Does it cause stroke and heart disease? Risks and Treatment of Sleep ApneaOtolaryngologist Ha Jong-kyun

If you want to know what snoring and sleep apnea are, you must first know normal breathing. Normal breathing is breathing during sleep when breathing is well maintained, so that breathing can be carried out smoothly without obstruction.

 

Snoring is a partial obstruction of the upper airway, resulting in tremors of the soft palate* and uvula of the throat.

 

Obstructive sleep apnea is more severe than snoring and is caused by a complete obstruction of the upper airway, resulting in a temporary pause in breathing or a decrease in breathing during sleep, resulting in frequent awakenings.

*Upper airway: the area from the nasal cavity to the pharynx

*Soft palate: the soft part behind the roof of the mouth

 

2. Causes and symptoms of sleep apnea

Why does sleep apnea occur and what are the symptoms?

 

There are a variety of factors that can lead to the development of sleep apnea. There are obesity, a congenitally narrow upper respiratory tract skeleton, and central factors. The longer this sleep apnea lasts, the worse it gets as the physiological response of the respiratory muscles decreases.

 

Symptoms of sleep apnea and the many complications that sleep apnea can cause by a lack of oxygen include:

 

 

Decreased oxygen saturation in the heart and brain can lead to strokes and heart diseases such as arrhythmias, high blood pressure, and heart failure. In particular, sleep apnea can cause secondary hypertension. The more severe the sleep apnea, the greater the risk of hypertension, resulting in secondary hypertension.

 

In addition, sleep apnea disrupts the hormonal system at night, leading to insulin resistance, which leads to obesity leading to sleep apnea, but conversely, sleep apnea leads to obesity. Insulin resistance can lead to diabetes and male sexual dysfunction.

 

These complications increase mortality. In a 2008 study, patients with moderate to severe sleep apnea had a 6.24 times higher mortality rate after 15 years than normal patients.

 

3. Diagnosis of sleep apnea

How is sleep apnea diagnosed?

 

Diagnosing sleep apnea requires a variety of tests and equipment. There are four main types of tests.

 

Polysomnography is the most frequently used and effective test for sleep apnea. The test is performed by measuring and recording and analyzing abnormal conditions such as apnea, wakefulness, and body tremors that occur during sleep during an overnight sleep in a hospital.

 

Among the sensors connected to the body, the 'sleep structure' stage is performed to check the sleep stage, sleep efficiency, and REM sleep through EEG, safety, and jaw electromyography, and the chest and stomach respiratory effort belts and oxygen saturation are measured with sensors attached to the nose and mouth to check the 'breathing status during sleep'. In addition, 'movement during sleep' is measured by electrocardiogram to look at heart rhythm during sleep and electromyography of the lower limbs to look at waking phenomena caused by unintentional movements during sleep.

 

In addition, a video recording is performed to see the overall condition along with the record of the polysomnography, and the total score is recorded and compared with the indicators. AHI, which stands for apnea and hypopnea index, is calculated by adding the apnea and hypopnea numbers and dividing by the total sleep time. The severity of sleep apnea according to AHI is as follows:

 

Nose, oral condition, tongue thickness, uvula navula, tonsils, and lower respiratory tract obstruction, lower jaw development, obesity level, and neck circumference are measured. The narrower the nasal and oral passages, the more jawless the lower jaw, the higher the level of obesity, and the thicker and shorter the neck, the more susceptible to sleep apnea.

 

Lateral X-rays and CT scans are used to check for deviated septum. If you have a deviated septum*, you will experience sleep apnea.

*Nasal septum curvature: A curved nasal septum that acts as a partition between the noses.

 

Drug-induced sleep endoscopy diagnoses sleep apnea by inserting an endoscope and observing the airway with a camera, rather than being hospitalized and falling asleep.

 

4. Treatment of sleep apnea

How is sleep apnea treated?

 

In order to treat sleep apnea, there must be a change in lifestyle.

 

First, you need to lose weight through regular exercise. Statistically, losing 10% of your body weight reduces the likelihood of complications from sleep apnea by 30%, and 20% reduces your chances of complications by 60%.

 

Second, sleeping pills and sedatives may interfere with a deeper sleep, depending on the type of medication, so it's best to avoid those types of medications.

 

Third, it is best to avoid smoking or drinking alcohol as it causes inflammation and swelling, which leads to narrowing of the upper airway.

 

In addition, it is necessary to adopt sleep hygiene habits, such as observing a certain sleep schedule, avoiding side-sleeping positions, and prohibiting non-sleeping activities in the sleeping area, which can help treat sleep apnea.

 

If you are unable to treat due to the above lifestyle changes, we will also tell you about surgical and non-surgical treatments that you can try.

 

<Non-surgical treatment>

 

CPAP is the most effective treatment for moderate to severe sleep apnea. When you put on a personalized mask and go to sleep, the machine blows in and maintains the pressure in the upper respiratory tract. There are some questions about whether CPAP is dangerous for pneumothorax or asthma, but many studies have shown that overall the risk is not great. If the benefits far outweigh the risks, you should give it a try.

 

The limitation of CPAP is that CPAP is not a fundamental treatment for sleep apnea, and it only prevents complications from sleep apnea while wearing CPAP. In addition, there is also the inconvenience of having to use it for the rest of your life if you are in a condition to use it.

 

When the jaw is pulled back, it is vulnerable to sleep apnea, so an intraoral device is used to pull the jaw forward. It reduces the resistance of breathing through the nose, inducing nasal breathing and avoiding mouth breathing. Intraoral devices, also known as personalized mouthpieces, are not available to everyone, but only to patients with healthy jaw joints.

 

<Surgical treatment>

 

The principle of treatment of surgical treatment is to induce nasal breathing and avoid mouth breathing by relieving the resistance of the nose during breathing.

 

If there is nasal congestion caused by a deviated nasal septum, surgery is performed to repair the nasal septum, and if apnea occurs due to a nodule in the nose due to sinusitis, surgery is performed to remove the nodule. Allergic rhinitis can be treated with radiofrequency rhinitis surgery.

 

 

Oropharyngeal and cleft palate surgery (uvula surgery) may also be performed. This surgery is performed to widen the upper airway that is visible when you look inside your mouth. After cutting off the sagging uvula of the neck, suture it and pull it out, and remove the tonsils on both sides. If necessary, the root of the tongue can also be shaved off with radiofrequency or surgical equipment such as the da Vinci Robot to reduce upper respiratory tract resistance.

 

 

Lastly, if the muscle tone of the tongue decreases when sleeping, causing it to droop toward the neck, resulting in sleep apnea, "hypopharyngeal surgery" may be performed. If there is a hypopharyngeal obstruction, it is a treatment in which the volume is shrunk with radiofrequency surgical equipment or the axis of the mandibular side to which the bone is attached is pulled forward and advanced.