1.The initial symptoms of snoring sleep apnea syndrome
Loud and irregular snoring, irregular breathing stop at night for a short time (within 10 seconds), snoring when lying on the back and relieved when lying on the side, weakness in the morning and easy fatigue during the day
2. Further performance of snoring sleep apnea syndrome
Sleeping without relief, holding breath for more than 10 seconds each time, snoring when lying on the back or side, morning headache, dry mouth, memory and attention loss, emotional impatience and irritability, abnormal profuse sweating, waking up at night, low sexual function, chronic pharyngitis, frequent urination at night, long-term use of antihypertensive drugs, secondary red blood cell hyperplasia leading to increased blood viscosity and high blood lipids
3. Long-term complications of snoring sleep apnea syndrome
Sleep hypertension – increased blood pressure after sleep, normal blood pressure before sleep, and poor efficacy of medication, heart rate disorders during sleep, heart failure, dilated cardiomyopathy, type II diabetes, stroke, depression, obesity and ineffective weight loss
Second, the etiology and pathology of snoring
Organic lesions
1.Pituitary tumor, nasal polyp;
2.Muscle relaxation at the bottom of the mouth or excessive collapse of pharyngeal and laryngeal muscles due to central nervous system disorders
3, mandibular deformity (small jaw), posterior tongue root
4.Extremity hypertrophy
5, Occipital foramen magnum malformation compression of the respiratory center (born with a short neck and very low occipital hairline)
Non-organic lesions
1.Increased tissue pressure around the pharynx
2.Severe nasal septal malformation (deviation)
3.Tonsils and lateral cords of the pharynx are enlarged
In patients with SAHS caused by non-organic lesions, obesity is the most typical sign. In addition, smoking, drinking alcohol before bedtime or taking sedative drugs are possible triggers of SAHS.
Three, snoring symptoms
1. Central type (CSA)
It is also called septal type, that is, the respiratory airflow and septal movement are both suspended. When measuring the time, no airflow is recorded in the cheek, and no septal muscle movement is recorded, and there is no obvious snoring sound.
2. Obstructive type (OSA)
It is also called peripheral type. Due to the obstruction of upper airway, although there is continuous movement of abdominal wall muscle and diaphragm, there is no effective airflow through the nasal cavity and oral cavity. In other words, during apnea, continuous strenuous respiratory movements are recorded in the chest and abdomen, but there is no airflow.
3.Mixed type (MSA)
It starts as a brief central apnea and continues as an obstructive apnea immediately after the recovery of diaphragmatic movement.
The central type is seen in damaged respiratory centers and certain cranio-cerebral diseases. Narrowing or blockage of any part of the upper airway, in any anatomy, can lead to obstructive sleep apnea.
Specific etiologies of obstructive .
1. nasal lesions 2. oral lesions 3. pharyngeal lesions 4. systemic diseases.
IV. Diagnostic examination of snoring
1.General examination
2.Ear, nose and throat specialist examination: nose and throat
3.Fiber laryngoscopy: awake state; sleep state
4.Imaging examination: cephalometric method, CT
5.Polysomnography (PSG)
V. Snoring treatment methods
1.General treatment
Through weight loss, exercise, regular sleep time, avoiding alcohol and sleep inducing drugs, taking side sleep position.
2.Use the neck pillow: reduce the head pillow appropriately, slightly higher against the neck and concave at the back of the head. It can slow down the process of snoring becoming serious in some patients with early obstructive sleep apnea hypoventilation syndrome (OSAHS).
3. Wearing a mouthpiece.
This method can be used for patients in the early stage of OSAHS. Since the mouthpiece correction makes the tongue root move forward and the pharyngeal cavity expand, it can reduce the airway resistance and alleviate hypoxia to a certain extent, but long-term wearing may induce temporomandibular arthritis.
The above methods can only slow down the process of apnea aggravation at a certain stage, and cannot play a therapeutic role.
4.Surgical treatment (for moderate and severe patients)
For apnea caused by simple deformity, surgical symptomatic treatment can be taken within the scope of surgical indications. However, during the perioperative period (surgery and before and after), non-invasive ventilator treatment must be colored to correct the severe hypoxia in the body, so as to avoid accidents caused by insensitivity to hypoxia during surgery.
A part of SAS patients with non-congenital malformation or non-organic lesions can be treated with UPPP (uvulopalatopharyngoplasty), laser, cryogenic radiofrequency ablation therapy, etc. and may achieve certain efficacy, and their symptoms can be cured or improved within a period of time, but the surgery cannot solve the functional disorder of muscle relaxation during sleep, and its long-term effect is unsatisfactory with a high recurrence rate, and at the same time there is a risk of becoming snore-free There is a risk of apnea and also other complications such as choking and coughing when swallowing.
5. For patients with non-surgical indications, it is necessary to adopt the current international “gold standard”: transnasal non-invasive ventilator for SAHS
Treatment principle: Most patients suffering from apnea have partial or total airway obstruction due to collapsed upper airway soft tissues and small airway atrophy (some of them are also central type). The ventilator is used to increase the airflow pressure in the upper airway and oropharynx for the purpose of maintaining the upper airway open. This allows the patient to breathe freely and prevents snoring and its complications.