Obstructive sleep apnea syndrome

obstructive sleep apnea syndrome called OSAS, is due to some reason Erzhi upper airway obstruction, sleep apnea when, accompanied by hypoxia, snoring, daytime sleepiness and other symptoms of a more complex disease. Occur in the obese, the elderly. Any part of the upper respiratory tract obstructive lesions can be caused by OSAS.
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briefly introduce the main cause of the pathogenesis of clinical diagnosis careful history taking, clinical examination cephalometric X polysomnography was monitored treatment of nasopharyngeal fiber endoscopy surgical treatment of non-surgical treatment major impact on the cardiovascular hazard of damage to the kidney effects on the nervous system influence on the spirit of the system affect the blood system, the endocrine system affect the function of nursing measures of the incidence of mortality brief obstructive sleep apnea comprehensive sign (Obstructivesleepapneahypopneasyndrome, OSAHS) is a cause very complex and not yet fully elucidated the pathological state, is a sleep disorder breathing regulator. This pathological state is not only snoring (snoring), and daytime sleepiness (excessivedaytimes
obstructive sleep apnea syndrome
leepiness, EDS), also due to hypoventilation or apnea, recurrent hypoxia caused hypercapnia can lead to heart and lung complications and other important vital organs and even sudden death. Therefore, OSAHS is a potentially fatal respiratory sleep disorders. Sleep apnea is defined as sleep over your nose and mouth air suspension over 10s. According to the different apnea causes and manifestations are divided into: ① obstructive sleep apnea, which in sleep due to upper airway obstruction caused by apnea, manifested as oral nasal airflow and thoracic and abdominal breathing movements stop surviving on. ② central sleep apnea, that is, nasal airflow and thoracoabdominal respiratory mouth movements and stop. ③ mixed sleep apnea, that is, the coexistence of the two, start to central apnea, followed by performance of obstructive sleep apnea. Sleep, decreased tidal volume, breathing air that is lower than normal strength of 50% air, with oxygen saturation decreased by 4% or more as respiratory insufficiency or low ventilation (hypopnea). Most scholars believe that the current international definition of OSAHS is: air nose and mouth during sleep to stop ≥ 10s, apnea plus hypopnea per hour more than 5 times that of sleep respiratory disturbance index (respiratorydisturbanceindex, RDI)> 5, or 7h breath every night hypopnea respiratory pause of 30 times or more. The prevalence of OSAHS in 1% to 4% prevalence rate of over 65 up to 20% to 40% incidence of male than female, about 5:1. Major cause of the pathogenesis of OSAHS is a direct narrow and the upper airway obstruction, but the incidence of OSAHS is not a simple airway obstruction, and respiratory disorders of central nervous regulatory factors. Cause of upper airway stenosis and obstruction for many reasons, including septal deviation, polyps, turbinate hypertrophy, tonsillar hypertrophy, tonsillar hyperplasia, long soft palate, palatal arch and flat, narrow mandibular arch, the next
obstructive sleep apnea syndrome
jaw retrusion deformity, micrognathia, temporomandibular joint ankylosis, especially on both sides of ankylosis secondary to micrognathia , tongue hypertrophy, macroglossia, hyoid bone backward and so on. In addition, obesity, upper airway mucous tissue edema, and oropharyngeal or hypopharyngeal cancer, also can lead to OSAHS. The anatomical pathology in the upper airway, but the most common oropharyngeal. Application polysomnography instrument check (polysomnograph, PSG) found that, OSAHS patients genioglossus muscle activity during sleep decreased pharyngeal muscle activity during sleep suddenly disappeared, causing gas trail stricture, or abrupt occlusion. Because apnea, the alveolar blood gas exchange impairment, resulting in hypoxemia and hypercapnia, which evoked a range of systemic symptoms, often severe oxygen saturation below 50%, arterial partial pressure of oxygen only 3.73kPa (28mmHg) below, which can lead to sudden death in patients with sleep. On the real cause of OSAHS and pathogenesis, but further study. Pathogenesis of obstructive sleep apnea (OSA) was mainly due to the incidence of upper airway stenosis and respiratory control on the result of dysfunction. Die channel support bone structure is missing, is a muscular tube composed of soft, has to collapsing. Road closure causing die pharyngeal airway is a major force in the negative pressure, which consists of the diaphragm and other respiratory muscle contraction when inhaling Movement; to genioglossus muscle-based pharyngeal expansion activities are against the negative pressure within the pharynx, maintain the upper airway open the main force. Found, OSA
