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Author: Zl Hao

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1. Snoring and sleep apnea.

Snoring is a kind of noise. When sleeping and breathing, the airflow moves in the narrow respiratory tract to produce noise, and other soft tissues such as soft palate and tongue vibrate under the action of airflow, which together form snoring. Therefore, the essence of snoring is the narrow respiratory tract during sleep.

when the respiratory tract is narrow to a certain extent, there will be respiratory atresia, which is called sleep apnea. Repeated apnea during sleep will lead to lack of oxygen at night, and then repeatedly wake up and interrupt sleep, and there will be a series of physiological changes such as daytime sleepiness due to poor sleep quality, which is called sleep apnea syndrome. The disease is one of the risk factors leading to hypertension and cardiovascular and cerebrovascular embolism, and it is potentially harmful.

It can be seen that sleep apnea is an upgraded version of snoring and a potentially harmful disease. While simple snoring is not a disease, it is called benign snoring. Snoring is not a sign of sound sleep, but the possibility of sleep hypoxia.

Then how can I judge whether I am benign snoring or sleep apnea syndrome? Dr. Hao gave you two indications for initial screening:

1. Is there any performance of holding your breath at night, or even holding your breath suddenly?

2. Are there any symptoms such as drowsiness, fatigue and drowsiness during the day?

If the answer to both questions is "Yes", then sleep apnea is highly suspected, and you need to go to the hospital in time.

second, the prevalence of snoring.

I often hear people complain that someone on the train snores like thunder and can't sleep! Someone snoring in the dormitory seriously affects sleep! Husband can't stand snoring or even get divorced ... So how many people snore?

Xiao Bian looked through some literatures. In China, Gao Xuemei was equal to the 13.4% prevalence of snoring found in a survey in Beijing in 1997. Among them, with the increase of age, the prevalence rate is rising, and the prevalence rate of snoring in 61-7 years old reaches 23.6%. The prevalence of sleep apnea is 3.1%. Some scholars in the United States believe that the prevalence of snoring over 6 years old is 5%! The incidence of sleep apnea in American adults is 9% for men and 4% for women. Think about the people around us, one in five people snores!

Obesity is a risk factor for snoring, so it is understandable that Americans have a slightly higher incidence rate than China. However, with the improvement of living standards in China, Xiao Bian thinks that the prevalence of snoring and sleep apnea must be higher than that in 1997.

Snoring and sleep apnea are also related to gender. Male snorers are about 2.-3.7 times as many as female snorers, but the clinical manifestations are 8:1 to 1:1.

So the male obese snorers around you should pay more attention to their sleep. Is there sleep apnea?

3. Diagnostic criteria, polysomnography.

two days ago, Dr. Hao introduced snoring and sleep apnea (OSAS), so how do you judge whether you are benign snoring or sleep apnea? The gold standard of diagnosis is polysomnography. Generally, the examination is carried out in the respiratory department or otolaryngology department of a general hospital.

polysomnography (PSG) is a continuous and synchronous recording of EEG, respiration, mandibular electromyography, oral and nasal airflow and respiratory activity, ECG, blood oxygen, snoring, limb movement, posture and other parameters during the whole night sleep. The next day, the instrument will automatically analyze it and then verify it item by item manually.

We can get the sleep, breathing and heart conditions from PSG, and we can also find some sleep disorders, especially sleep breathing disorders. Finally, we can get a sleep monitoring report. Dr. Hao will teach you how to read the report.

the two most important indicators in the sleep monitoring report are apnea hypopnea index (AHI) and minimum oxygen saturation minSpO2.

AHI refers to the number of apnea and hypopnea per hour, which reflects the severity of apnea, among which normal AHI <: 5。 Patients with mild sleep apnea (OSAS) 5 <: AHI< 2, patients with moderate OSAS 2 <: AHI< 5, AHI > in patients with severe OSAS; 5。 (According to the classification of diseases in stomatology, the classification of respiratory department is stricter)

The minimum oxygen saturation refers to the lowest blood oxygen content level during sleep, which reflects the severity of hypoxia caused by apnea. Normal people > 9%, mild hypoxia in 8-9%, moderate hypoxia in 7-8%, severe hypoxia below 7%.

if you meet the two indexes of the initial screening, please go to the hospital for sleep monitoring. After getting the sleep monitoring report, you can understand the most important part of the report by yourself!

fourth, treatment one, behavioral measures.

let's share some behavioral measures today. What are behavioral measures? That is, you don't need to go to the hospital, and you can improve your snoring method by changing your behavior.

the most effective way is to lose weight, because the fatter people are, the more serious they snore. Fat accumulates around the neck, pressing the airway to make it narrow. When the neck is fat, the airway is narrow. Here is an indicator-body mass index BMI= weight/(height 2). China's criterion is overweight if it is greater than 24, and obese if it is greater than 27. Reducing weight to BMI below 24 will make snoring much better.

