Sleep apnea hypoventilation syndrome
Snoring loudly at night, drowsy during the day; blood pressure is getting higher and higher, difficult to control with medication; memory is getting worse and worse, emotions are getting worse …… These may be caused by sleep apnea syndrome (commonly known as snoring) which is ignored by people. There are more than 50 million snorers in China, however, most people do not understand the impact of sleep apnea on the quality of sleep and the harm to the body, and very few people take the initiative to go to the hospital to find a doctor because of snoring.
What is the difference between general snoring and snoring disorder?
Snoring in sleep is a common phenomenon in daily life, but not all snoring is sleep apnea. If the snoring is even and regular, with a consistent high and low sound, it is mostly caused by fatigue or drinking, and generally does not cause any harm to human body.
If the snoring is loud and irregular, intermittent, and the sound is high and low, it marks the aggravation of airway narrowing and the occurrence of airway obstruction, which will cause apnea.
The main clinical manifestations of sleep apnea syndrome include snoring during sleep, open-mouth breathing, frequent breathing stops; repeatedly waking up during sleep, headache after waking up, elevated blood pressure; angina pectoris at night, heart rhythm disorder; sleep without relief, daytime sleepiness, drowsiness; memory loss, slow reaction, reduced work ability, etc. Many snorers doze off while watching TV, riding in a car or even driving. You should seek medical attention promptly if you have any of the above manifestations.
If you have the above phenomena, you should go to the respiratory department or sleep center of the hospital and do sleep-related examination to understand the number and nature of apnea, the number of awakenings at night, and the number and degree of intermittent oxygen saturation drop.
How is sleep apnea defined? If apnea occurs more than 30 times a night, or more than 5 times an hour on average, and the patient repeatedly wakes up from sleep, it is medically known as sleep apnea syndrome.
What are the dangers of sleep apnea?
Fragmented sleep: Under normal circumstances, people have four or five sleep cycles each night that include deep sleep, light sleep, and rapid eye movement sleep. The deeper sleep is concentrated in the early stages of sleep, while the REM period occurs when you are about to wake up. Such a sleep pattern helps the body control hormone production, metabolism, and regulate stress. Although brief pauses in breathing do not usually cause a person to wake up, they can cause a person to repeatedly enter the process of falling asleep → pauses in breathing → breathing resumes → falling asleep. This process interferes with the person’s normal sleep pattern and prevents the person from getting effective sleep. Therefore, daytime drowsiness is the most common symptom of snorers. In mild cases, it is manifested as sleepiness and dozing during daytime work or study, and in serious cases, people fall asleep when eating or chatting with others, and even serious consequences may occur, such as traffic accidents caused by dozing off while driving.
Inducing cardiovascular diseases: Normal people breathe evenly during sleep, and oxygen intake meets the needs of all parts of the body. In contrast, snorers have 300-400 seconds of anaerobic inhalation during 7 hours of sleep every night, and the blood oxygen concentration is about 8-10% below the normal value. In this way, night after night, year after year, the fragmented sleep makes the oxygen intake significantly reduced and induces various serious diseases.
Snoring during sleep and repeated pauses in breathing cause severe hypoxia in the brain and blood, increasing blood viscosity and forming hypoxemia, plus the heart needs to pump more blood to compensate for the lack of oxygen, so the heart rate during sleep at night is instead faster. This makes the blood pressure increase and heart rate accelerate, thus inducing hypertension, coronary heart disease, arrhythmia, myocardial infarction, angina pectoris, and even more can lead to the serious consequences of sudden death at night. Statistics show that the number of people who die of various coronary heart disease in China every year exceeds 1 million, of which, sudden death in sleep up to 30%, the culprit is sleep apnea.
Causes hypertension: epidemiological surveys show that the prevalence of hypertension in patients with sleep apnea can reach more than 50%. It can be said that sleep apnea is a risk factor for hypertension independent of obesity, age and other factors, and is an important cause of secondary hypertension.
Affects mood: The lack of sleep brought on by apnea can also lead to depression, anxiety and other bad moods. It can also cause headaches and trigger a decrease in concentration, thinking ability and memory.
What are the methods of snoring treatment?
Most of the general snoring can be controlled by weight reduction and side sleeping, but if it is diagnosed as snoring by a doctor, the treatment should be selected individually according to different causes (such as tonsil hypertrophy, low hanging hypertrophy of soft palate, deviated nasal septum, nasal polyps, etc.) and different degrees. For example, wearing a positive pressure respirator and braces, or undergoing surgical treatment. At this sleep conference, experts also introduced the Pillar anti-snoring stent therapy developed by Medtronic, which is based on the principle of implanting tiny stents made of biomedical materials into the soft palate through minimally invasive surgery to increase the tension of the soft palate so that it is less likely to collapse loosely, thus correcting sleep apnea.
In terms of prevention, experts recommend doing the following –
1, avoid smoking and alcohol, because smoking can cause aggravation of respiratory symptoms, and drinking alcohol can aggravate snoring, nocturnal breathing disorder and hypoxemia, especially drinking alcohol before bedtime.
