Snoring is a very common phenomenon in the crowd, and almost everyone has experienced snoring. Many people think that snoring is sleeping well, so long-term snoring does not care. However, some people who snore for a long time or severely may have health risks, and some have even developed complications without realizing the seriousness of the problem. For this group of people, it is important to note that snoring can cause a disorder - obstructive sleep apnea (OSA).
According to epidemiological surveys, there are about 176 million OSA patients in mainland China. In addition, snoring may also make the pillow person unbearable, and many families will even sleep in separate rooms.
Copyright images in the gallery are not authorized to be reproduced
01
How is snoring generated?
There are many causes of snoring, when the upper airway resistance increases, the soft tissues such as the base of the tongue and soft palate of the throat are in a relaxed state, collapse downward, and the sound produced by the vibration of the tissues during the process of air flow through the narrowed part of the airway during breathing is called snoring. The narrower the airway, the stronger the airflow, the more pronounced the tissue vibration, and the louder the snoring.
However, not all snoring affects physical health, some people only have snoring, but sleep structure is good, there is no lack of oxygen, at this time does not affect health.
When the upper airway resistance is too large, the airway becomes narrower when inhaling, or even completely blocked, and the airflow cannot pass through the airway smoothly (just like the water flow thins or even no water flow when the water pipe is blocked), resulting in a decrease in the oxygen content in the blood, the brain perceives such a state, will wake us up from sleep, so that the airway is reopened for breathing, this arousal time is usually so short that we do not remember, this pattern will appear many times intermittently, or even last all night, Such a state is called obstructive sleep apnea (OSA).
Copyright images in the gallery are not authorized to be reproduced
People who snore chronically, if they cause OSA, can directly or indirectly cause serious, multisystem health problems.
02
What are the symptoms?
Daytime sleepiness, fatigue: This is a very common but very easy to ignore symptom, often in the case of reading, meeting, driving, etc. fatigue, drowsiness, lack of concentration, and may also appear temper tantrums. Sometimes I am not aware of it, but I am discovered by my family before I see a doctor, which will lead to reduced work efficiency, reduced quality of life, and in severe cases, it may lead to traffic accidents and endanger lives;
Breathing interruption: usually found by family members, snoring process suddenly for a period of time very quiet, even breathing interrupted, but with loud snoring will resume breathing, sometimes I will be awakened;
Morning headache: about 10%~30% of OSA patients are accompanied by headache symptoms within hours of waking up in the morning;
Sore throat or pharyngeal discomfort in the morning: After a whole night of throat soft tissue vibration and mouth breathing, many people will experience morning pharyngeal pain and pharyngeal discomfort;
Slow growth: common in children
03
Diseases of the cardiovascular system
It should be noted that more and more studies have shown that OSA is associated with many cardiovascular complications, including hypertension, atrial fibrillation, heart failure, coronary artery disease, stroke (stroke), pulmonary hypertension, and severe OSA is associated with cardiovascular mortality.
Mechanisms influencing cardiovascular disease Source: Author
In addition, OSA is a condition with potentially negative feedback, for example, OSA → high blood pressure → worsening OSA, so into a vicious cycle.
04
What are the risk factors
Can OSA be easily caused or aggravated?
Age: With the increase of age, the incidence gradually increases, the elderly are a high-risk group, especially in the mainland now there are more and more elderly people, the snoring population is very large;
Gender: the prevalence of men is 2~3 times that of women, and the risk of postmenopausal women is close to that of men;
Obesity: BMI (mass index) is a closely related indicator of OSA risk and is the main cause of many snoring patients, and fat accumulation in the upper airway can further narrow the airway.
