What Are the Different Types of Sleep Apnea Machines?

Sleep apnea-hypopnea syndrome refers to recurrent episodes of apnea more than 30 times or sleep apnea-hypopnea index (AHI) 5 times / hour with clinical symptoms such as drowsiness during sleep every night. Apnea refers to the complete cessation of oral and nasal respiratory airflow for more than 10 seconds during sleep; low ventilation means that the intensity (amplitude) of respiratory airflow during sleep is reduced by more than 50% from the basic level, and accompanied by a decrease in blood oxygen saturation from the basic level 4% or slightly awake; sleep apnea hypopnea index refers to the number of apnea plus hypopnea per hour during sleep time.

Sleep apnea hypopnea syndrome

Sleep Apnea Hypopnea Syndrome (SAHS) refers to recurrent apnea and / or hypoventilation, hypercapnia, and sleep interruption caused by various causes in the sleep state, causing a series of pathological changes in the body Clinical Syndrome of Physiological Changes.

Definition and classification of sleep apnea hypopnea syndrome

Definition of sleep apnea hypopnea syndrome (1)

Sleep apnea-hypopnea syndrome refers to recurrent episodes of apnea more than 30 times or sleep apnea-hypopnea index (AHI) 5 times / hour with clinical symptoms such as drowsiness during sleep every night. Apnea refers to the complete cessation of oral and nasal respiratory airflow for more than 10 seconds during sleep; low ventilation means that the intensity (amplitude) of respiratory airflow during sleep is reduced by more than 50% from the basic level, and accompanied by a decrease in blood oxygen saturation than the basic level 4% or slightly awake; sleep apnea hypopnea index refers to the number of apnea plus hypopnea per hour during sleep time.

Sleep apnea hypopnea syndrome (b) classification

1. Central (CSAS) 2. Obstructive (OSAS) 3. Hybrid (MSAS)

Epidemiology of sleep apnea hypopnea syndrome

Take OSAHS as an example. Among people over the age of 40, the prevalence rate in the United States is 2% -4%, more men than women, the prevalence rate is higher in the elderly, as high as 6.5% in Australia, 4.1% in Hong Kong, and 3.62 in Shanghai. %, Changchun City is 4.81%.

Causes and pathogenesis of sleep apnea hypopnea syndrome

CSAS Sleep Apnea Hypopnea Syndrome Central Apnea Syndrome (CSAS)

CASS alone is rare, generally not exceeding 10% of patients with apnea, and only 4% have been reported. Unblocking can be further divided into two major categories, hypercapnia and normal carbonate. It can coexist with obstructive sleep apnea ventilation syndrome, and most have neurological or motor system lesions. The pathogenesis may be related to the following: 1. Reduced responsiveness of the respiratory center to various stimuli during sleep; 2. Instability of the central nervous system's respiratory feedback regulation caused by hypoxemia, especially changes in CO2 concentration; 3 , Abnormal exhalation and inspiratory conversion mechanism.

OSAHS Sleep Apnea Hypopnea Syndrome Obstructive Apnea Hypopnea Syndrome (OSAHS)

The majority of SAHS have family agglomeration and genetic factors, and most of them have the pathological basis of narrowing of the upper respiratory tract, especially the nose and pharynx, such as obesity, allergic rhinitis, nasal polyps, hypertrophy of tonsils, soft palate relaxation, and prolonged prolapse Excessive thickness, hypertrophy of the tongue, fall of the root of the tongue, mandibular retraction, temporomandibular joint dysfunction, and small jaw deformity. Some endocrine diseases can also be combined with this disease. The pathogenesis may be related to the increase of the collapse of the upper airway soft tissues and muscles during sleep, and the reduction of the responsiveness of upper airway muscles to hypoxia and carbon dioxide stimulation during sleep. In addition, it is also related to the combination of nerve, body fluid, endocrine Role related.

Clinical manifestations of sleep apnea-hypopnea syndrome

Sleep apnea hypopnea syndrome (a) clinical manifestations during the day

1. Drowsiness: The most common symptoms are drowsiness and drowsiness during daytime work or study, and can fall asleep when eating or talking to people in severe cases, even serious consequences, such as dozing when driving and causing traffic accidents.

2. Dizziness and fatigue: Due to repeated apnea and hypoxemia at night, the sleep continuity is interrupted, the number of awakenings is increased, and the sleep quality is reduced. There are often mildly different dizziness, fatigue, and fatigue.

