What is Sleep Apnea?

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a sleep respiratory disorder of unknown etiology, with clinical manifestations of nocturnal sleep snoring with apnea and daytime sleepiness. Repeated nocturnal hypoxia and hypercapnia caused by apnea can cause complications such as hypertension, coronary heart disease, diabetes and cerebrovascular disease, and traffic accidents, and even sudden death at night. Therefore OSAHS is a potentially lethal sleep and respiratory disease.

Basic Information

nickname: Sleep apnea syndrome, severe snoring, snoring, snoring
English name: obstructive sleep apnea hypopnea syndrome, OSAHS
Visiting department: Respiratory Medicine
Multiple groups: Middle-aged obese men

Common causes: Nasal septum curvature, tonsil hypertrophy, soft palate, long mandibular arch stenosis, etc.
Common symptoms: Snoring, daytime sleepiness, apnea during sleep
Contagious: no

Causes of Obstructive Sleep Apnea Hypopnea Syndrome

The direct pathogenesis of OSAHS is narrowing and obstruction of the upper airway, but its pathogenesis is not simple airway obstruction. Actually, the upper airway is collapsed, and it is accompanied by a disorder of the respiratory central nervous system. There are many causes of upper airway stenosis and obstruction, including bending of the nasal septum, tonsil hypertrophy, soft palate, narrowing of the mandibular arch, mandibular retraction deformity, ankylosis of the temporomandibular joint, and a few cases of bilateral jaw secondary to rigidity Deformity, macroglossia, hyoid bone shift, etc. In addition, obesity, myxedema of the upper airway tissue, and tumors of the oropharynx or hypopharynx can also cause OSAHS. The etiology and pathogenesis of OSAHS need further research.

Clinical manifestations of obstructive sleep apnea-hypopnea syndrome

Hiccup

Snoring during sleep is caused by the vibration of the soft palate as air passes through the oropharynx. Snoring means that the airway is partially narrowed and blocked. Snoring is a characteristic manifestation of OSAHS. This snoring is different from simple snoring. It is loud and loud; the snoring is irregular and intermittent.

2. Daytime sleepiness

Patients with OSAHS present with daytime fatigue or lethargy.

3. Apnea during sleep

Heavier patients often have radon at night, even sitting up suddenly, sweating heavily, and feeling near death.

4. Increased nocturia

Nocturia increased due to apnea at night, and individual patients developed enuresis.

5. headache

Due to hypoxia, the patient developed a morning headache.

6. Personality changes and other systemic complications

Including severe temper, mental and memory loss, and sexual dysfunction, etc., severe cases can cause hypertension, coronary heart disease, diabetes and cerebrovascular disease.

Obstructive sleep apnea hypopnea syndrome test

Should understand the upper airway obstruction and craniofacial surface development is abnormal, such as the shape and position of the jaw, occlusion and the oropharyngeal, nasopharyngeal and so on.

1. X-ray head shadow measurement

Indirect knowledge of airway obstruction, but not necessary for all patients with OSAHS

2. Polysomnography

The polysomnography monitor (PSG) is the most important method for diagnosing OSAHS. It can not only judge the severity of the disease, but also comprehensively assess the patient's sleep structure, sleep apnea, hypoxia, and changes in ECG and blood pressure . In some cases, it can also be distinguished from central sleep apnea syndrome with the help of esophageal pressure measurement. It is not enough to rely solely on the symptoms described by the patient. Every patient should have at least one PSG check before treatment, before and after surgery, and after treatment. PSG examination should be monitored in the sleep breathing laboratory for at least 7 hours. PSG tests include EEG, electroencephalogram, diaphragm electromyography, anterior tibial electromyogram, electrocardiogram, chest and abdominal wall breathing movement, oral and nasal airflow, and blood oxygen saturation.

3. Nasopharyngeal fiberscope

X-ray cephalometry can diagnose airway conditions statically, while nasopharyngeal fiberscope focuses on dynamic diagnosis.

Obstructive sleep apnea hypopnea syndrome diagnosis

The diagnosis is based on comprehensive evaluation of the patient's symptoms, examination and polysomnography.

Obstructive sleep apnea hypopnea syndrome treatment

Except for side lying, smoking cessation, and weight loss for obese people, OSAHS is divided into non-surgical treatment and surgical treatment.

(I) Non-surgical treatment

1. Nasal Continuous Positive Airway Pressure Breathing (CPAP)

This method is currently the most effective treatment method for the treatment of moderate to severe OSAHS. Most patients can achieve satisfactory treatment results through CPAP treatment.

2. Oral appliance

Wearing an oral appliance during sleep can raise the soft palate, pull the tongue actively or passively forward, and advance the mandible to enlarge the oropharynx and hypopharynx. It is the main method for treating simple hysteria or an important auxiliary method for non-surgical treatment of OSAHS. One, but ineffective for patients with moderate to severe OSAHS.

(B) surgical treatment

The purpose of surgical treatment is to reduce and eliminate airway obstruction and prevent collapse of airway soft tissue. The choice of surgical method depends on the location of the airway obstruction, the severity, whether there is morbid obesity, and general conditions. There are several common surgical methods.

1. Tonsil and adenoidectomy

This type of surgery is suitable for adult patients with tonsil hyperplasia, or children with adenoid hyperplasia. Generally effective short-term after surgery, with the development of youth, the tongue and soft palate muscles can still relapse after development.

2. Nasal Surgery

Nasal septal angioplasty, nasal polyp or turbinate resection can be performed to reduce symptoms due to nasal septum curvature, nasal polyps or turbinate hypertrophy.

3. Tongueplasty

Tongue angioplasty is feasible for those who have hypertrophy of the tongue, giant tongue disease, back of the tongue, and enlarged tonsil.

4. Stagnation, Sacral, Pharyngoplasty

This operation is to remove the long sacral soft palate and the loose pharyngeal mucosa. The pharyngeal mucosa is tightened and sutured forward to relieve the soft palate and oropharyngeal horizontal airway obstruction. The airway in the department is blocked, so be sure to master the indications.

5. Orthognathic surgery

Orthognathic surgery is mainly used for OSAHS of oropharyngeal and hypopharyngeal airway obstruction caused by jaw deformities.