2024-05-31 10:26:52
[인터뷰] Seunghoon Lee, Professor of Otolaryngology, Head and Neck Surgical procedure, Korea College Ansan Hospital
“Numerous signs + apnea or hypopnea for greater than 10 seconds throughout sleep greater than 5 instances per hour”
“Causes cardiovascular ailments akin to hypertension, myocardial infarction, cerebral infarction, and cerebral hemorrhage.”
“Utilizing a constructive airway strain machine is the simplest remedy and likewise enormously helps with weight reduction.”
What for those who go to sleep throughout the day and at all times really feel drained although you bought sufficient sleep? What in case your loud night breathing is extreme, you get up continuously even if you go to sleep, and your reminiscence and focus clearly decline for no purpose? If somebody reveals these signs although they don’t have every other particular ailments, it is advisable suspect sleep apnea, which happens if you repeatedly get up with out respiration throughout sleep.
The primary symptom of sleep apnea is loud night breathing, however not everybody who snores has sleep apnea. If an individual with extreme loud night breathing is excessively sleepy throughout the day and at all times feels drained, it’s mandatory to go to an otolaryngologist or sleep heart and obtain a polysomnography. Sleep apnea is so frequent that statistics present that it happens in about 27% of males and 16% of ladies in Korea, however it’s critical in that it reduces the standard of life because of daytime sleepiness and decreased reminiscence and focus, and causes deadly issues akin to heart problems. That is huge.
In actual fact, in 2023, 5 years after polysomnography turned eligible for Nationwide Well being Insurance coverage protection in 2018, the variety of sleep apnea sufferers elevated to 153,802, roughly 5 instances greater than the variety of 31,377 in 2017. Additionally, on the similar time, a part of the price of constructive airway strain remedy, crucial and efficient remedy methodology for sleep apnea (50 to 80% of the month-to-month rental charge for constructive airway strain gear), is being sponsored by nationwide medical insurance, resulting in a fast enhance within the variety of sufferers receiving constructive airway strain remedy.
To seek out out what sort of illness sleep apnea is and what the remedy is, we met with Lee Seung-hoon, a professor of otolaryngology and head and neck surgical procedure at Korea College Ansan Hospital, who’s a grasp of sleep apnea remedy in Korea and a famend knowledgeable within the discipline. Professor Lee served because the Chairman of the Sleep Committee of the Korean Society of Otolaryngology and the President of the Sleep Analysis Society of the Korean Society of Rhinology, and is serving because the President of the Korean Society of Sleep and Respiration beginning this 12 months. Professor Lee stated, “Sleep apnea is a critical continual illness, however it may be handled via numerous strategies, so it’s essential to obtain knowledgeable prognosis and actively deal with it to enhance the standard of life and forestall issues that will accompany it.”
I fell asleep however I can’t breathe?!
What’s the medical definition of sleep apnea?
“It’s a respiratory dysfunction during which respiration briefly stops or decreases throughout sleep, inflicting blood oxygen saturation to drop and waking as much as breathe once more. If an grownup experiences apnea or hypopnea, which is an lack of ability to breathe for greater than 10 seconds throughout sleep, it’s thought-about to have a clinically vital respiration dysfunction. In adults, if there are signs akin to daytime drowsiness, loud night breathing, continual fatigue, hypertension, or heart problems, apneas and hypopneas happen greater than 5 instances per hour on polysomnography, or apneas and hypopneas happen greater than 5 instances per hour no matter signs or issues. “If respiration happens greater than 15 instances per hour, it’s recognized as sleep apnea.”
What causes sleep apnea?
“It’s divided into closedness and centrality. Obstructive sleep apnea happens when the higher airway repeatedly narrows or turns into utterly blocked throughout sleep, inflicting short-term cessation of respiration. In most sufferers, respiration efforts don’t disappear and are effectively maintained. Then again, in central sleep apnea, even when the higher airway doesn’t slim throughout sleep, the hassle to breathe itself decreases or disappears for numerous causes, making it troublesome to breathe correctly. “It primarily happens in circumstances of extreme coronary heart failure or mind illness.”