obstructive sleep apnea syndrome
breathing during sleep in patients with reduced central drive, muscle tone decreased pharyngeal expansion, it is difficult to overcome the inspiratory pharyngeal negative pressure occurs when the state of the die Road, passive collapse of soft tissue. Together with the anatomy of patients die on the road itself is defective, so blocking further aggravated, there OSA. OSA occurs in the process, decreased oxygen, carbon dioxide partial pressure increased gradually increasing negative pressure within the pharynx, both of the corresponding chemical and by stimulating baroreceptor and excitement caused by brain stem reticular activating system, a brief awakening, air recovery, OSA end. On the sensitivity of the respiratory center in patients with OSA during sleep decreased , which might be different, and some lines of primary (genetic factors), some system secondary to certain factors, both will have an impact on sleep apnea so frequent and prolonged apnea episodes time, adding to hypoxia. Clinical manifestations and symptoms of clinical manifestations mainly from the upper respiratory tract stenosis, occlusion and the resulting decline in oxygen saturation. The main clinical manifestations are: ① snoring. Sleep snoring is due to air through the oropharynx when the vibration caused by the soft palate. Snoring means that some of airway narrowing and obstruction, snoring is the characteristic performance of OSAHS, snoring and habitual snoring that different: the sound
obstructive sleep apnea syndrome
large, very loud; snore Music irregular, sometimes interrupted, this time for the apnea period . ② daytime sleepiness. OSAHS patients showed drowsiness or sleepiness during the day and a sense of place, patients can immediately go to sleep, but can not control, and sometimes fall asleep in meetings, work can also fall asleep, talk to each other during sleep, eat sleep, or even fall asleep while riding a bicycle may fall down. ③ sleep apnea, abnormal behavior and symptoms. Patients are often awakened, and even suddenly sat up, sweating, a sense of impending doom. Often sleep slap in the similar kind of tremor-like limb movements and sleepwalking psychosis. ④ nocturnal enuresis. ⑤ headache. ⑥ personality changes, including impatience, depression, mental confusion, hallucinations, extreme sensitivity, hostility, hyperactivity, prone to misconduct, jealousy, suspicion, anxiety, depression, intelligence and memory loss and ######ual dysfunction, severe cases may be associated with cardiovascular system and other important vital organs of the disease manifestations. Jaw deformity caused by OSAHS as well as the corresponding oral and maxillofacial symptoms, such as mandibular retrusion, mandibular shift , jaw deformities, disorders and difficulty opening. Diagnosis be confirmed before the diagnosis of airway obstruction during sleep and block the existence of the site of occurrence and severity, and the important vital organs of the body to assess. Careful history, including diseases of the time, especially snoring, daytime sleepiness and other symptoms of the presence, duration, previous consultation, systemic medical history. Routine clinical examination in addition to general medical check, but should focus on the
obstructive sleep apnea syndrome
respiratory and upper digestive tract to make a comprehensive inspection, preferably upright and supine position were examined to understand the airway obstruction, followed by abnormal craniofacial development is checked. Such as jaw shape and location of occlusion and the oropharynx, nasopharynx and so on. Particular attention to rule out the nasopharynx, oropharynx, tongue base, there is a lump. Cephalometric X to indirectly understand the airways, and airway obstruction site inspection, and made a preliminary diagnosis of OSAHS, X cephalometric very important. Used to measure airway and related values , including: ① ∠ SNA, said the maxilla relative position of the Skull Base. ② ∠ SNB, mandibular, said the relative position of the skull base. ③ ∠ ANB, on behalf of the relative position between the upper and lower jaw. ④ PNS-P, post-nasal crest point (PNS) to the soft palate down the end of the palate (P) in length, on behalf of the soft palate length. ⑤ PAS, as the tongue base to posterior pharyngeal intramural distance, on behalf of the airway space, also known as the life space. ⑥ MP-H, mandibular plane to hyoid bone on the front-most points (H) distance, representing the position of the hyoid bone. ⑦ SPD, on behalf of the widest range of soft palate shape that the thickness of the soft palate. According to Xiao-Feng Lu and Wei-Liu Qiu and other research reports, RDI and PAS was a significant negative correlation. When the PAS ≥ 9.12mm time, RDI may be less than 95% of the value of 5; and PAS ≤ 4.61mm, then the opposite, RDI may be greater than 95% of the value of 5. Yi Biao and Zhang Zhenkang and other research reports, OSAHS patients with normal SNA angle, indicating that the upper normal position; SNB angle was significantly decreased, indicating significant mandibular retrusion; ANB angle was increased, indicating that the mandible is relatively obvious in the maxilla retracted position; PAS significantly reduced, hypopharyngeal airway; MP-H increased, indicating that the hyoid bone is lower than low; PNS-P most of the normal. Polysomnography Polysomnography was monitored device (PSG) monitoring is the most authoritative method of diagnosis of OSAHS, it is not only to determine its severity, but also a comprehensive quantitative assessment of the patient's sleep architecture, sleep disordered breathing, low oxygen conditions, as well as ECG, blood pressure changes. Membership in particular to help esophageal pressure testing, but also with central and mixed sleep apnea phase identification. Or simply relying on a small number of indicators to diagnose the symptoms described in patients with OSAHS is not comprehensive. Each patient before treatment, preoperative and postoperative, and
obstructive sleep apnea syndrome
treatment should be carried out at least 1 PSG examination. PSG examination should be conducted in the sleep laboratory to monitor the data at least 7h. PSG testing included EEG, EOG, chin EMG, anterior tibial EMG, ECG, chest wall breathing exercises, diaphragmatic function, your nose and mouth flow, and oxygen saturation. PSG shall result in the following indicators: ① total sleep time, sleep stages, waking, muscle spasms and EEG situation; ② obstructive, central and mixed sleep apnea and hypopnea frequency of the frequency of occurrence; ③ oxygen saturation level down to 89% to 80%, 79% to 70%, 69% below the number of segments and its lowest point; ④ RDI values. Nasopharyngeal fiber endoscopy is the X Cephalometric airway under static conditions on the diagnosis, and nasopharyngeal fiber mirror the emphasis on the dynamic diagnosis. Should be under local anesthesia, in the upright and supine position were examined in patients with nasopharynx, oropharynx and hypopharynx and larynx, including soft tissue conditions, location and extent of airway obstruction, with or without clinical airway and surrounding tumor and tumor; and by Zhu Huanzhe to do certain actions in order to observe changes in airway tissue and, if no other airway tissue invagination. Diagnosis of OSAHS should be comprehensive and detailed history, physical examination targeted multi-disciplinary body,asics mid runner red sole, local craniofacial examination, X ray cephalometry, PSG, nasopharyngeal fiber lens based on the study, comprehensive analysis, in order to make the correct diagnosis. Most scholars internationally recognized diagnostic criteria for OSAHS were: nose and mouth during sleep to stop airflow ≥ 10s, but there were abdominal EMG activity; RDI> 5. Even so, it should also be differentiated, and some diseases, such as primary or benign snoring, chronic low-hypopnea syndrome, upper airway resistance syndrome (theupperairwayresistancesyndrome), obesity hypoventilation syndrome (obesityhypoventilationsyndrome), chronic obstructive pulmonary disease and so on. But others believe the development of the disease at different stages of OSAHS. In addition, identification of the thyroid function should be reduced, narcolepsy (narcolepsy), myasthenia gravis, acromegaly, epilepsy, gastric reflux, and renal failure. In addition to the treatment of OSAHS treatment quit alcohol, obesity and diet to lose weight, but divided into non-surgical treatment and surgical treatment of Type 2. Non-surgical treatment 1. Nasal continuous positive airway pressure breathing (nasalcontinuouspositiveairwaypressure, nCPAP). This method is the treatment of OSAHS most effective non-surgical treatment, CPAP is like an air of upper airway dilator to prevent inspiratory collapse of the soft tissue of the passive and mechanical stimulation of genioglossus receptors, so that the airway tension increased. Separately as a therapy, and surgery can also be used in conjunction with, but generally patients with difficult long-term adherence. In other countries, especially the United States, most patients treated by CPAP, can achieve satisfactory therapeutic effect, while in the country, most of the hospitals, due to cognitive problems, most of the patient's treatment or surgery. 