媒體報導治療睡眠呼吸中止 

知名作家H治療睡眠呼吸中止 

謝醫師談睡眠呼吸中止的治療方式

Pay attention to sleep apnea which related to higher incidence of sudden death, accident and depression

Do you feel tired or dozeoff during daytime, or unable to sleep through night? Be aware! These are the signs of obstructive sleep apnea (OSA). Recent news reported a tired motorbike rider crashed into the median island and fell badly on the street, and another drift-off car driver lost control of the car and crashed into a house. These accidents might be caused from bad night's sleep, which may lead to many illnesses. So don't underestimate the bad sleep caused by OSA.

Do you show thesigns of OSA?

Let us go through a simple test checklist before further discussion. Please make a tick when having the sign.

Unable to sleep through the night/ discontinuous sleep
Frequent urination at night
Daytime sleepiness or tiredness
Morning headache
Dry mouth or sore throat in the morning
Easily irritated, depressed, with violent mood swings or sudden personality changes
Trouble concentrating
Forgetfulness
Inhibited sexual desire

Be aware! These are the common symptoms of OSA. If you show any of the symptoms, please ask your sleep partner to observe you at night:do you show breaks or pauses whilesnoring, or suddenly waking up and breathing hardly then fallingback into sleep? Theses signs implyinterrupted sleep by lack of oxygen caused by airway obstruction.
 

Sometimes it is not easy for the patient and the family to identify sleep apnea from observing the sleep condition. Based on my experience of treating OSA patients, people who meet the following 4 characteristics are at high risk for OSA.If you have allthese 4 OSA risk factorsplus one or more of the above-mentioned signs, please be extra cautious, particularly if you used to sleep along. Please visit sleep medicine center or related medical facilities to receive exam and check for your health.
 

Agedover 65
Obesity
Having smoking and drinkinghabits
With receding chinand short neck

Nearly one million Taiwanese show the signs ofsnoring combined with sleep apnea

Obstructive Sleep Apnea (OSA)? OSA is one form of the commonly known sleep apnea. There are two forms of sleep apnea: central (CSA) and obstructive (OSA) while OSA constitutes the majority of sleep apnea cases.

OSA is defined as partial or complete upper airway obstruction during sleep. To explain in more details, sleep apnea occurs duringthe back-sleepingposition, the nasopharyngeal cavity moves back toward the throat and narrows down the airway,together with the relaxedpalatine uvula and tongue falling backwards, leading to the airwayblockage.

 

Long time ago, the only way to treat the emergency patient suffered from severe sleep apnea leading to death is tracheostomy, a surgical procedure to cut open the trachea and let air in. Studies showed theOSA prevalence in Taiwan is about 1.7-4.3%, which means at least 0.4-1 million people in Taiwan's total population of 23 million show the signs of snoring combined with sleep apnea.Hence OSA is a common disease in Taiwan,tracheostomywon't be a good choiceto treat every OSA patients.

Fortunately there has been substantial progress in treating sleep apnea with advancedorthognathic surgerythat widens the upper airway thus completely cures the diseases caused by airway blockage.

Do notunderestimate sleep apnea which may put your life in great danger

You might not understand the significant negative impact of OSA on your health. Let's cut to the point "sleep apnea patients are in the condition of periodical lack in oxygen".

As we all know, long time lack of oxygen can cause death. People suffered from periodical oxygen deficiency cannot sleep through the night. The discontinuous sleep keeps a man from getting into deep sleep and causes the so-called "change of sleep structure". Sleep apnea patients show the clinical signs of daytime tiredness and excessive daytime sleepiness (EDS). People in such condition are prone to many kinds of accidents including car accident. In the USA the truck drivers and the pilots must pass the sleepexamto exclude sleep apnea. Besides long-term sleep disorders may lead to depression.

In addition periodical oxygen deficiency enhances the insulin resistance thus induce or worsen the diabetes. One studyin the USA shows 53% of diabetic patients had sleep apnea, and the prevalencefurther increased to 86% in diabetic patients with obesity. The bad thing is people in lack of oxygen go through anaerobic metabolism and desire to eat high calories food, which greatly increases the chance of getting over-weighted. Weight gain with excessive fat tissue further deteriorates the airway obstruction, forming a vicious cycle.

What health problems are caused by long-term periodical lack of oxygen? Studies showed the OSA patients have higher risks of cardiovascular diseases including myocardial infarction, resistant hypertension and stroke, which further increase the risk of death.

Here I summarize seven health problems caused by OSA, hoping to awake the public awareness on OSA:

1. Motor vehicle accident
2. Cardiovascular disease
3. High blood pressure
4. Stroke
5. Diabetes
6. Depression
7. Weight gain and obesity

Narrow airway is prone to become flat and blocked during inhalation

The airway is flexible tract composed of muscle and soft tissues. It is similar to a straw. The inhalation generates negative pressure that flattens the tract. In OSA patients, a physical block to airflow caused by flattened airway during inhalation interrupts the breathing.