Another very effective method is sleeping on your side. When sleeping on one's back, the tongue is easy to fall backwards and press the airway, but when lying on one's side, the tongue will not press the airway backwards, and the snoring sound will be obviously reduced. Here is a way to keep sleeping on your side-back ball. Pin a pocket with a safety pin on the back of pajamas and put a ball in the pocket, so that when you sleep on your back, you will feel uncomfortable with something behind you in a daze and turn back to your side. The size of this ball needs to be mastered by yourself. If too many people wake up, it will not work, and if it is too small, it will not work.

In addition, we should give up smoking and drinking and avoid drinking strong tea and coffee at night. Smoking will cause chronic hypoxia, because carbon monoxide will be produced when tobacco is burned, which will combine with hemoglobin and crowd out the sites that combine with oxygen. In addition, these cigarettes, alcohol, tea and coffee can increase nerve excitability, which is a kind of pre-paid excitement. When you stop smoking, alcohol, tea and coffee, you will be less excited than normal during sleep, whether it is the innervation of the respiratory center or the innervation of the muscles around the airway. So, don't drink at night if you want to drink!

Also, relieving nasal obstruction will also help breathing. Airway is a continuous whole from nasal cavity to lung. Snoring or sleep apnea will be caused by stenosis or obstruction in any part. Therefore, active treatment of rhinitis and other diseases and improvement of nasal ventilation will help to smooth sleep breathing.

Thirdly, do not take sleeping pills with central inhibitory effect. Some sleeping pills inhibit the excitement of the central nervous system and put people to sleep. However, this sleeping pill can inhibit the excitement of the respiratory center, leading to the decline of people's perception of hypoxia during sleep, severe hypoxemia or sleep apnea still can not be compensated or awake, which increases the harm of the disease.

finally, keep exercising regularly. Exercise helps to improve the excitability and tension of nerves and muscles, helps to maintain the tension of muscles around the airway during sleep, and reduces airway collapse.

5. Treatment 2. Ventilator.

Today, Dr. Hao continues to bring you a series of treatments for snoring, sharing the classic treatment of respiratory department-positive pressure ventilation CPAP, commonly known as ventilator.

The modern respiratory department has three branches: traditional respiratory diseases (emphysema, chronic obstructive pulmonary disease, etc.), emergency medicine and some sleep disorders. Snoring/sleep apnea belongs to sleep apnea. The respiratory department is very tall, and there are many ways to control the primary lung disease and improve daytime and night breathing. Dr. Hao can do what he can, and the ventilator mentioned can only be a small part. Welcome colleagues in respiratory department to criticize, correct and supplement.

don't get scared when you hear the ventilator! Don't think that the ventilator can only be a large noisy machine placed beside the ICU bed in the hospital. The ventilator can be a small, convenient and exquisite box, which is portable at home.

after breaking your preconceptions about the ventilator, Dr. Hao will introduce the treatment principle of the ventilator. As mentioned before, snoring and obstructive sleep apnea OSAS are both caused by airway stenosis and collapse, so providing airflow from the outside into the respiratory tract can flush the blocked airway and achieve the purpose of patency. The core component of the ventilator is a pump that provides pressure. Positive pressure air is pressed into the respiratory tract through the nose and mouth mask to flush the airway.

when the doctor recommends the ventilator to you, he will let you try it overnight. If the effect is good, buy it. If it is intolerable, give it up. Due to individual differences, everyone needs different pressure to open the airway, so professional technicians must adjust the pressure after purchasing the ventilator! If the pressure is too low, the airway can't be opened, and if the pressure is too high, you will feel that you can't tolerate holding your breath. Some complicated cases even need to adjust the pressure several times, and finally find the pressure that suits you.

Of course, using a ventilator for snoring alone is overqualified. Benign snoring is not harmful to the body, so you can stop snoring with the snorer introduced later in Xiaobian. However, sleep apnea is harmful to the body and must be treated. Patients with moderate and severe sleep apnea are recommended to use a ventilator to cure.

VI. Treatment III. Otolaryngology.

Today, Dr. Hao continues to introduce a series of treatments for snoring. Today, what techniques can be used in otolaryngology to treat snoring and sleep apnea? Because Dr. Hao's ability is limited, colleagues in otolaryngology are welcome to criticize, correct and supplement him.

a term of popular science-blocking point. Snoring is the performance of airway stenosis, which is not necessarily uniform, but wide and narrow. The narrowest place is blocked when the airway collapses during sleep and becomes a blocking point. The common blocking points are the posterior margin of soft palate and the base of tongue. In supine position, the soft palate and the base of the tongue fall backwards, leading to obstruction and sleep apnea. If we ask patients to open their mouths, ordinary people may see the patient's small tongue (uvula), but patients who snore may struggle to see small tongue because of the thick and long soft palate, or they may not see it at all.

uvulopalatopharyngoplasty (UPPP) is a classic operation method in otolaryngology. The purpose of this operation is to remove the small tongue, the long posterior margin of the soft palate and the loose mucosa of the pharyngeal side wall, so as to prevent the long soft palate from falling back and touching the blocking point of the posterior margin of the soft palate during sleep.

with the development of surgical procedures, there are many improved surgical procedures, all of which are aimed at minimizing trauma, preserving the original tissue as much as possible, and maintaining the effect of the original operation. In addition, minimally invasive concepts and methods, such as laser and radiofrequency ablation, were introduced in the operation, which further reduced the pain of patients.