2. Various appliances. Sleep wear special appliances can raise the soft palate, pulling the tongue forward active or passive, and mandibular advancement, to expand the oropharynx and hypopharynx, the purpose of improvement of breathing is a major
treatment of obstructive snoring Sleep apnea syndrome
means or non-surgical treatment of OSAHS adjunct to one of the important, but critically ill patients is not valid. 3. Oxygen and a variety of drug treatment . Respiratory irritants, such as neural medroxyprogesterone acetate, etc., are also supporting the treatment methods. Surgery is the treatment of OSAHS surgical treatment of the basic method of surgical treatment aimed at reducing and eliminating airway obstruction, airway soft tissue to prevent collapse. Choice of surgical airway obstruction according to location,onitsuka tiger Australia, severity, whether there is morbid obesity and general circumstances. Commonly used surgical methods are the following. 1. Tonsillectomy, adenoidectomy. Only this type of surgery before puberty tonsils, adenoids hyperplasia in pediatric patients. General postoperative short term, with puberty, tongue, soft palate muscle development, the still can recur. 2. Nasal surgery. The septal deviation, nasal polyps or turbinate hypertrophy induced nasal airway obstruction, possible septoplasty, nasal polyps or turbinate resection to relieve symptoms. 3. Glossoplasty. Hypertrophy of the tongue, macroglossia, tongue backward, tongue tonsils were larger, viable glossoplasty. 4. Palate down, palate, pharynx angioplasty (uvulopalatopharyngoplasty, UPPP). This surgery is the removal of the soft palate, the palate long after the vertical edge and the relaxation of the pharyngeal wall mucosa,onitsuka tiger mexico 66 blue, the mucosa of the pharyngeal wall tension suture forward to achieve the level of ease the soft palate and oropharyngeal airway obstruction purpose, but can not lift the swallow Department of airway obstruction, so be sure to choose the right indications. 5. Tracheostomy. Tracheostomy is a permanent tracheostomy, 70 in the 20th century and is the only effective treatment. Tracheostomy but a series of problems: complicated life care, infection, loss of language skills, reduced quality of life, work ability and social communication difficulties, has been rarely used. 6. Orthognathic surgery. Since the 70s of the 20th century, orthognathic surgery maxillofacial deformities technology becomes more mature, orthognathic jaw deformity caused by surgical treatment of oropharyngeal and hypopharyngeal airway obstruction in OSAHS has become one of effective methods. Commonly used method has the following 4. (1) before the migration of mandibular surgery: This type of surgery can relieve jaw hypoplasia, mandibular retrusion caused by OSAHS. The lower jaw forward, the genioglossus, chin forward suprahyoid accordingly, pulling tongue forward, thereby expanding the pharyngeal airway. Mandibular bilateral migration technique more commonly used sagittal split ramus surgery. (2) Resettlement chin surgery: This type of surgery for no chin receding OSAHS. To preserve the lower edge of jaw surgery, the chin osteotomy may Block rotated 90 ° so that the fixed osteotomy. (3), before Resettlement chin, hyoid suspension surgery under the muscle off: such operations as addition to the chin resettlement operation, the same time cutting off all the muscles in the hyoid bone hyoid bone under the horn on the body and attached to the hyoid bone, the hyoid bone also move forward and upward shift, and then use
obstructive sleep apnea syndrome