Based on the concept, treatment of OSA is widening the airway. Imagine there are two straws in different size. For sure it is easier to suck flat the smaller size straw. Likewise orthognathic surgery widening airway grants better resistance ofairway obstruction during inhalation.

Conservative and invasive approaches are currently available to treat OSA. Conservative approaches include: 1) Side sleeping: This position eases snoring but it is difficult for most people to adopt certain positionwhile sleeping; 2) Avoid alcohol or sedatives: Alcohol and sedatives cause relaxation of tongue and its musclesleading to airway obstruction while sleeping on the back. However this approachis difficult for those who regularly use sedatives to induce sleep; 3) Weight control: As above mentioned, obesity is one of the risk factors for sleep apnea,and obesity and sleep apnea form a vicious cycle. Weight control is the key to treat OSA. However it's easier said than doneproved by weight control remains as one of the hottest business in the world for centuries.

and 4) continuous positive airway pressure (CPAP): Apart from the above mentioned advice or suggestions,CPAP has been introduced in Taiwan to treat sleep apnea. CPAP modalities applypositive pressure continuouslyinto the airway to reverse the airway obstruction in sleep apnea. CPAP therapy has shown to provide physiological benefits and improvequality of life in sleep apnea patients. However patients on CPAP often complain of dry eyes and mouth, and there have been concerns regarding the patient's low adherence to CPAP, as only 30% of the patients reported to be adherent to CPAP treatment after 3 years.

On the contrary, invasiveapproaches involvesurgical procedures to widen the airway as the radical cure of sleep apnea. Some doctors choose to remove the uvula or part of the tongue to create more breathing space. However this approach would not apply to patients with congenitalcraniofacial abnormalities. Besides there are patients underwent uvula/partial tongue removal surgerycomplaining of gettingeasily choked while eating. I do not recommend all sleep apnea patients receivesurgical treatment. Only when the sleep apnea is caused by narrow airway, I will performorthognathic surgery to widen the airway to the level that the airway is not affected by the negative pressure generates from inhalation. I dobelieve every part of the body has its meaning of existence.

In addition, based on my experience over the years, almost every patient with receding chin and short neck hasconstricted airway and sleep apnea problem. For this kind of patients, I highly suggest orthognathic surgery to widen the airway so as to improve the quality of sleep and life.
 

Orthognathic surgery applies to 7 types of sleep apnea patients

Which types of patients are recommended to receive orthognathic surgery? I would suggest orthognathic surgery to patients with congenitalcraniofacial abnormalities, patients with moderate to severe sleep apnea (Apnea-hypopnea Index score≥15),and patients with mild sleep apnea (Apnea-hypopnea Index score of 5-14) accompanying severe excessive daytime sleepiness and the lowest sleep-related oxyhemoglobin saturation<90％indicating severe oxygen deficiency.

What is Apnea Hypopnea Index (AHI)? Sleep apnea is associated with apnea (complete cessation of airflow for at least 10 seconds) and hypopnea (airflow decreases by 50 percent for 10 seconds). AHI is an index used to indicate the severity of sleep apnea and is represented by the number of apnea and hypopnea events per hour of sleep. Sleep apnea is classified as mild (AHI<15), moderate (AHI=15-30) and severe (AHI>30).

Orthognathic surgery also applies to sleep apnea patients with arrhythmia or hypertension, or those who tried conservative treatmentbut the illness not improved.

Sleep apnea is actually a common sleep disorder in Taiwan, but few people pay attention to it or undergo screening exams. Most sleep apnea patients do not care or not even know themselvesis ill. Sleep apnea not only affects the quality of sleep and life, but also is associated with high risk of cardiovascular disease, depression and diabetes. I strongly urge those who show the signs of or at high risk for sleep apnea to seek assessment and screening exams.

If constricted airway is confirmed to be the only cause of sleep apnea, orthognathic surgery is highly recommended. In the past the doctor could only reply on2D lateral cephalogramfor diagnosis and surgical treatment planning. Nowadays with the aid of 3D CT scan, experienced surgeon can visualize the airway structure in a 360-degree view and perform the airway widening surgery in a more accurate and efficient way.

Take sleep apnea patients with overbite for example, surgically widening the anterioposteriordiameter of the airway over certain levelwill deteriorate the overbite condition. In the past the doctor could relyonlyon 2D lateral cephalogramto adjust the anterioposterior diameter as much as needed to create enough breathing space yet not able to pay much attention to the outer beauty. Nowadays with the support of 3D CT scan, the surgeon can widenboth the anterioposterior(less extent) and transverse diameter to enlarge the airway sufficiently and serve the double purpose of solving the sleep apnea and overbite problems.