What are the principle signs of sleep apnea?
“Signs embody extreme loud night breathing and never respiration whereas sleeping, however then ‘squeaking’ and exhaling unexpectedly. Many sufferers complain of extreme sleepiness and fatigue throughout the day as a result of they can not sleep at evening. “As focus and reminiscence lower, work effectivity decreases.”
What occurs if sleep apnea is left untreated?
“If signs of apnea and waking up throughout sleep proceed repeatedly for an extended time frame, oxygen saturation within the blood decreases considerably, stopping oxygen from being correctly equipped to the guts and mind. As well as, the chance of blood clots forming within the blood will increase and it impacts arteriosclerosis, which might trigger coronary heart ailments akin to hypertension, myocardial infarction, coronary heart failure, arrhythmia, and cerebrovascular ailments akin to cerebral infarction and cerebral hemorrhage to happen extra continuously. Specifically, when blood oxygen saturation decreases beneath 60%, the frequency of ventricular arrhythmia considerably will increase.”
Why do most sleep apnea sufferers snore?
“Loud night breathing happens when the higher airway partially narrows throughout sleep and the uvula and mucous membrane contained in the throat vibrate. If the higher airway turns into severely narrowed or utterly blocked whereas sleeping whereas loud night breathing, sleep apnea, akin to apnea or hypopnea, happens. “Most sleep apnea sufferers are accompanied by loud night breathing, but when very extreme sleep apnea continues for an extended time frame, the higher airway could also be utterly blocked, which can really scale back the frequency of loud night breathing sounds.”
Polysomnography with considerably diminished out-of-pocket prices
Amongst sleep apnea sufferers, many individuals breathe via the mouth.
“If the higher airway, the nostril, is clogged, loud night breathing or sleep apnea might happen. If these sufferers discover it troublesome to breathe via their nostril, they may naturally breathe via their mouth. “When you sleep together with your mouth open, your mouth can change into dry and irritation can happen continuously.”
How is sleep apnea recognized?
“First, we verify whether or not the higher airway, akin to contained in the nostril or throat, is narrowed, after which verify the prognosis via polysomnography, which examines sleep and respiration circumstances whereas sleeping. Polysomnography is a take a look at that measures numerous bodily actions akin to mind waves, electrocardiogram, blood oxygen saturation, respiratory circulate, and respiration effort in actual time whereas sleeping in an examination room for one evening. By way of this take a look at, the diploma and variety of respiration stops throughout sleep, awakening from sleep, modifications in blood oxygen saturation, loud night breathing stage, sleep stage, and many others. are checked and the outcomes are analyzed to objectively diagnose sleep apnea and decide the severity. . Previously, the price of a non-covered take a look at was about 700,000 to 800,000 received, however with the introduction of medical insurance in July 2018, the affected person’s personal take a look at value was diminished by about 80%, and the take a look at may be accomplished for 130,000 to 160,000 received.”
Does weight problems trigger sleep apnea?
“Sudden and extreme weight acquire generally is a direct reason for sleep apnea. Statistics present that roughly 40% of overweight sufferers have sleep apnea, and 70% of sleep apnea sufferers are overweight. If you acquire weight, fats accumulates within the neck space, which narrows the area contained in the neck and might make sleep apnea worse. Moreover, if belly weight problems is extreme, the diaphragm strikes upward, making it troublesome to breathe, which might result in extreme sleep apnea.”
Can losing a few pounds alone enhance sleep apnea?
“Weight reduction in overweight sufferers enormously helps enhance sleep apnea. Though there are variations relying on the diploma of weight problems, statistics present that normally, when overweight sufferers lose about 10% of their physique weight, sleep apnea improves by about 26%. Subsequently, for overweight sleep apnea sufferers, it is vitally necessary to drop a few pounds via applicable train and food regimen.”
It’s stated that signs may be improved by correcting sleeping posture.
