Reasons and Hazards of Sleep-disordered Breathing

Etiology and Pathogenesis

Obstructive sleep apnea hypopnea syndrome (OSAHS)

The obstructive type is mainly related to the following factors:

1. Muscle factor: When inhaling, the negative pressure of the pharynx increases, the airway expands and the tension of the abductor muscle group decreases, which is prone to upper airway obstruction. In addition, muscle fatigue and relaxation of upper airway muscles may also be one of the reasons.

2. Nervous factors: The upper airway is controlled by two different nervous systems, voluntary and voluntary, and both nerve impulses can act on the diaphragm and upper airway dilation muscles. If the two are not coordinated, contradictory movements occur, and there are anatomical defects in the upper airway, etc., which can cause the upper airway to narrow during inspiration.

3. Humoral and endocrine factors: It may be related to the disorder of the humoral endocrine, or it may be related to other factors such as obesity and genetics.

Obstructive sleep-disordered breathing accounts for the majority of sleep-disordered breathing diseases, and most of them have narrow upper airway, especially the nose and pharynx, such as obesity, allergic rhinitis, nasal polyps, tonsil hypertrophy, loose soft palate, long and thick palate, Upper airway narrowing caused by tongue hypertrophy, tongue root drop, mandibular retrusion, temporomandibular joint dysfunction, and micrognathia.

Some endocrine diseases are also the cause. Its pathogenesis may be related to the increased collapsibility of upper airway soft tissue and muscles during sleep, and the decreased response of upper airway muscles to hypoxia and carbon dioxide stimulation during sleep. In addition, it is also related to the combination of nerves, body fluids, endocrine and other factors. function related.

Central Sleep Apnea Syndrome (CSAS)

Pure CSAS is rare, generally not more than 10% of patients with apnea. Most of these patients have neurological or motor system lesions. The pathogenesis may be related to the following factors:

1. Responsiveness of the respiratory center to various stimuli decreases during sleep;

2. Instability of the central nervous system to hypoxemia, especially the respiratory feedback adjustment caused by changes in CO2 concentration;

3. The exhalation and inhalation conversion mechanism is abnormal.

Central type and obstructive sleep apnea syndrome may co-exist.

Harm

The primary harm to patients with sleep-disordered breathing lies in the cardiovascular system, which may also lead to neuromodulatory dysfunction, endocrine disorders, and hemodynamic changes, resulting in multi-system and multi-organ damage. In severe cases, patients may suffocate to death during sleep. The 10-year mortality rate for sleep apnea patients was 9%, which was much higher than the 1.8% for the control group.

1. Hypertension: The incidence of hypertension in sleep apnea patients is 51.6%, and the treatment effect of antihypertensive drugs is not good.

2. Coronary heart disease: The incidence rate of coronary heart disease is 41.3%, mainly manifested as various types of arrhythmia, nocturnal angina and myocardial infarction. 20% of them are caused by hypoxia-induced coronary endothelial injury, lipid deposition in the intima of blood vessels, and increased blood viscosity due to polycythemia.

3. Pulmonary heart disease and respiratory failure, the incidence rate of pulmonary heart disease was 10.9%, and the incidence rate of respiratory failure was 21.3%.

4. Various types of arrhythmia.

5. Ischemic or hemorrhagic cerebrovascular disease.

6. Mental abnormalities: such as manic psychosis or depression.

7. Diabetes.