What is sleep apnea? What are the ways to improve and treat sleep apnea?

The medical community estimates that 12% of adults in Taiwan (approximately 2.3 million people) suffer from sleep apnea, but fewer than 5,000 actually seek medical treatment. What are the effects of sleep apnea and how to judge whether there is sleep What are the common improvements and treatments for the problem of apnea?

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What is Sleep Apnea?

Sleep apnea, also known as happy hypoxia or sleep apnea, is a risk factor for cardiovascular diseases. Many studies have confirmed that sleep apnea can cause chronic diseases that are difficult to control. For example, the probability of suffering from high blood pressure is higher than that of ordinary people. Similarly, there are Patients with high blood pressure are also more likely to suffer from sleep apnea at the same time, and sleep apnea is divided into obstructive sleep apnea (OSA), central sleep apnea (Central sleep apnea, CSA) and Compound sleep apnea (Mixed sleep apnea, MSA), also known as mixed sleep apnea, central sleep apnea is a disease of the brain's breathing center, resulting in the inability to send out breathing messages, which need to rely on sleep monitoring to distinguish, compound sleep apnea Suspension means that the brain cannot send a breathing signal and at the same time, the airway is blocked. Since 85%-90% of patients are obstructive sleep apnea, this article focuses on obstructive sleep apnea.

Obstructive sleep apnea causes patients to repeatedly lack air and hypoxia during sleep. During the process of waking up, it promotes sympathetic nerve activity, triggers the constriction of peripheral blood vessels, and causes blood pressure to soar repeatedly between each breath. Long-term The probability of suffering from high blood pressure, myocardial infarction, angina pectoris and other cardiovascular diseases is higher than that of ordinary people, and the cerebral cortex will also degenerate early, and in severe cases, it may even lead to sudden death from stroke!

image - MtM+ Technology
(Figure 1) Sleep Apnea

How is sleep apnea triggered?

Sleep apnea occurs because the upper respiratory tract (including the nasopharynx, oropharynx, and throat) collapses repeatedly during sleep, which leads to blockage of the airway, resulting in shallow and laborious breathing, and in severe cases, complete blockage of the airway , resulting in the situation of not being able to breathe air and suffocation, so it is called sleep apnea, and most people are caused by obesity, which causes airway narrowing or lack of muscle tension to maintain airway smoothness, and it is easy to collapse. Of course, some people are Due to congenitally small or retracted chin, tonsils, overhanging or congenital craniofacial defects, resulting in narrow airway.

Common features of sleep apnea

Because obstructive sleep apnea is closely related to body structure, it can be easily judged through some superficial observations, so as to think whether you meet the common triggering characteristics.

  1. Fat and short neck
    A man with a neck circumference greater than 43 cm or a woman with a circumference greater than 38 cm is at high risk.
  2. tongue hypertrophy
    If no uvula can be seen when opening the mouth and sticking out the tongue, there may be narrowing of the upper airway.
  3. Chin retraction
    The chin is narrow and retracted, and the trachea is easily blocked when lying down.
(Figure 2) Three common features of sleep apnea

Sleep apnea trigger process

Sleep apnea may seem like a small problem, but the long-term results will lead to some complications. The initial metabolic hormone abnormalities cause diabetes and obesity, and later high blood pressure, stroke and sudden death may all come from sleep apnea.

  1. When you sleep, the body struggles to breathe due to poor breathing, which increases the workload on the heart.
    Effects: Possibility of ventricular failure.
  2. The body begins to lack oxygen, and the carbon dioxide in the body increases.
    Effects: Abnormalities in vasoconstriction and metabolic hormones.
  3. The body is awakened, and the breathing is adjusted to go back to sleep.
    Impact: Being in a light sleep state all the time can easily cause the body to never really enter a deep sleep.

How to Diagnose Sleep Apnea by Symptoms?

