Snoring = sleep soundly?

*Only for medical professionals to read and explain in a simple way.

Snoring is a common phenomenon in daily life.
If you stop breathing during night snoring, hold your breath, or even sit up suddenly, sweat profusely, and have a sense of dying, you are most likely to suffer from obstructive sleep apnea syndrome (OSAS).

Due to the aging of the population, the increase in obesity, changes in dietary structure and life>
The hazards of sleep apnea are mainly manifested in two aspects: causing intermittent hypoxia, destruction of sleep structure, leading to high blood pressure, cardiovascular and cerebrovascular diseases, and premature multiple organ aging; severe cases can suffocate and die during sleep.

This article mainly talks about the definition, clinical classification, risk factors, disease risk (especially as an independent risk factor for stroke), diagnosis and treatment of OSAS.
Let's learn together.

1.
The definition and clinical classification of sleep apnea syndrome (SAS) is referred to as snoring, which refers to more than 30 apneas per night during sleep, or sleep apnea index (AHI, that is, average hourly sleep apnea/low The number of ventilations) is greater than or equal to 5.

Clinically, it is divided into 3 types, obstructive type, central type, and mixed type.

▌ Clinical classification■ Obstructive type: There is no airflow in the nose and mouth during sleep, but chest-abdominal breathing exists.

■ Central type: during sleep, the breathing exercises of the nose, chest and abdomen are suspended at the same time, and the movement of the diaphragm and ribs stops.

■ Mixed type: refers to the central type of apnea at the beginning, followed by obstructive type of apnea during an apnea process.

Figure 1: PSG examination waveform of sleep apnea II Obstructive sleep apnea syndrome (OSAS) OSAS is the most common in SAS, accounting for more than 90% of SAS, and its most harmful, mainly caused by extracranial anatomical and physiological abnormalities, etc.
The upper airway collapses intermittently during sleep, causing breathing disorders.▌ OSAS is defined as a disease in which upper airway obstruction occurs repeatedly during sleep and causes intermittent breathing pauses.
It refers to the absence of airflow through the upper airway for more than 10 seconds in the presence of chest and abdomen breathing during 7 hours of sleep every night , Repeated apnea attacks more than 30 times, or AHI is greater than or equal to 5.

▌ The prevalence rate of OSAS in epidemiological survey is 2%-15%, which increases with age, and it can be as high as 20%-40% over 65 years old.
The ratio of male to female prevalence is 2 to 3:1, but women have menopause Later, the incidence increased and approached the male level.

OSAS is an independent risk factor for hypertension, as well as an independent risk factor for coronary heart disease and stroke.

People with OSAS have greatly reduced their quality of life, increased family and social problems, and increased traffic accidents.
In severe cases, they can die from suffocation during sleep.

In 2015, a prospective survey study involving 153417 samples showed that compared with people without sleep breathing disorder, the risk of cardiovascular disease and cerebrovascular disease was significantly higher in people with sleep breathing disorder, and the relative risk ( Relative Risk, RR) were 3.
45 and 2.
87, respectively.
The risk of death from cardiovascular and cerebrovascular diseases was 13.
13% (RR=2.
87), while the risk of death due to cardiovascular and cerebrovascular diseases for people without sleep breathing disorder was no more than 4%.

3.
OSAS is so harmful, who are at risk? ▌ OSAS clinical diagnosis clues (1) Figure 2: OSAS clinical diagnosis clues (1) ▌ OSAS clinical diagnosis clues (2) Figure 3: OSAS clinical diagnosis clues (2) ▌ OSAS clinical diagnosis clues (3) OSAS The main risk factor is overweight.

If there are signs of overweight or obesity, large neck circumference (men's neck circumference is more than 43cm, women's neck circumference is more than 40.
5cm), upper airway anatomy abnormalities (tongue hypertrophy, tongue base fall) and other signs, people suffering from sleep apnea syndrome The higher the probability. Figure 4: Clinical diagnostic clues of OSAS (3) Diagnosis of obstructive sleep apnea syndrome (OSAS): PSG polysomnography monitor (PSG) is the most important method for diagnosing OSAS, it can not only judge the severity of the disease It can also fully evaluate the patient's sleep structure, sleep apnea, hypoxia, and changes in ECG and blood pressure.

