There are some common predisposing factors of sleep apnea:

• Smoking

• Platybasia

• Lymphoma

• Myxoedema

• Acromegaly

• Retrognathia

• Macroglossia

• Micrognathia

• Increasing age

• Enlarged uvula

• Nasal deformity

• Down’s syndrome

• Marfan’s syndrome

• Iatrogenic stenosis

• Scheie’s syndrome

• Myotonic dystrophy

• Pharyngeal neoplasms

• Prader-Willi syndrome

• Guillain-Barré syndrome

• Craniofacial disproportions

• Hypertrophic palatine tonsils

• Enlarged oropharyngeal tissue

Sleep apnea-hypopnea syndrome refers to a variety of causes repeated sleep apnea and (or) low ventilation, hypercapnia, sleep disruption, leading to  the bod a series of pathophysiological change to the body.

Definitions and classifications:

(A) Definition: sleep apnea-hypopnea syndrome refers to the night during sleep apnea episodes repeated 30 times or more, or sleep apnea-hypopnea index (AHI) “= 5 times / hour and was accompanied by lethargy and other clinical symptoms. Sleep apnea refers to the complete cessation of airflow in the nose and mouth breathing for more than 10 seconds; hypopnea refers to the respiratory airflow during sleep intensity (amplitude) was higher than the basic level decreased by 50% or more, accompanied by a more basic level of oxygen saturation down “ = 4% or micro-awareness; Sleep apnea-hypopnea index is within an hour of sleep apnea-hypopnea frequency.

B) Classification: 1, central type (CSAS) 2, obstructive (OSAS) 3, mixed type (MSAS)

Epidemiology:

With OSAHS, for example, in the population over 40 years, the U.S. prevalence rate of 2% -4%, more men than women, the elderly a higher prevalence in Australia of up to 6.5%.

Etiology and pathogenesis:

• (A) central-type sleep apnea syndrome (CSAS)

CSAS pure rare, generally no more than 10% of patients with apnea, also have reported that only 4%. Patency can be further divided into high and normal hypercapnia hypercapnia two major categories. CSAS can co-exist with obstructive sleep apnea hypopnea syndrome, and common accompanied with nervous system or motor system lesions.

Pathogenesis may be related to the following factors:
1.sleep respiratory center response to a variety of different stimuli decreased.

2. the instability of respiratory feedback regulation of  the central nervous system to hypoxia, especialy those caused by changes in CO2 concentration.

3.  exhale and inhale conversion mechanism disorders.

• obstructive sleep apnea-hypopnea syndrome (OSAHS)

Accounted for the majority of SAHS, a family gathering and genetic factors, most with upper respiratory tract, especially the nose, pharynx narrow part of the pathological basis, such as obesity, allergic rhinitis, nasal polyp, tonsil hypertrophy, soft palate relax, the palate is too long vertical too thick, tongue hypertrophy, tongue base after the fall, mandibular retrusion, temporomandibular joint dysfunction and small jaw deformities. Some endocrine diseases can also be combined with this disease. Its pathogenesis may be related to sleep state, the upper airway soft tissue, muscle collapse of increased upper airway muscles during sleep, hypoxia and carbon dioxide decreased the stimulus-response, in addition, but also nervous, humoral and endocrine factors such as the comprehensive effects.

Clinical manifestations

(A) the day time of clinical performance:

• lethargy: The most common symptoms, the performance of light who work or study time during the day and sleepiness, lethargy, severe eating, talking with people you can go to sleep, or even serious consequences, such as dozing off while driving cause traffic accidents .

• Dizziness and weakness: As the night repeated apnea, hypoxemia, so that the continuity of sleep disruption, increased frequency of awakening, sleep quality, decrease, often slightly different from the dizziness, fatigue, weakness.

• Spirit Abnormal behavior: can not concentrate, fine drop operation ability, memory and judgment decline symptoms in severe cases can not do the work, the elderly can be expressed as dementia. Nocturnal hypoxemia on the brain damage and changes in sleep architecture, especially the deep sleep phase reduction is the main reason.

• Headache: usually occurs early in the morning or at night, pain more common, non-violent, sustainable 1-2 hours, and sometimes required to the pain medication in order to ease the pain.

• Personality changes: irritable, easily agitated, anxiety, family and social life are subject to a certain extent, due to gradually alienation with family members and friends , depression may occur.

• Sexual dysfunction: About 10% of patients, there may be loss of libido and even impotence.

(B) the night of clinical performance:

• snoring: is the main symptom, snoring irregular, high and low ranges, often snoring – flow stops – breathing – snoring interspersed with the general flow interruption time for 20-30 seconds, the individual up to 2 minutes more, this time in patients with may appear obvious cyanosis.