The easiest way to judge sleep apnea is to observe the snoring during sleep. If you have apnea during sleep, you are overweight, have a short neck, have high blood pressure or diabetes at a young age, etc., you can observe and communicate with others. According to the data, it is recommended to seek medical attention first and seek professional medical assistance for conditions such as asthma, heart attack or stroke at night, and for daytime sleepiness, it is easy to fall asleep in a short period of time during meetings or watching TV. If you doze off, or have a car accident or accident due to dozing off, you can observe by yourself. If you meet multiple symptoms, you can suspect the possibility of sleep apnea. The following common symptoms can be used for reference.

Common Symptoms of Sleep Apnea

  • Drowsiness during the day can cause inability to concentrate for a long time, and it is easy to doze off while driving, and even cause car accidents.
  • Angina pectoris, myocardial infarction, or cerebral apoplexy occur during normal sleep, which may lead to sudden death during sleep.
  • Young people have problems such as obesity, diabetes, high blood pressure, irregular heartbeat or heart failure.
  • Rapid memory loss in the short term, although this may also be associated with early onset dementia.
  • Changes in personality traits (such as anxiety, insomnia, bad temper, restlessness, etc.), even including patients with depression or insomnia.
  • Decreased libido resulting in sexual dysfunction.
  • Frequent urination during night sleep is obvious.
  • Abnormal body movements during night sleep, such as sleepwalking, sleep talking and nightmares.

Severity index of sleep apnea

目前評估睡眠呼吸中止症的黃金標準方法是睡眠多項生理檢查(PSG),而呼吸中止指數(AHI)是當中最廣泛參考的指標,根據臨床試驗,血氧濃度下降指數或血氧飽和度下降指數(ODI)與呼吸中止指數(AHI)具有高度關聯性,因此在醫療數據判斷上,ODI為AHI的初步篩檢參考的重要依據,而ODI可分為3%及4%來記錄血液含氧量(SpO2%),在根據睡眠缺氧的狀況,計算出每小時血氧濃度下降3%與4%的次數,以下提供血氧濃度分級供參考,更深入的說明請參考ZionCare SpO2 Classification During Sleep

Sleep blood oxygen concentration grading

  • L1: Normal: ODI 3% < 5
    The number of oxygen desaturation drop per hour of sleep is in the normal healthy range.
  • L2: Mild: 5 ≦ ODI 3% <15
    The number of oxygen desaturation drop per hour of sleep is slightly higher, please continue to track and observe.
  • L3: Moderate: 15 ≦ ODI 3% <30
    The number of oxygen desaturation drop per hour of sleep is higher than the standard range, it is recommended to consult a professional doctor.
  • L4: Severe: 30 ≦ ODI 3% or T88 ≧ 3%
    The number of oxygen desaturation drop per hour of sleep or the cumulative time with low oxygen saturation is much higher than the standard range, it is recommended to seek further diagnosis by a professional doctor immediately.

How can sleep apnea be improved?

There are hundreds of ways to improve sleep apnea. There are products on the market that use negative pressure tongue suction machines to ensure that the tongue does not fall backwards. Some are anti-snoring braces or masks. The following habits can also be used to improve sleep quality while relying on additional devices.

Common ways to improve sleep apnea

  • Weight Loss: Losing even a tenth of your body weight can reduce the frequency of apnea for most patients, and weight loss is usually the first priority in treating apnea.
  • Sleeping on the side: Sleeping on the back will narrow the airway, making sleep apnea more likely to occur, while sleeping on the side will reduce the incidence, so it can be improved by using special pillows or side sleeping aids.
  • Nasal Congestion Relief Medications: People with sinus problems or nasal congestion can reduce snoring with nasal sprays, breathing patches, or nasal congestion medications, which can improve airflow for more comfortable nighttime breathing and a healthier sleep quality.
  • Avoid Alcohol and Hypnotic Drugs: Do not drink alcoholic beverages before bedtime, and avoid sedative hypnotic drugs before bedtime, as this will make the airways more relaxed, making it easier to collapse during sleep, prolonging the duration of apnea.

What are the treatments for sleep apnea?

If the above improvement methods cannot relieve sleep apnea, more advanced treatment methods may be considered. However, it is recommended to seek professional testing and advice from a doctor before adopting the following treatment options. After all, treatment methods will vary from person to person. In addition to selecting according to the indicators of severity, clinical examination of the location of the overhang is also quite important.