The above three factors are relatively clear risk factors that can cause OSA, and the following are risk factors that may aggravate OSA:
Smoking: smoking increases upper airway inflammation, and smokers are nearly 3 times more likely to develop OSA than nonsmokers
Alcohol or sedatives: can cause excessive relaxation of the soft tissues of the throat during sleep, worsening snoring symptoms
Craniofacial and upper airway anatomy: from the anterior nostril to the larynx, anatomical factors that cause narrowing of the airway in any plane may increase the risk of OSA, if the airway is compared to a water pipe, any part of the tube is narrowed, the water flow will become smaller, and it is more likely to be dehydrated, such as large neck circumference, retraction of the lower jaw, small mandibular, hypertrophy of the tongue, hypertrophy of the uvula and soft palate, tonsil and adenoid hypertrophy (common in children), deviated nasal septum, sinusitis, etc
Copyright images in the gallery are not authorized to be reproduced
Heredity: OSA has a certain family cluster, family members with OSA may lead to an increased risk of disease, but it should be noted that for children's snoring, many parents think that it is caused by genetics, and do not pay attention to it. In fact, children snoring need to focus on whether there is an enlarged tonsil or adenoid problem
05
When do you see a doctor? How is it diagnosed?
If the above clinical symptoms appear, or there are related cardiovascular and cerebrovascular complications, especially in high-risk factors, it is recommended to go to the hospital as soon as possible.
In addition to a detailed medical history and physical examination, the doctor may order some relevant tests. Among them, sleep monitoring is a test that can evaluate the frequency of respiratory events and the degree of blood oxygen decline during all-night sleep, and can obtain a relatively objective, intuitive and quantitative sleep result, which is very meaningful for guiding treatment.
The gold standard for diagnosing OSA is polysomnography (PSG) attended by technicians, which needs to stay in a hospital sleep center for one night, but many hospitals do not have the conditions, and many people are not willing to stay overnight in the hospital, at this time, you can combine the local hospital conditions and my own wishes, choose portable sleep monitoring to take home to do, the accuracy and completeness of this device is not as high as PSG, but it is still instructive for treatment.
06
How is it treated?
OSA is a chronic disease that requires long-term, multidisciplinary management, and it is not something that can be done once and for all by taking a medicine or sticking to something. Early diagnosis, early treatment, and long-term treatment confer additional benefits, including improved clinical symptoms (eg, reduced daytime sleepiness), reduced future medical-related costs, and possibly reduced cardiovascular morbidity and mortality. Here are some common treatments and adjuvant treatments:
1. Wearing a ventilator: Once OSA is diagnosed, the first-line treatment plan is to wear a ventilator, carry out positive pressure ventilation therapy (such as continuous positive pressure ventilation, CPAP), assist in opening the blocked airway through external pressure, and meet the oxygen supply during night sleep, which can reduce the frequency of respiratory events during sleep, reduce daytime sleepiness, improve blood pressure, reduce the risk of crash, improve erectile dysfunction and improve the quality of life.
Copyright images in the gallery are not authorized to be reproduced
Clinically, I often encounter such a situation, when I recommend wearing a ventilator, many patients, even friends, are very repulsed when they hear about the ventilator. Probably because they don't know much about it, but still highly recommend trying it, which can be given more and more patient health education. If intolerance occurs after use, other treatment options may be considered.
2. Oral aligners: is an alternative treatment method for OSA, which can be used for patients with mild and moderate OSA who refuse or cannot tolerate positive airway pressure treatment, usually evaluated and treated in the Department of Stomatology, oral orthosis can extend the lower jaw forward and increase the pharyngeal cavity, thereby preventing the upper respiratory tract from collapsing during sleep.
3. Behavior modification: It is recommended to do it as a precaution and long-term management matter for daily life. Weight loss, diet control, and exercise are cost-effective treatments; Non-smoking, alcohol; Patients with postural OSA should be in a lateral decubitus position whenever possible.
4. Surgical treatment: patients who refuse positive airway pressure or oral orthosis treatment, or who have tried these treatments and are ineffective, patients with obvious tonsil hypertrophy or structural abnormalities such as nasal septum deviation, may consider surgical treatment.
Bibliography:
[1] Expert consensus on screening and management of high-risk groups for obstructive sleep apnea in adults
[2] UpToDate
[3] Mayoclinic
[4] Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association
Produced by Popular Science China
Author|Li Huimin Department of Otorhinolaryngology, Zhuozheng Medical
Audit|Chen Gang, Chief Physician, Beijing Friendship Hospital, Capital Medical University