• Apnea: 75% of the same room or bed with sleep apnea have found that patients often worry about breathing can not be restored while the push awake patients with apnea breathe more, choke, or loud snoring waking terminated. OSAHS patients have significant paradoxical thoracoabdominal

• Hold in Peter: respiratory choke suddenly wake up after a pause, often accompanied with emancipated, involuntary movements of limbs and even convulsions, or suddenly start feeling flustered, chest tightness or precordial discomfort.

• Hyperactivity anxiety: a result of hypoxemia, the patient stand up at night, turning more frequently.

• Hyperhidrosis: Sweating more, to the neck, upper chest clear and airway obstruction and apnea after forced breathing caused by the hypercapnia.

• Nocturia: Some patients with increased frequency of urination at night v. individual appears enuresis.

• Sleep Abnormal behavior: the performance of the fear, screaming, nonsense, night, hearing voices.

(C) the performance of systemic organ damage:

OSAHS patients with different cardiovascular system usually manifested often the first symptom and signs, which can be high blood pressure, coronary heart disease an independent risk factor.

• Hypertension: OSAHS patients with hypertension incidence rate of 45%, and poor therapeutic effect of antihypertensive drugs.

• Coronary heart disease: the performance for various types of arrhythmia, angina and myocardial infarction at night. The 20 coronary artery endothelial injury caused by lack of oxygen, lipid deposition in the intima, as well as an increase in red blood cells due to the increase of blood viscosity.

• Various types of arrhythmia.

• Pulmonary heart disease and respiratory failure

• Ischemic or hemorrhagic cerebrovascular disease

• Mental disorder: such as psychosis or manic depression

• Diabetes

Laboratory and other test:

• Blood tests: long illness, severe hypoxemia, blood red blood cell count and hemoglobin may have different extents of growth.

• Arterial blood gas analysis: a serious illness or combined pulmonary heart disease, respiratory failure who may have hypoxemia, hypercapnia and respiratory acidosis.

• Chest X-ray examination: concurrent pulmonary hypertension, high blood pressure, coronary heart disease, it can shadow determined to increase the corresponding salient symptoms of pulmonary arterial segment.

• Pulmonary function tests: a serious condition with pulmonary heart disease, respiratory failure, there are different degrees of ventilation dysfunction.

• ECG: high blood pressure, coronary heart disease occurs when ventricular hypertrophy, myocardial ischemia or arrhythmia and other changes.

Diagnosis

According to the typical clinical symptoms and signs, diagnosis, SAHS is not difficult, diagnosis and understand the severity and type of illness, you need to conduct the appropriate examination.

• Clinical diagnosis: according to the patients with sleep apnea snoring, daytime sleepiness, obesity, neck circumference and other clinical symptoms of rough preliminary clinical diagnosis can be made.

• Polysomnography: PSG monitoring is the gold standard for diagnosis SAHS, and can determine the type and severity.

• Etiological diagnosis: The diagnosis of SAHS routinely ENT and oral examination, to understand whether the local anatomy and developmental abnormalities, hyperplasia and tumors. Skull and neck X-ray photographs, CT and MRI cross-sectional area measured oropharynx and can be used to determine the positioning of the narrow. Some patients with the endocrine system can be determined.

Differential Diagnosis

• Simple snoring: There are significant snoring, PSG examination does not meet the upper airway resistance syndrome, non-apnea-hypopnea without hypoxemia.
• Upper airway resistance syndrome: airway resistance increased.
• Narcolepsy: excessive daytime sleepiness, cataplexy attack.Family history.

Treatment

(A) central sleep apnea syndrome treatment

• Treatment of primary disease: If the nervous system disease, congestive heart failure treatment.

• Respiratory stimulant drugs: The main respiratory center to increase the driving force to improve the apnea and hypoxemia. Drugs: almitrine (50mg ,2-3 times / day), acetazolamide (125-250mg ,3-4 times / min or 250mg bedtime) and theophylline (100-200mg ,2-3 times / days)

• Oxygen therapy: You can correct hypoxemia, right heart failure secondary to congestive heart patients, can reduce apnea and hypopnea frequency of pairs of neuromuscular disease may be aggravated hypercapnia, but if the merger is likely to contribute to OSAHS obstructive sleep apnea.

• Assisted ventilation therapy: severe patients, mechanical ventilation can enhance breathing on his own may make use of non-invasive positive pressure ventilation and invasive mechanical ventilation.

(B) Obstructive sleep apnea-hypopnea syndrome treatment

• General treatment: (1) weight loss: diet, drugs and surgery. (2) sleep position changes: lateral sleep, raising the bed. (3) quit smoking wine, to avoid taking sedatives.