Common sleep apnea treatments

  • Non-invasive treatment: such as oral braces, can reduce snoring and reduce the degree of sleep apnea, and a small number of patients can eliminate sleep apnea.
  • Surgical treatment: such as cutting enlarged tonsils and adenoids, widening the upper respiratory tract, orthognathic surgery, uvulopalatopharyngeal plastic surgery (UPPP surgery), minimally invasive soft palate anti-snoring stent implantation surgery , distraction osteogenesis, etc.
  • Medication: Currently there is no effective drug to treat OSA, but treating nasal allergy can slightly improve the symptoms of OSA.
  • Instrument treatment: such as wearing a ventilator during sleep, a continuous positive airway pressure (CPAP) (Continuous Positive Airway Pressure, CPAP) (Figure 3) adjusted by a doctor and a respiratory therapist (Figure 3) uses air pressure to open the upper respiratory tract, improve sleep quality, and breathe According to its function, it can be divided into single pressure (CPAP), automatic pressure adjustment (Auto CPAP), bi-pressure (BiPAP), etc., which is currently one of the standard treatment methods for adult sleep apnea, and currently obstructive sleep apnea Among the patients with apnea, less than 10% are willing to accept the use of CPAP. The reason is that it is too bulky and inconvenient to carry. If you want to use a light instrument for sleep apnea detection, please refer to Wearable pulse oximeter (Figure 4), early Understand sleep status through simple wearable devices to reduce the probability of chronic diseases.
  • Others: Fitness, dental (surgical) surgery, smoking cessation, alcohol cessation, and sleeping pills all help relieve the condition.
(Figure 3) Continuous Positive Pressure Ventilator

How is sleep apnea detected?

The most accurate option for sleep testing is of course outpatient clinics, but the cost of testing is relatively high. In addition to cost considerations, you also have to queue up to match the outpatient clinic hours. If you need to sleep in a sleep center for one night, your working hours may also be affected. This is also the fundamental reason why the medical community estimates that 12% (2.3 million) adults in Taiwan suffer from sleep apnea, but fewer than 5,000 actually seek medical treatment. Therefore, if you want to check yourself first, you can give priority to blood oxygenation. Wearable devices such as mobile phones to record the status of hypoxia at night, and also attach the unit for sleep apnea hypoxia detection and cooperation with Frontier Technology for reference.

Common Sleep Detection Methods

PSG sleep multiple physiological examination

  • Where to check: Hospital or sleep center
  • Waiting time for screening: 6~9 months
  • Report output time: about 2 weeks
  • Detection line: about 20 detection lines
  • Continuous multi-night monitoring: Difficult to implement
  • Relevant certification: FDA
  • Test items: EEG, electrooculogram, electromyogram, electrocardiogram, apnea index, blood oxygen saturation, blood oxygen concentration drop index, snoring
  • Advantages: Monitor multiple data at once
  • Disadvantages: The time needs to be coordinated with the hospital, and it takes a long time to obtain the report, and most people think that it is difficult to obtain objective data while sleeping in an unfamiliar environment and wearing multiple detection lines on the body
  • Reference: Taiwan Sleep Center Outpatient Test

Home sleep detection device

  • Check location: home
  • Waiting time for inspection: 1~2 days
  • Report output time: Immediately, can be viewed through the App
  • Detection line: no
  • Continuous multi-night monitoring: easy
  • Relevant certification: FDA/TFDA/TGA/CE
  • Test items: SpO2, ODI, PR, RR
  • Advantages: Comfortable to wear while sleeping at home, and easy to perform multi-night monitoring to gain insight into sleep trends, and check medical-grade data directly through the App the next day
  • Disadvantages: It is not as good as hospitals and sleep centers that can monitor various data at one time, and can only accurately monitor data related to sleep apnea
  • Reference: Wearable pulse oximeter machine