3, mental and behavioral abnormalities: inattention, decreased precision operation ability, memory and judgment decline, severe symptoms can not be competent for work, the elderly can manifest as dementia. Nocturnal hypoxemia causes damage to the brain and changes in sleep structure, especially during deep sleep.

4, headache: often appear in the morning or at night, common pain is not common, not severe, can last 1-2 hours, and sometimes need to take painkillers to ease, and blood pressure, intracranial pressure and changes in cerebral blood flow.

5, personality changes: irritability, irritability, anxiety, etc., family and social life are affected to some extent, due to gradual alienation from family members and friends, depression may occur.

6, sexual dysfunction: about 10% of patients can appear hyposexual, or even impotence.

Sleep apnea-hypopnea syndrome (b) clinical manifestations at night

1. Snoring: It is the main symptom, snoring is irregular, ranging from high to low, often snoring-airflow stop-panting-snoring alternately, the general interruption of airflow is 20-30 seconds, and individual up to 2 minutes. Visible cyanosis can occur.

2. Apnea: 75% of people who sleep in the same room or bed find that the patient has apnea, and often worry about the inability to breathe and awaken the patient. Apnea usually ends with wheezing, awake or loud snoring. Patients with OSAHS have significant chest-abdominal paradoxical breathing.

3. Awake: Suddenly awake after apnea, often accompanied by turning over, involuntary movement of limbs or even convulsions, or suddenly starting, feeling palpitation, chest tightness or discomfort in the anterior heart area.

4, restlessness: due to hypoxemia, patients turn over and rotate more frequently at night.

5, hyperhidrosis: sweating more, with neck and upper chest obvious, related to breathing force after airway obstruction and hypercapnia caused by apnea.

6. Nocturia: Some patients complained that the number of nocturnal urination increased and some enuresis occurred.

7, abnormal sleep behavior: manifested as fear, screaming, slang, night travel, hallucinations and so on.

Sleep apnea-hypopnea syndrome (3) manifestations of systemic organ damage

OSAHS patients often show abnormal symptoms of the cardiovascular system as the first symptoms and signs, which can be independent risk factors for hypertension and coronary heart disease. 1. Hypertension: The incidence of hypertension in OSAHS patients is 45%, and the therapeutic effect of antihypertensive drugs is not good.

2. Coronary heart disease: manifested as various types of arrhythmia, nocturnal angina pectoris and myocardial infarction. Twenty is caused by hypoxia-induced coronary endothelial damage, lipid deposition in the lining of blood vessels, and increased red blood cells due to increased blood viscosity.

3. Various types of arrhythmia.

4. Pulmonary heart disease and respiratory failure.

5. Ischemic or hemorrhagic cerebrovascular disease.

6, mental disorders: such as manic psychosis or depression.

7. Diabetes.

Signs of Sleep Apnea Hypopnea Syndrome (IV)

CSAS may have corresponding signs of primary disease, and patients with OSAHS may have obesity, turbinate hypertrophy, etc.

Sleep apnea hypopnea syndrome laboratory and other tests

(1) Blood test: For a long time and severe hypoxemia, the red blood cell count and hemoglobin may increase to varying degrees.

(B) Arterial blood gas analysis: those who are seriously ill or have pulmonary heart disease and respiratory failure may have hypoxemia, hypercapnia, and respiratory acidosis.

(3) Chest X-ray examination: When pulmonary hypertension, hypertension, and coronary heart disease are complicated, there may be corresponding symptoms such as enlarged heart shadow and prominent pulmonary artery segment.

(D) Pulmonary function test: When the condition is severe, there are pulmonary heart disease and respiratory failure, and there are different degrees of ventilation dysfunction.

(5) ECG: changes in hypertension, coronary heart disease, ventricular hypertrophy, myocardial ischemia or arrhythmia.

Diagnosis of sleep apnea hypopnea syndrome

According to typical clinical symptoms and signs, the diagnosis of SAHS is not difficult. To confirm the diagnosis and understand the severity and type of the disease, you need to check accordingly.

(1) Clinical diagnosis: A preliminary clinical diagnosis can be made based on snoring accompanied by apnea during sleep, daytime drowsiness, body obesity, thick neck circumference and other clinical symptoms.

(2) Polysomnography: PSG monitoring is the gold standard for the diagnosis of SAHS, and can determine its type and severity.

