Hysteria

Introduction

Introduction to snoring

Hysteria, also known as snoring, snoring, and sleep apnea syndrome, is a ubiquitous sleep phenomenon that is a heavy sound caused by breathing blocked tongues and soft twitching while sleeping. Because of snoring, sleep breathing is repeatedly suspended, causing severe hypoxia in the brain and blood, forming hypoxemia, and inducing hypertension, brain heart disease, arrhythmia, myocardial infarction, and angina pectoris. A nighttime apnea of more than 120 seconds is prone to sudden death in the early hours of the morning.

basic knowledge

Probability ratio: about 10% incidence in obese people

Susceptible people: no specific population

Mode of infection: non-infectious

Complications: pulmonary hypertension, respiratory failure, hypertension, arrhythmia

Pathogen

Cause of hysteria

Any stenosis or blockage of the upper respiratory tract can result in obstructive sleep apnea.

Nasal and pharyngeal and laryngeal lesions (30%):

Narrow stenosis or atresia, nasal septum deviation, nasal polyps, hypertrophic rhinitis, allergic rhinitis, various benign or malignant tumors of the nose; nasopharyngitis, adenoid hypertrophy, nasopharynx atresia or stenosis, tonsil granules, Overhang or hypertrophy, pharyngeal tumor, pharyngeal muscle paralysis; epiglottis, epiglottic cyst, epiglottic tumor, glottic edema, vocal cord paralysis, larynx, laryngeal cartilage softening; and goiter in the neck and other primary Sexual or metastatic mass compression.

Some congenital facial deformities (20%):

1Piene-Robin syndrome, characterized by small jaw, neck split, hard waist arch, tongue drooping and so on.

2Prader-Willi syndrome, mainly manifested as dysphagia, obesity, facial deformity, low sexual function, mental retardation and so on.

2Down syndrome, there is a low level of the bridge of the nose, the infertility is awarded, the lower collar is small, the high waist bow, and the mental retardation waits.

4Treacher-C011ins syndrome, characterized by hypoplasia of the mandibular and facial bones, such as the following defect, upper iliac margin deformity, small jaw, frontal bone subsidence, lumbar rupture, epiglottis deformity and ear malformation.

5Crouzon syndrome, mainly craniofacial bone hypoplasia, nasal bridge low width, hook-shaped nasal nostrils, narrow nasal cavity, nasal septum deviation, upper collar depression, upper lip shortening, hard palate high arch, mandibular large and prominent.

6Hurler-Scheie syndrome, its clinical features are between Hurler syndrome and Scheie syndrome, characterized by buccal retraction (small jaw), symptoms of mental retardation, ruins, multiple bone dysplasia, corneal opacity, deafness, etc. .

Systemic disease (20%):

Acromegaly causes enlargement of the tongue, mucinous edema caused by hypothyroidism, chronic lymphocytic leukasytic angina, endocrine disorders after menopause, and obesity are all likely to cause OSAS. The reasons why obese people are prone to OSAS may be:

1. Such patients have hypertrophy of the tongue, and there are excessive fat deposits in the soft, uvula and pharyngeal wall, which may cause airway obstruction.

2. The degree of pharyngeal opening is related to the volume change of the lung. When fat is used, obese people can significantly reduce the lung volume, resulting in obesity-induced hypoventilation syndrome; this may be due to an increase in abdominal fat resulting in an increase in volume, making the banner It is elevated, and because fat is deposited on the diaphragm and intercostal muscles, it reduces the intensity of breathing, so it is easy to cause the intrinsic.

Oral lesions (10%):

It is affected by the lesions of the tongue, such as giant tongue disease, tongue tumor, ectopic thyroid gland at the base of the tongue, enlarged tongue secondary to mucinous edema, and some patients with cleft palate repaired with pharyngeal flap.

Prevention

Hysteria prevention

1. Enhance physical exercise and maintain good living habits.

2, to avoid alcohol and tobacco hobbies, because smoking can cause increased respiratory symptoms, drinking increased snoring, nocturnal breathing disorders and hypoxemia. Especially drinking before going to bed.

3. For obese people, actively reduce weight and strengthen exercise.

4, patients with snoring have a lot of blood oxygen content, so often accompanied by high blood pressure, heart rhythm disorder, increased blood viscosity, increased heart burden, easily lead to cardiovascular and cerebrovascular diseases, so pay attention to blood pressure monitoring, take time on time Press the drug.

5, sedative, sleeping pills are not allowed before going to bed, so as not to aggravate the inhibition of respiratory center regulation.

6, taking the lateral position of the sleeping position, especially in the right lateral position is appropriate, to avoid the tongue, soft palate, uvula and sagging during sleep, and then the upper airway blockage. It can be used to hold a small ball on the back during sleep, which helps to maintain sleep in the lateral position.

7, patients after surgery should be soft food-based, do not eat too hot food. Avoid strenuous activities.

Complication

Hysteric complications Complications pulmonary hypertension respiratory failure hypertension arrhythmia

Gradually, the disease can develop severe complications such as pulmonary hypertension, pulmonary heart disease, respiratory failure, hypertension, and arrhythmia.

