyroidism.  2.General treatment: Provide guidance to each patient with OSAHS in various aspects, including: ① losing weight, controlling diet and weight, and exercising appropriately; ② stopping alcohol, smoking, sedative-hypnotic drugs and other drugs that can cause or aggravate OSAHS; ③ sleeping in lateral position; ④ elevating the head of the bed appropriately; ⑤ avoiding excessive exertion during the day.  3. Intra-airway positive pressure ventilation therapy: by providing a physiological pressure to support the upper airway and ensure the opening of the upper airway during sleep. It is by far the most effective method to improve snoring and sleep apnea. It is simple and non-invasive, and although it cannot cure the disease, it can relieve the symptoms and prevent and improve the occurrence of long term complications. Positive airway pressure ventilation has become the treatment of choice for OSAHS for many years.  4.Oral orthodontic appliances: It is an effective method, but the problem is that the use of these small appliances is very uncomfortable for the patient and difficult for the patient to tolerate.  5.Surgical treatment: In mild and moderate OSAHS patients with combined nasopharyngeal disease, some patients can be improved by surgical treatment, but the long-term effect is less satisfactory. Children snoring patients mostly have tonsillar hypertrophy or jaw deformity, and surgical treatment method is mainly used.  6.Drug treatment: Years of practice have proved that the effect of drug treatment on snoring is not satisfactory, and at present, there is no special drug for OSAHS.