The problem of sleep is a "worldwide conundrum". According to research data, insomnia is a common sleep problem, and in adults, 10% to 15% of people who meet the diagnostic criteria for insomnia, and show a chronic course, and nearly half of severe insomnia can last for more than 10 years.
Insomnia seriously damages the physical and mental health of patients, affects the quality of life of patients, and even induces accidents such as traffic accidents to endanger personal and public safety, posing a serious burden on individuals and society.
For sleep, I believe that many people think that "whirring and sleeping" and "sleeping and snoring" are the manifestations of sleeping soundly, sleeping deeply, and sleeping well. In fact, some people sleep at night snoring like thunder, but the sound is suddenly loud or irregular, and sometimes even stop breathing. This way of sleeping and snoring is likely to be a serious disease , apnea hypopnea syndrome — that is extremely harmful.
Today is the 15th World Sleep Day, and this year's theme is: Quality Sleep, Happy Puzzle! The Fourth People's Hospital of Chengdu invited Dr. Tan Chunyan to talk about what is apnea hypopnea syndrome and how to improve poor sleep status.
What is apnea hypopnea syndrome?
As the name suggests, obstructive sleep apnea-hypopnea syndrome (OSAHS) is due to the collapse or obstruction of the upper airway, patients with nocturnal snoring, repeated apnea, disturbance of sleep structure, increased nocturia, headache, dry mouth, drowsiness, drowsiness, lack of concentration, memory loss, irritability, anxiety or depression after waking up in the morning.
In recent years, studies have found that 40-60% of OSAHS patients will have chronic insomnia, and the two affect each other, further aggravating the condition. For example, reduced objective and subjective sleep time, greater emotional and cognitive impairment, more severe physical impairment, and so on. The clinical treatment of this disease is often more difficult.
OSAHS is not easy to detect, and the middle-aged and elderly population needs special attention
OSAHS is often not easily detected, especially in middle-aged and elderly patients, who may not snore much due to weakened breathing strength and do not have prominent symptoms of daytime drowsiness.
At the same time, in insomniac people, if there is an older age, increased nocturia, poor insomnia, etc., it is especially necessary to be vigilant against OSAHS.
Patients can be screened at a specialized medical institution in the following ways:
I. Polysomnography (PSG)
For patients with OSAHS, PSG can be used for screening and sleep structure assessment. Insomnia with OSAHS is considered if the apnea low ventilation index AHI (sum of the average hourly pauses and hypopneases in sleep) ≥ 5 times/hour.
EPworth Sleep Score (ESS)
If PSG is not available, the Epworth Sleep Scale may also be selected to evaluate the degree of daytime sleepiness. An overall score of 0-24, ≥ 9, is considered osahs risk.
What are the main treatment options?
General treatment: active treatment of basic diseases that cause OSAHS or aggravation such as hypothyroidism, acromegaly, etc., should also quit smoking and alcohol, avoid the use of sedative hypnosis drugs, correct sleeping posture, maintain good sleep habits, and encourage weight loss for obese patients.
Continuous positive airway pressure ventilation (hereinafter referred to as CPAP): CPAP is the most commonly used clinical treatment at present, and can be used as a first-line treatment for patients with moderate to severe OSAHS. However, due to oral and nasal discomfort, claustrophobia and other reasons, patients have poor acceptance. At the same time, insomnia combined with OSAHS can affect the pressure titration effect of positive airway pressure ventilation, resulting in poor treatment compliance, and further reduced adherence if anxiety or depression are combined. Therefore, treatment of patients with COMISA may be considered with cognitive behavioral therapy, physical therapy, and low-dose sleep aid adjunct prior to CPAP.
Cognitive behavioral therapy CBTI: Maintain reasonable sleep expectations and don't pay too much attention to sleep; go to bed when you are sleepy, avoid forcing yourself to fall asleep; don't do activities in bed that are not related to sleep; maintain regular wake-up times and avoid daytime naps; don't feel frustrated because you haven't slept well one night, and blame all problems on insomnia.
Physical therapy: such as light therapy, transcranial repetitive magnetic stimulation therapy, biofeedback therapy.
Pharmacotherapy: Antidepressants (eg, rice nitrogen tablets, trazodone) and melatonin receptor agonists (eg, agomelatine, ramemetimide, and lemmelton) may be used to aid sleep therapy when CBTI is ineffective.
Oral appliances: including tongue pullers, soft palate lifters, and mandibular preflection appliances, of which the mandibular preflection appliances are the most widely used. Recommended for mild to moderate OSAHS and severe OSAHS that do not respond to CPAP therapy. However, oral appliances cannot accurately assess the corrective distance of each patient in advance, nor can they predict the efficacy of oral appliances, which limits the clinical application of this treatment.
Surgical surgery: the purpose is to relieve the abnormal anatomy caused by upper airway obstruction, mainly divided into soft airway and bone airway reconstruction surgery, commonly used surgical methods include tonsil/adenoid resection, nasal surgery, tongue plasty, palate poop/palatal/pharyngealoplasty, and orthodontic and jaw combination therapy. However, there is still insufficient evidence on whether surgery can benefit patients in the long term, taking into account the risks and pros and cons, and surgery is no longer recommended as a first-line treatment option.