(3) Etiological diagnosis: ENT, ENT, and oral examinations are routinely performed on the diagnosed SAHS to understand whether there are local anatomy and developmental abnormalities, hyperplasia and tumors. Skull and neck X-ray pictures, CT and MRI measurements of the oropharyngeal cross-sectional area can be used for narrow localization judgment. Endocrine system can be measured in some patients.

Differential diagnosis of sleep apnea hypopnea syndrome

(1) Simple snoring: there is obvious snoring, PSG examination does not meet the diagnosis of upper airway resistance syndrome, no apnea and hypoventilation, and no hypoxemia.

(2) Upper airway resistance syndrome: increased airway resistance.

(3) narcolepsy: excessive drowsiness during the day, and sudden collapse during the onset. Have family history.

Sleep apnea hypopnea syndrome treatment

( I) Treatment of central sleep apnea syndrome:

1. Treatment of primary disease: such as the treatment of neurological diseases and congestive heart failure.

2. Respiratory stimulants: mainly increase the driving force of the respiratory center, improve apnea and hypoxemia. Medication: Almitrazine (50mg, 2-3 times / day), acetazolamide (125-250mg, 3-4 times / minute or 250mg before bedtime) and theophylline (100-200mg, 2-3 times / day) day).

3. Oxygen therapy: It can correct hypoxemia. For patients secondary to congestive heart failure, it can reduce the number of apnea and hypoventilation. It may worsen hypercapnia in neuromuscular diseases, but if it is combined with OSAHS, May worsen obstructive apnea.

4. Assisted ventilation therapy: For severe patients, the application of mechanical ventilation can enhance spontaneous breathing. Noninvasive positive pressure ventilation and invasive mechanical ventilation can be selected.

(B) the treatment of obstructive sleep apnea hypopnea syndrome

1. General treatment: (1) Weight loss: diet control, drugs and surgery. (2) Changes in sleeping position: sleep in the lateral position and raise the bedside. (3) Quit smoking and alcohol and avoid taking sedatives.

2. Drug treatment: the effect is uncertain. Try acetazolamide. Modafinil has an effect on improving daytime sleepiness, and is applied to patients whose sleepiness symptoms are not significantly improved after receiving CPAP.

3. Device treatment:

(1) Nasal-continuous positive airway pressure (CPAP)

Indications: Patients with AHI 15 times / hour. AHI <15 times / hour, but the symptoms such as daytime sleepiness are obvious. Patients with failed or relapsed surgical treatment. Those who cannot tolerate other treatment methods.

Contraindications: Coma, bullae, hemoptysis, pneumothorax, and unstable blood pressure.

(2) Bilevel positive airway pressure (BIPAP) treatment.

(3) Auto-CPAP ventilator therapy (4) Oral appliance (OA) therapy.

Indications: Simple Hysteria. Patients with mild to moderate OSAHS. can not tolerate other treatment methods.

Contraindications: People with temporomandibular arthritis or dysfunction should not take it.

4. Surgical treatment: (1) nasal surgery (2) sacroiliac soft palatopharyngoplasty (3) laser-assisted pharyngoplasty (4) low-temperature radiofrequency ablation (5) orthognathic surgery. ^[1]

Prevention of sleep apnea-hypopnea syndrome

1. Strengthen physical exercise and maintain good living habits ^[2] .

2. Avoid tobacco and alcohol addiction, because smoking can cause respiratory symptoms to worsen, drinking to increase snoring, breathing disturbances at night, and hypoxemia. Especially before bedtime.

3. For obese people, actively reduce weight and strengthen exercise. Our experience is to lose more than 5% -10% of weight.

4. Most patients with snoring have decreased blood oxygen content, so they are often accompanied by high blood pressure, heart rhythm disturbances, increased blood viscosity, and increased heart burden, which can easily lead to cardiovascular and cerebrovascular diseases. Therefore, we should pay attention to blood pressure monitoring and take it on time. Pressure.

5. It is forbidden to take sedatives or sleeping slumbers before going to bed, so as not to aggravate the inhibition of respiratory central regulation.

6. Take a sleeping position in the lateral position, especially in the right position, to avoid the tongue, soft palate, and uvula sagging during sleep, and increase the upper airway obstruction. A small ball can be rubbed on the back while sleeping, which helps to keep the side lying forcibly.

7. Patients after the operation should take soft food as the main, and do not eat hot food. Avoid strenuous activities.