Symptom

Symptoms of snoring common symptoms sleep apnea sleepiness sleep rhythm disorder snoring fatigue sleep sudden cardiac arrhythmia

1. History The patient's snoring loudness increased more than 60dB after cooking, hindering the gas exchange during normal breathing, called snoring, 5% of snoring patients have different degrees of hernia during sleep, called obstructive sleep apnea syndrome (obstructive sleep apnea syndrome, OSAS), clinical manifestations of severe snoring, hernia, nocturnal apnea, sleepwalking, enuresis and white sleepiness, may also be associated with cardiovascular and respiratory secondary diseases such as hypertension, cardiac hypertrophy, arrhythmia, Pulmonary function tests in 30% of patients have different degrees of chronic lung injury, in addition to emotional depression and forgetfulness.

2. Physical examination Fiber nasopharyngoscopy has new organisms and cavity size; tongue movement is posterior; pharyngeal cavity is narrow and collapsed; epiglottis is displaced into the larynx.

Examine

Hysteric examination

Sleep breathing monitoring:

Monitoring Methods Sleep Respiratory Monitoring monitors the results of central nervous system, respiratory and cardiovascular system functions, and sleep-disordered breathing during sleep, providing a basis for diagnosis. Standard polysomnography should record the following variables throughout the night: EEG, EMG Figure, electrocardiogram, ventilation, chest and abdomen breathing exercise and respiratory disorders, direct monitoring of ventilation requires the use of a bite or mask to collect exhaled breath, but patients are not easily tolerated, and affect the natural sleep state, indirect monitoring ventilation including qualitative and semi-quantitative The method can be applied to the respiratory gas passing through the nose and mouth using a thermistor or a fast CO 2 analyzer. The semi-quantitative method can use a magnetometer or a respiratory inductive body plethysmograph, and the chest and abdomen breathing motion can be performed by a diaphragm electromyogram. Through the measurement of pressure and the detection of respiratory plethysmography, the monitoring of the results of respiratory disorders mainly directly or indirectly measured the partial pressure of CO 2 and oxygen saturation of arterial oxygen.

Laboratory and other inspections:

1, blood test for a long time, severe hypoxemia, blood cell count and hemoglobin can be increased to varying degrees.

2, arterial blood gas analysis of serious or complicated pulmonary heart disease, high blood pressure, coronary heart disease, may have hypoxemia, hypercapnia and respiratory acidosis.

3, chest X-ray examination with pulmonary hypertension, hypertension, coronary heart disease, may have increased heart shadow, pulmonary artery segmentation and other corresponding performance.

4, pulmonary function test severity of pulmonary heart disease, respiratory failure, there are varying degrees of ventilatory dysfunction.

Electrocardiogram has hypertension, coronary heart disease, ventricular hypertrophy, myocardial ischemia or arrhythmia changes.

Diagnosis

Diagnosis of hysteria

diagnosis

Check parts

1. Pay attention to the ear, nose, throat, weight and cardiopulmonary examination.

2. Fiber nasopharyngoscopy to check for new organisms, cavity size.

3. Whether the movement of the tongue moves back.

4. Whether the pharyngeal cavity is narrow or collapsed.

5. Whether the epiglottis is displaced into the larynx.

6. Polysomnography (including electrocardiogram, EEG, EMG, eye movement, number of apneas, and oxygen saturation).

7. Sleep fluoroscopy, from the side of the fluorescent screen to observe the pharyngeal isthmus, nasopharyngeal cavity and posterior airway for stenosis and obstruction.

8. Sound level measurement and sound spectrum analysis of the hum.

Before treatment of snoring, it is necessary to find out whether there is obstructive sleep apnea syndrome, the most common is to perform nighttime sleep examination, that is, polysomnography (in the hospital), treatment of OSAS can also be treated simultaneously The buzz is heard, so the first thing to do is to find out if there is OSAS.

If you only have snoring, you can use the same treatment method as mild OSAS, such as losing weight, even if you only lose a small amount of weight, it will have a clear expectation of snoring. If there is a nasal congestion at the same time, various methods of treating nasal obstruction can alleviate snoring. The nasal obstruction may be due to allergic rhinitis, nasal septum deviation or other mechanical causes such as tumors. According to different causes of nasal congestion, drugs or surgical methods may be used. To treat. Patients with nasal septum deviation can correct the nasal septum.

Differential diagnosis

Your doctor will ask you about all history of sleep discomfort, excessive sleep during the day, bursting snoring as reflected by your bedmate, and/or long-term apnea. These symptoms strongly suggest that you have sleep apnea and the doctor needs to check you further for treatment.

These tests are usually performed in a sleep lab and include:

Visual observation of sleep to detect difficult breathing with long pauses, and subsequent sleep arousal.

Use pulse oximetry to measure oxygen levels and pulse rates in the blood. At least 8 hours of overnight recording is required. Can be done at home.

Multiple peaks in the horizontal and multiple peaks in the pulse rate can occur in patients with sleep apnea.

Polysomnography, involving many methods of sleep measurement, including determining eye movement and chin patterns in the sleep phase, airflow through the nose and mouth, chest wall motion, oxygen levels in the blood, and ECG (used to measure severe abnormal heart rhythm) ECG).

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