2, weight control, obesity and sleep apnea are closely linked. Randomized controlled trials have shown that a 10 kg reduction in body weight can reduce the apnea hypoventilation index by about 5 events/hour, and 63% of patients with mild disease can have their symptoms relieved, while only 13% of patients with severe obstructive sleep apnea are relieved.
Although bariatric surgery can be highly effective in reducing weight, it does not necessarily eliminate apnea in the long term. Studies have shown that obstructive sleep apnea symptoms can persist or recur after surgical or non-surgical weight loss.
3, avoid sedative, sleeping drugs before bedtime, so as not to aggravate the inhibition of the central regulation of respiration.
4.Take side sleeping position to avoid the tongue, soft palate and uvula from falling back loosely during sleep and aggravating the upper airway blockage.
Treatment.
(1) General treatment: weight loss, more exercise, lateral sleeping position, quit smoking and alcohol, caution in taking sedative sleeping drugs, etc.
(2) Oral appliance treatment: wear relevant apparatus in the mouth to open the airway. The disadvantage is that it is often not tolerated by the patient, and the scope of application is narrow.
(3) Non-invasive ventilation therapy: A nasal mask ventilator is worn during sleep to deliver air at a certain pressure, thus eliminating snoring and apnea. The advantage is that it is non-invasive and highly effective, and should be preferred especially for seriously ill patients. The disadvantage is that it is expensive and needs to be worn for a long time.
(4) Surgical sequential treatment: including nasal reconstruction, uvula-palatopharyngoplasty, hyoid suspension, chin-lingual muscle advancement and so on. The disadvantage is that the surgery is very traumatic and difficult for patients to accept.
(5) Radiofrequency ablation minimally invasive treatment: It is the latest minimally invasive technology that has been widely recognized by the international medical community in recent years as an effective treatment for snoring.
Treatment progress
1.Continuous positive airway pressure ventilation treatment
Continuous positive airway pressure ventilation via the nose is the preferred treatment option for adults with obstructive sleep apnea, and was first reported in 1981 as an effective means to prevent collapse of the pharyngeal airway. The mechanism of continuous positive airway pressure ventilation remains controversial and may involve the maintenance of positive pharyngeal transmural pressure, thereby allowing intraluminal pressure to exceed the surrounding pressure.
Patients with severe snoring, severe sleep apnea, and excessive daytime sleepiness are more likely to adhere to long-term therapy. Short-term treatment and observable early benefit are the best predictors of long-term outcomes, so it is best to take steps to optimize adherence before or soon after treatment initiation.
The evidence supporting the use of new technologies to improve patient adherence is not strong, but the clinical benefits do occasionally appear.
2. Oral appliances and surgery
Alternative treatments for those with failed positive airway pressure ventilation include: oral appliances, upper airway surgery, positioning therapy, and other conservative measures. Different oral appliances work in different ways, but the general mechanism is to apply pressure to the jaw to prevent tongue collapse. For some patients, especially those with mild to moderate obstructive sleep apnea, oral appliances are the best option for their continuous positive airway pressure ventilation.
However, the efficacy of the oral appliance is uncertain, and there are few data on the outcome of continuous positive airway pressure ventilation. Also the use of the device requires multiple visits to the dentist, gradual adjustments, and, after 6-9 months, the results can be judged. Although the cost of the device and repeated visits may be expensive, the method may still be economically beneficial if it is successful in treating obstructive sleep apnea.
Some simple soft palate procedures (sleep correction, laser-assisted uvulopalatopharyngoplasty, etc.) may also be used as alternative treatments, but are less useful in improving symptoms.
More complex surgical treatments such as maxillary mandibular advancement-may be more effective than simple surgery, but many patients with obstructive sleep apnea would prefer to avoid major surgery.
Tracheotomy can eliminate obstructive sleep apnea, but it greatly reduces quality of life. There are few studies to predict which patients will benefit from specific procedures. Although some relevant studies are underway, definitive data are still not available. Therefore, further research is needed to determine the best treatment options for obstructive sleep apnea.
3. Conservative treatment
Patients may benefit from conservative treatment. For example, sedatives, including substances such as alcohol that may aggravate symptoms, should be avoided; sleeping 7-8 hours at night may reduce drowsiness; avoiding supine positions may also help improve apnea caused by sleeping positions.
Because it is difficult to monitor sleep position therapy performed at home, its clinical outcomes are inconsistent. Sleep posture therapy can also be used as an adjunct in combination with other methods if patients do not respond well to oral appliances or surgical treatment.
Diet and exercise for weight loss can also be helpful in relieving symptoms. Few patients are able to achieve long-term sustained weight loss, so patient education and support may be helpful.
Central apnea, also known as complex apnea, occurs in about 10% of patients who are treated with continuous positive airway pressure ventilation as initial therapy. The mechanism is unclear. Most studies suggest that these patients with central apnea may resolve on their own with continuous positive airway pressure ventilation.