In addition to the most classic surgical procedures, there are still many surgical methods to improve nasal ventilation in otorhinolaryngology, such as inferior turbinate ablation, radiofrequency tissue volume reduction, cryoablation palatoplasty, soft palate stent therapy (to increase the rigidity of soft palate and reduce posterior collapse), and nasal septum deviation plastic surgery.

It is worth noting that, unlike ventilators, not every patient with snoring and sleep apnea is suitable for otorhinolaryngology surgery. If the patient only has a single soft palate obstruction point, the effect after UPPP operation will be very good; If the patient has multiple blockages, relieving only one of them will even aggravate the blockages at other points. Therefore, otolaryngology surgery must choose the surgical indications!

In addition, the problem with soft tissue surgery is that after the meat is cut off, it may grow back slowly-relapse. So maybe just after the operation, the effect is great and the snoring disappears completely; But with the passage of time, the effect may be discounted. But even if it recurs, it will definitely be better than before the operation.

VII. Treatment IV. Oral appliance.

Today, Dr. Hao continued to introduce the treatment series of snoring/sleep apnea OSAS-oral appliance.

First of all, Xiaobian takes you to review why you snore /OSAS, because during sleep, the airway is narrow, the airway collapses, and the soft palate and the base of the tongue are completely or partially blocked, which is called the blocking point. From this perspective, lifting the blocking point can improve snoring.

Oral appliances in a broad sense are divided into mandibular advancement device, soft palate effector and tongue retractor. Soft palate effector is used to lift the soft palate and relieve the blocking point of soft palate falling back during sleep, but it is easy to produce vomiting reaction, so the application is reduced because of the patient's intolerance; Tongue tractor is a vacuum tongue bubble, which draws the tongue outward by negative pressure to remove the blocking point at the base of the tongue, but it is not widely used because of easy falling off and poor sleep. The mandibular advancement device keeps the patient's mandible in the extended position while sleeping, and at the same time relieves the obstruction of the base of the tongue and the soft palate, thus improving the symptoms such as snoring, which is the most widely used in clinic.

Oral appliances have no corrective effect. Just like wearing glasses, they are effective when worn, but the effect disappears when removed, so they need to be worn every night.

because of its definite curative effect and small side effects, oral appliance is the best choice for patients with simple snoring, patients with mild to moderate OSAS and patients with severe OSAS who can't tolerate CPAP. However, there are no more than ten hospitals in China that can treat OSAS with oral appliances. We welcome more dentists to participate in the treatment of snoring and hope that more patients can enjoy comfortable and convenient treatment.

VIII. Treatment V. Orthognathic surgery.

Today, Dr. Hao continues to bring you a series of treatments for snoring and obstructive sleep apnea. Obstructive Sleep Apnea is hereinafter referred to as OSA.

Let's review. Among the risk factors of snoring and OSA, one of the most important ones is maxillofacial deformities, such as mandibular retraction and bimaxillary retraction. Patients with mandibular retraction generally have a narrow airway space. If they encounter other risk factors, such as obesity and tongue hypertrophy, they are prone to obstruction points, which lead to airway collapse and apnea during sleep.

However, the growth and development of adults have ended, and it is impossible to change the length of mandible through growth improvement. From the treatment point of view of lengthening the mandible and opening the airway, either temporarily use oral appliances to maintain the mandibular protrusion during sleep every night, or extend the length of mandible through surgery.

This surgical method of changing the length of the jaw is called orthognathic surgery. Moving the jaw forward can significantly increase the airway space of patients, so it is one of the most effective treatments for snoring and OSA.

The whole treatment process includes: because the teeth are occluded, direct surgery often leads to inability to eat, so the teeth should be arranged orthodontically before operation to relieve the possible occlusion interference after operation (about 1-2 years); The second step is orthognathic surgery to cut off the jaw, rejoin it and fix it; After the operation, fine adjustment of the occlusion in orthodontics (it takes about .5-1 year).

In fact, orthognathic surgery can not only treat mandibular retrusion, but also extend and shorten maxillary/mandibular protrusion/retrusion through surgery. In addition, in view of the importance of the lower third of the face for facial beauty, it can improve the face (profile) after surgery, so some people call it "cosmetic surgery". In other words, angelababy said that she only had orthognathic surgery and became so beautiful.

But orthognathic surgery is a big operation.