suspension of autologous fascia lata on the mandible. Expansion of such operations on the oropharynx and of great benefit under the pharynx,asics onitsuka tiger, while not changing the relationship, no intermaxillary fixation, as surgery alone, surgery can also be used for other ancillary operations. (4) bimaxillary resettlement, chin and hyoid former Resettlement Resettlement surgery: This type of surgery, including the standard type LeFortI maxillary osteotomy and sagittal split ramus osteotomy, the upper and lower jaws forward, and the same line before migration chin osteotomy, hyoid muscles cut off and sling. This procedure not only fully forward on the mandible, improve airway, face shape and relations will be improved. Due to surgery so broad, surgical indications should be strictly controlled, in particular, identification of central sleep apnea syndrome, and mixed sleep apnea syndrome, Type 2 syndrome because of this simple treatment can not be cured with surgery. Of elderly patients, severe obesity, systemic organ dysfunction, surgical great danger, it should be very cautious. The main hazards of obstructive sleep apnea patients syndrome (OSAS), due to repeated episodes of hypoxemia, hypercapnia, can cause neurological disorders, catecholamines, endothelin and renin - angiotensin system disorders, endocrine function disorders and hemodynamics, resulting in multiple organ system damage and more serious impact on human health. The damage is mainly manifested in the following areas. Cardiovascular effects (1) hypertension: data show that, OSAS is the development of hypertension and an important factor, at least 30% of hypertensive patients with OSAS, 45% ~ 48% of OSAS patients with hypertension. This loss of normal circadian rhythm of blood pressure changes, more performance for the morning I wake up high blood pressure, difficult to control with medication, treatment, return to normal after more than OSAS.
obstructive sleep apnea syndrome
(2) coronary heart disease: The coronary angiography showed single or multiple coronary heart disease in patients with coronary artery stenosis, 35% combined with OSAS, such patients angina pain during the night attack, taking nitroglycerin drugs can not be relieved, and after treatment can alleviate OSAS. (3) Heart Failure: OSAS patients with heart disease can cause or worsen heart failure, mainly due to myocardial ischemia caused by apnea, hypoxia and intrathoracic pressure changes, the increased cardiac load, cardiac output decreased. Have occurred in patients with acute left heart failure due to repeated hospitalization and subsequently by polysomnography screening, diagnosis severe OSAS, by continuous positive airway pressure treatment, heart function quickly recovered. (4) arrhythmia: About 80% of the OSAS patients had significant bradycardia, 57% ~ 74% of patients with premature ventricular contractions , 10% of patients with second degree atrioventricular block. Sudden death in patients with this arrhythmia is the main cause. Therefore, on the arrhythmia, should think of it with OSAS. Had a 45-year-old male patient with third degree atrioventricular block , heart rate was 35 beats / minute, to be installed pacemaker. Other tests by coronary angiography after and found no organic disease, and polysomnography examination, diagnosis of OSAS. After 1 week continuous positive airway pressure, atrioventricular block disappeared, heart rate also returned to normal. OSAS damage to the kidneys can be combined proteinuria or nephrotic syndrome, renal damage caused is due to upper airway closure, chest negative pressure increased, returning to increase right heart, ischemia, pulmonary vasoconstriction, right ventricular load increase, leading to expansion of the right atrium to stimulate the secretion of atrial natriuretic factor, renal proximal tubular sodium reabsorption rate decreased urinary osmotic pressure and renal function of lower concentration. The clinical manifestations of nocturia increased and the swelling, severe renal insufficiency may occur a series of performance. Showed increased glomerular pathological changes, a small amount of focal sclerosis, it is functional early proteinuria, treatment with OSAS improved or cured, proteinuria can be reduced or disappear, clinical symptoms can be improved or disappeared. Effects on the nervous system with lower oxygen saturation , EEG arousal graphics often appear, showing non-rapid eye movement sleep, and rapid eye movement sleep and reduction of sleep disorder result in reduced sleep efficiency. Before sleep can have hallucinations, unconscious behavior, sleep limb twitching, spasms. Circulation disorder caused by lack of oxygen and brain damage can cause mental deterioration, memory loss and personality