Diagnosis Treatment and Prevention of Sleep-disordered Breathing

Diagnosis

It is not difficult to diagnose sleep-disordered breathing based on typical symptoms, but it is necessary to carry out corresponding examinations to confirm the diagnosis and understand the severity and type of the condition.

1. Clinical diagnosis: According to the patient's snoring with apnea during sleep, daytime sleepiness, body obesity, thick neck circumference and other clinical symptoms, a preliminary clinical diagnosis can be made.

2. Polysomnography: PSG monitoring is the gold standard for diagnosing SAHS, and can determine its type and severity.

3. Diagnosis of etiology: Perform routine ear, nose, throat and oral examinations on confirmed patients to find out whether there are local anatomy and dysplasia, hyperplasia and tumors. The cross-sectional area of the oropharynx can be determined by head and neck X-ray photographs, CT and MRI, which can be used to determine the location of upper airway stenosis. For some patients, endocrine system testing is required.


Definition
1. Sleep apnea (SA): During sleep, the airflow of mouth and nose breathing disappears or is significantly weakened (decreased by ≥90% compared with the baseline) for a duration of ≥10s;
2. Hypopnea: Oral and nasal airflow decreases by ≥30% compared with the baseline level during sleep, accompanied by a decrease in SaO2 by ≥4%, and lasts for ≥10 seconds; or a decrease in oral and nasal airflow by ≥50% compared with the baseline level accompanied by a decrease in SaO2 ≥3%, duration ≥10s;
3. Apnea Hypopnea Index (AHI): the sum of the average number of times of sleep apnea and hypopnea per hour.
4. Obstructive sleep apnea-hypopnea syndrome (OSAHS): more than 30 repeated episodes of apnea and hypopnea during 7 hours of sleep every night, or AHI≥5 times/h, if conditions permit, the RDI shall prevail.

Types: There are three types of sleep-disordered breathing:

1. Obstructive type: there is no air flow in the nose, mouth and mouth, but thoracoabdominal breathing movement still exists;

2. Central type: finger-nose and oral airflow and thoracoabdominal breathing movement disappear at the same time;

3. Mixed type refers to the central apnea at the beginning, followed by obstructive apnea at the same time during an apnea.

Basis for judging the severity of OSAHS and apnea-hypopnea index (AHI) and/or hypoxemia in adults
1. Mild: AHI 5-15, SpO2 85-90%;
2. Moderate: AHI >15～30, SpO2 80 ~ < 85%;
3. Severe: AHI >30, SpO2 < 80%.

Treatment

Treatment of Obstructive Sleep Apnea Hypopnea Syndrome

1. General treatment: change living habits and eliminate the cause. It is effective for mild patients. (1) Weight loss: diet control, drugs and surgery. (2) Change in sleeping position: Sleep on the side and raise the head of the bed. (3) Quit smoking and drinking, and avoid taking sedatives.

2. Drug treatment: try acetazolamide. Modafinil is not effective in improving daytime sleepiness. It has a certain effect on patients whose drowsiness symptoms do not improve significantly after receiving sleep apnea therapy.

3. The use of sleep apnea machine for treatment is the most important treatment method of choice at present.

Indications: ①Patients with AHI≥15 times/hour. ②AHI<15 times/hour, but with obvious symptoms such as daytime sleepiness. ③ Surgical treatment failure or recurrence patients. ④ Those who cannot tolerate other treatment methods.

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

4. Use oral appliance (oral appliance, OA) for treatment.

Indications: ①Simple snoring. ②Patients with mild obstructive sleep apnea. ③Those who cannot tolerate other treatment methods. Contraindications: People with temporomandibular arthritis or dysfunction should not take it.

5. Surgical treatment: (1) Nasal surgery; (2) Vertebral pharyngoplasty; (3) Laser-assisted pharyngoplasty; (4) Low-temperature radiofrequency ablation; (5) Orthognathic surgery.


Treatment of central sleep apnea syndrome:

1. Treat the primary disease and solve the cause. Such as the treatment of nervous system diseases, congestive heart failure, etc.

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

3. Oxygen therapy: It can correct hypoxemia, reduce the number of apnea and hypopnea for patients secondary to congestive heart failure, and may aggravate hypercapnia for neuromuscular diseases, but if OSAHS is combined May exacerbate obstructive apnea.

4. Use sleep apnea machine for assisted ventilation therapy: For severe patients, the application of mechanical ventilation can enhance spontaneous breathing, and non-invasive positive pressure ventilation and invasive mechanical ventilation can be selected.


Prevention Method

1. Strengthen physical exercise and maintain good living habits.

2. Quit smoking and drinking. Smoking will aggravate respiratory symptoms, and drinking will aggravate snoring, nocturnal breathing disorders and hypoxemia. Especially drinking alcohol before bed.

3. For obese people, it is necessary to actively reduce weight and strengthen exercise.

4. Patients with snoring often have decreased blood oxygen content, so they are often accompanied by high blood pressure, cardiac rhythm disorders, increased blood viscosity, increased heart burden, and easily lead to cardiovascular and cerebrovascular diseases. pressing objects.

5. It is forbidden to take sedatives and sleeping pills before going to bed, so as not to aggravate the inhibition of the regulation of the respiratory center.

6. Sleep on the side, especially on the right side, to prevent the tongue, soft palate, and uvula from relaxing and falling down during sleep, which will aggravate upper airway blockage. A small ball can be placed on the back during sleep, which helps to force the sleep on the side.

7. Patients after surgery should mainly eat soft food, and do not eat too hot food.