“Sure. When you lie down whereas sleeping, your tongue could also be pushed again, additional narrowing the higher airway. “For some sufferers, after they lie on their aspect, the tongue that was pushed again can transfer ahead, widening the higher airway and enhancing sleep apnea.”
What if the within of the nostril is narrowed because of one other illness?
“If the within of the nostril, which is a part of the higher airway, is blocked by ailments akin to rhinitis or deviated septum (a situation during which the bone within the nasal partition is bent), it may trigger loud night breathing and obstructive sleep apnea. In these circumstances, loud night breathing or sleep apnea may be improved by remedy with drugs akin to topical nasal steroids or by opening the blocked nasal passages via surgical procedure.”
When is surgical remedy mandatory?
“If the mucous membranes on either side of the mouth are enlarged or the tonsils are enlarged and the within of the throat is narrowed, the within of the neck may be widened via surgical remedy akin to uvulapalapharyngoplasty (uvulapalapharyngoplasty). Sufferers whose decrease jaw, that’s, the decrease jaw itself, is small or pushed again, narrowing the neck, require surgical procedure to chop the decrease jaw bone and transfer it ahead, however this isn’t accomplished typically in Korea for numerous causes. As a substitute, there’s a remedy that entails sleeping with a tool within the mouth that strikes the chin ahead to develop the airway.”
Constructive airway strain remedy, efficient for grownup apnea
What’s a constructive airway strain machine and which sufferers use it?
“It’s a remedy that widens and maintains the narrowed throat by blowing air via the nostril or mouth throughout sleep. Constructive airway strain remedy is thought to be the simplest remedy methodology for grownup sleep apnea. In Korea, it’s used first in circumstances the place it’s judged that the impact of surgical remedy is not going to be vital.”
There are sufferers who’ve issue utilizing a constructive airway strain machine.
“The sensible downside with CPAP remedy is that, like glasses, it should be used constantly all through one’s life, and compliance decreases over time. With a purpose to enhance compliance with CPAP remedy, energetic schooling and adaptation coaching for sporting the CPAP machine for 1 week to 1 month after beginning to use it are crucial. Even if in case you have tailored to the constructive airway strain machine, conditions that have an effect on your respiration, akin to fast weight acquire or loss, might happen throughout use. On this case, a change within the initially prescribed constructive airway strain could also be mandatory, so common shut session and session together with your physician must be held each 3 to six months.”
Does medical insurance cowl CPAP compliance coaching?
“Systematic academic counseling to extend compliance with CPAP is just not individually lined by medical insurance, making it troublesome to offer enough time for schooling and remedy.”
Severity of sleep apnea in youngsters
They are saying pediatric sleep apnea is extra scary.
“Even youngsters beneath the age of 10 can develop sleep apnea, which is accompanied by loud night breathing, sleep apnea, mouth respiration, and frequent tossing and turning throughout sleep. In youngsters, the commonest trigger is enlarged tonsils and adenoids within the higher airway. If sleep apnea is extreme, the kid might have issue respiration throughout sleep and will have issue consuming because of enlarged tonsils and adenoids, which can result in progress issues. As well as, sleep apnea in youngsters is intently associated to studying disabilities, behavioral problems, and a focus problems, so warning is required.”
What’s the remedy for pediatric sleep apnea?
“If enlarged tonsils and adenoids are the trigger, resection surgical procedure may be carried out. In youngsters, sleep apnea is improved in additional than 90% of circumstances via this surgical procedure. It’s particularly efficient in youngsters than in adults. When you suspect sleep apnea in a baby, it’s best to first go to an otolaryngologist to examine for enlarged tonsils and adenoids and examine the diploma of respiration dysfunction via polysomnography. Consequently, whether it is decided that resection is important, the affected person should actively pursue the surgical procedure. Contemplating the seriousness of pediatric sleep apnea, it’s pressing to ascertain a system to make sure early prognosis and remedy by including pediatric sleep apnea to the well being check-up objects for every life cycle.”
Planning Committee Member Choi Younger-cheol [email protected]
2024-05-31 10:26:52