changes and so on. The impact on the mental system (1) cognitive dysfunction: comprehensive cognitive function of patients affected, of which the attention, concentration, complex problem solving ability and short-term memory impairment is most obvious. OSAS patients decreased alertness, increased the incidence of motor vehicle accident. Most of OSAS patients had fallen asleep while driving the phenomenon, 54% fell asleep while driving a car accident. These patients often nap in the car of private prosecution, and sometimes hit the tree, sometimes against the wall, or injured a pedestrian, and often had to stop the car for a clear and easier to fall asleep driving on the highway. In general, OSAS more serious condition, the higher the risk of an accident, it should be treated. (2) mental disorders: which depression, anxiety, hypochondriasis and other symptoms as a. Application of the OSAS patients was the Minnesota Multiphasic Personality Inventory (MMPI) test, found that 56 % of the patients had depression, 38% had suspected disease, 29% had conversion hysteria. A few patients showed a pure form of paranoid psychosis, manic psychosis and so on. Abnormal behavior is not uncommon, such as sleep, less secure, tamper with hands and feet, and sometimes sleepwalking phenomenon. The impact of low oxygen blood system can stimulate the kidneys secrete erythropoietin, caused by secondary polycythemia, leading to increased blood viscosity, blood flow is slow, increasing the chance of cerebral thrombosis. The other can accelerate atherosclerosis, the increase in vascular disease. Anterior pituitary endocrine system effects of growth hormone secretion mainly during REM sleep in the release, people with obstructive sleep apnea of ​​the sick child, because the reduction of REM sleep, the release of growth hormone decreased in varying degrees is the slow growth of the sick child one of the factors. The impact on ######ual function in patients with sleep apnea ######ual dysfunction can occur due to the following aspects: ① hypoxemia and hypercapnia in the brain injury, decreased excitability, ######ual activity was inhibited; ② disease patient response,cheap onitsuka australia, attention, observation decreased, difficult to achieve orgasm during intercourse, short duration; ③ cause ######ual organs and the male hormone produce oxygen barrier. Nursing obesity upper airway soft tissue of fat deposition, the lumen is small , the upper airway fat infiltration within muscle tissue, muscle tissue can cause loose connections, leading to increased compliance of the upper airway, causing airway collapse, shortness of breath. Data reported that obese OSAS three times more likely than normal people's congress. We have repeatedly stated on the health hazards of obesity, patients and their families to assist with weight loss. Application of diet, exercise, psychological care, patients to correct diet, living habits and behavior therapy, the patient conscious diet, within the specified time for the weight loss of 5% to 10%. The patients, 72% of patients addicted to alcohol and tobacco, alcohol and tranquilizers can reduce the movement of the muscles around the airways, increasing the occurrence of sleep-disordered breathing, to enable patients to avoid these risk factors, to persuade them to refrain from smoking, avoid the use of sedatives before sleep. Observed in patients with supine sleep, breathing disorder worsened after the fall caused by the tongue base causing airway obstruction. Patients control the sleep position of our church , to avoid the supine position, to alleviate the symptoms. The incidence of OSAS in high prevalence populations, about 2% to 4%, male and female incidence ratio of about 6.3:1, common in 40 to 70-year-old obese, more than 65 years of age up to 20% prevalence rate ~ 40%. Children of the tonsil and adenoid hypertrophy, but also a high incidence of this syndrome in the age group. OSAS is a set of mortality potentially dangerous sleep-disordered breathing disease , complicated by cardiac arrhythmia, hypertension, respiratory failure or even sudden death. It is estimated that 3,000 people die every day around the world this disease. Thorpy of 269 patients followed up for 7 years, 43 cases of death, accounting for 16%, 71% died of cardiovascular disease. It is reported that untreated patients, 5-year mortality was 11% to 13%, apnea index> 20 persons, 8-year mortality rate was 37%, while the apnea index

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