In some cases, with the help of esophageal pressure detection, it can also be distinguished from central sleep apnea syndrome.

It is not enough to rely solely on the symptoms described by the patient to make a diagnosis.

Every patient should have at least one PSG examination before, before and after treatment, and after treatment.

The PSG examination should be monitored for at least 7 hours in the sleep breathing laboratory.

PSG test items include electroencephalogram, electrooculogram, mental electromyogram, tibial anterior tibial electromyogram, electrocardiogram, chest and abdominal wall breathing exercises, nose and mouth airflow, and blood oxygen saturation.

Figure 5: Judging the severity of OSAS by PSG.
Pathophysiological changes of obstructive sleep apnea syndrome (OSAS).
The main pathophysiological changes that are currently believed to occur in OSAS patients include: chronic intermittent hypoxia, increased sympathetic nerve excitability, and oxidation Stress and antioxidant imbalance, local and systemic inflammation, repeated large fluctuations in pleural pressure, and destruction of sleep structure, resulting in damage to multiple target organs throughout the body.
Therefore, this disease is the source of many chronic diseases, such as diabetes , Coronary heart disease, stroke, etc.

Figure 6: SAS is a widespread systemic damage throughout the body.
Six obstructive sleep apnea syndrome (OSAS) and stroke OSAS can directly damage the brain through changes in autonomic nerves, abnormal hemodynamics, changes in blood coagulation mechanisms, and damage to vascular endothelial cells Blood vessels cause stroke, which can also cause and aggravate the risk factors of stroke, such as high blood pressure, hyperlipidemia, glucose metabolism disorder, heart disease, etc.
, and indirectly affect the occurrence and outcome of stroke.

Figure 7: The relationship between OSAS and stroke OSAS is an independent risk factor for stroke, and the more severe the OSAS, the higher the risk of stroke [1].

A six-year study involving 1022 patients with sleep disorders (obstructive sleep apnea syndrome OSAS) after stroke.

AHI>5 was used as the basis for judging OSAS.
A total of 697 patients were judged to have OSAS at the same time.

The end point of the test is death.

Comparing the OSAS group and the control group, the disease-free survival rate and overall survival rate of the control group were significantly better than those of the OSAS group (p=0.
003 and p=0.
02) [2].

Figure 8: The disease-free survival rate and overall survival rate of the control group were significantly better than those of the OSAS group.
Therefore, domestic and foreign guidelines have made corresponding opinions on OSAS: Figure 9: How the guidelines recommend seven obstructive sleep apnea syndrome (OSAS) Intervention For those who are suspected of OSAS, you can go to a qualified hospital for sleep breathing monitoring.

If OSAS is clear, early intervention and treatment should be carried out, including: etiological treatment, life>
Figure 10: Intervention Treatment 1 Life>
For those who are overweight or obese, it is especially important to lose weight, limit the food intake of overweight patients, and increase exercise.

Quit smoking, limit alcohol, work and rest on time, and avoid overwork during the day.

Figure 11: Step out the legs and keep the mouth closed.
2 Sleep position guidance and intervention methods: Instruct the patient to sleep on the side with the head and body.
In order to ensure sleeping on the side during sleep, a side-lying auxiliary bedding should be selected, such as a side-lying pillow , Headrest, or side-lying chest strap.
For those who are sleeping with snoring, the best position is to reduce or no snoring when lying on the side.

3 Non-invasive continuous positive pressure ventilation (CPAP) Figure 12: CPAP indications and contraindications 4 Surgical treatment is only suitable for patients whose upper airway obstruction can be relieved by surgery, and surgical indications need to be strictly controlled.

Summary With the aging of our country's population, the increase in obesity, the changes in dietary structure and life>
In the process of clinical diagnosis and treatment, we need early detection, early diagnosis, early intervention and treatment to prevent the occurrence of cardiovascular and cerebrovascular events.

References: [1] Arzt M, Young T, Finn L, et aL Association of sleep-disordered breathing and the OCCUlTenCe of stroke.
Am J Respir Crit Care Med.
2005.
172:1447--1451.
[2]Yaggi HK et al.
N Engl J Med.
2005 Nov 10;353(19):2034-41