Taiwan sleep center outpatient testing

* Certified by the Taiwan Society of Sleep Medicine

Hospital nameHospital addressHospital phone
* 國立臺灣大學醫學院附設醫院台北市中正區中山南路7號東址15樓A棟(02)2356-2755
* 永愉診所台北市中正區忠孝東路一段54號(02)23218799
* 臺北醫學大學附設醫院台北市信義區吳興街252號(02)2737-2181#2155
* 新光吳火獅紀念醫院台北市士林區文昌路95號新光醫院地下二樓(02)2833-2211#2933
* 台北榮民總醫院台北市北投區石牌路二段201號(02)2875-7564
* 振興醫院台北市北投區振興街45號02-28264400
* 基隆長庚紀念醫院基隆市安樂區基金一路208巷200號7樓(02)2431-3131#2657
* 馬偕紀念醫院淡水院區新北市淡水區民生里民生路45號(02)2809-4661#2863
* 桃園長庚紀念醫院桃園市龜山區舊路里頂湖路123號B1(03)3196200#2680
* 衛生福利部雙和醫院新北市中和區中正路291號(02)2249-0088#70213
* 臺北市立聯合醫院陽明院區台北市士林區雨聲街105號9樓(02)2835-3456#6224
* 衛生福利部桃園醫院桃園市桃園區中山路1492號醫療大樓7樓03-3699721#3791、3792
* 彰化秀傳醫療社團法人紀念醫院彰化市南平街61巷6號(健檢大樓四樓)04-7256166#85055
* 中國醫藥大學附設醫院台中市北區美德街166號7樓(04)2205-2121#1781
* 中山醫學大學附設醫院(中興院區)台中市南區復興路二段11號(04)2262-1652#71217
* 佛教慈濟醫療財團法人台中慈濟醫院睡眠醫學中心台中市潭子區豐興路一段66、88號(04)3606-0666#4836
* 財團法人彰濱秀傳紀念醫院睡眠中心彰化縣鹿港鎮鹿工路6號(彰濱工業區鹿港區)(04)781-3888
* 台中榮民總醫院睡眠中心台中市西屯區台中港路三段160號(04)2359-2525#3225
泰安醫院台中市霧峰區本堂里中正路928號04-23393015 # 611
台中勝美醫院台中市北區五權路482號04-22013333 # 103
* 光田綜合醫院台中市沙鹿區沙田路117號(04)2662-2511#2640
* 彰化基督教醫院彰化縣彰化市南校街135號(04)723-8595
* 嘉義長庚紀念醫院嘉義縣朴子市嘉朴路西段6號(05)362-1000#2585
* 衛生福利部台南醫院 台南市中西區中山路125號 (06)220-0055#3383
奇美醫療財團法人奇美醫院 台南市永康區甲頂里中華路901號 (06)281-2811
台南市立醫院 台南市東區崇德路670號 (06)260-9926
台南市立安南醫院 台南市安南區州南里12鄰長和路二段66號(第二醫療大樓六樓) 06-3553111#2665
* 國立成功大學醫學院附設醫院 台南市勝利路138號 06-2353535#4063
* 高雄醫學大學附設中和紀念醫院 高雄市三民區自由一路100號 (07)312-1101#6785
* 高雄長庚紀念醫院 高雄市鳥松區大埤路123號 (07)731-7123
義大醫療財團法人義大醫院 高雄市燕巢區角宿村義大路1號 (07)615-0011
高雄榮民總醫院 高雄市左營區大中一路386號 07-3422121
國軍高雄總醫院 高雄市苓雅區中正一路2號 07-7494965
屏東市寶建醫院 屏東市中山路123號 (08)7665995#2026
屏東東港安泰醫院 屏東縣東港鎮中正路一段210號 (08)8329966#1388
羅東博愛醫院睡眠檢查中心 宜蘭縣羅東鎮南昌街83號 (03)954-3131#3303
羅東聖母醫院 宜蘭縣羅東鎮中正南路160號 (03)954-4106
佛教慈濟綜合醫院花蓮醫學中心 花蓮縣花蓮市中央路三段707號 (03)8561825#9
國軍花蓮總醫院 花蓮縣新城鄉嘉里路163號 (03)8266694
Taiwan sleep center outpatient testing

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