• Drug treatment: Effects not sure. Could try acetazolamide. Modafinil to improve the role of daytime sleepiness, drowsiness applied to receive CPAP treatment in patients with symptom improvement was not obvious, there are some success.

• Equipment Treatment.

• Surgical treatment: (1) Nose surgery (2) vertical palatal palatal pharyngeal angioplasty (3) Laser-assisted UPPP (4) low-temperature radiofrequency ablation (5), orthognathic surgery

Disease Overview

Obstructive sleep apnea syndrome (OSAS), is due to some attributable to upper airway obstruction, sleep apnea from time to time, accompanied by hypoxia, snoring, daytime sleepiness and other symptoms of a more complex disease. Occur in the obese, the elderly. Any parts of the upper respiratory tract obstructive lesions can cause OSAS.

OSAS showed snoring loudness is greater than 60dB, prevent those who sleep in the same room of people, and with sleep apnea, apnea index greater than 5; Night-time low oxygen saturation measured values, during the sleep apnea,  the forced breathing movements of chest and abdomen can be seen. In the suffocating nature of the end of the outbreak can be heard a snoring sound, and exhaled a long-winded, and fiberoptic endoscopy and CT, Polysomnography and other auxiliary examination can help diagnose.

Symptoms and signs

More common 40-60 years of age, overweight men, more common in the elderly. Clinical features is loud snoring, short-term asthma and lasted 10 seconds or more of apnea alternating. Nose and mouth breath stoped, but chest and abdominal breathing still exist. Apnea produced a sense of suffocation and accompanying physical activity can be awakened suddenly appeared to fall asleep again after a few breathing. Frequently stand up during sleep or physical movement. Sometimes, suddenly sat up, mouth mutter prayers, suddenly stiff neck while sleeping. During the day time,  feeling tired, sleepy, no spirit, early morning headaches, retardation, as well as memory, attention, common sense and vigilance power drops. , There may be depression, anxiety, irritability, dry mouth, loss of libido and high blood pressure.

Disease etiology

Nasopharyngeal throat abnormalities lead to narrowing of the upper respiratory tract is the main reason of airway obstruction during sleep .

Diagnostic

Polysomnography is the gold standard for diagnosis of this disease. In the night of 7 hours sleep, recurrent apnea for more than 30 times, each time for more than 10 seconds, or apnea-hypopnea index (AHI; refers to the average length of the whole night of sleep apnea and hypopnea per hour, the total number) more than 5 times . Hypopnea refers to more than 50% reduction in respiratory airflow for more than 10 seconds. Sleep apnea common in 1,2 non-REM stages, rare 3,4 stages, most common in REM sleep. Non- REM 3,4  sleep stages shortened, with an average sleep latency often within 10 minutes.

Treatment

Available non-surgical therapy, such as weight loss, side sleep, avoiding alcohol and sedatives before going to bed and so on. Now commonly used and effective therapy is nasal continuous positive airway pressure airway ventilation, sleep wear a face mask and breathing machine connected from the ventilator resulting increase in upper airway pressure on forced air, both in inspiratory or expiratory able to maintain a constant state of pressure, so that the upper airway is kept open to avoid the collapse or obstruction. You can also use different types of oral appliance, put the mandible or tongue forward at the top, Increase in pharyngeal cross-sectional area to increase the breathing gas flow rate.

Warning signs and symptoms of sleep apnea include:

• Loud snoring

• Mouth breathing

• Frequent silences during sleep due to breaks in breathing (apnea)

• Sudden awakenings to restart breathing or waking up in a sweat

• Sleep does not recover from fatigue, daytime sleepiness, lethargy

• Sleep at night angina, heart rhythm disorder

• After the sleep blood pressure, headache

• Night-time sleep enuresis, nocturia increased

• Choking or gasping during sleep to get air into the lungs

• Daytime sleepiness and feeling unrefreshed by a night’s sleep, including falling asleep at inappropriate times

• Memory loss, unresponsive, decreased working and learning ability

• Impotence, loss of libido

• Alzheimer

• Waking up with a very sore and/or dry throat

There are several treatment options for individuals with obstructive sleep apnea. These treatment options include:

1.lose weight
Obesity can cause the airway to be under more pressure than usual and can easily cause the collapse of soft tissue on the airway.

2.Changing sleep positions
Sleeping on your side can also be helpful opposed to sleeping on your back.

3.No alcohol and Stop smoking
Try this can reduce muscle relaxants.

4.Use Oral Appliances
There are various oral appliances that can hold the airways open while you sleep.

5.Try Use CPAP Breathing Machines
There are the CPAP breathing machines that assist some people. CPAP stands for continuous positive pressure. It is a method of ventilation for the respiratory system. In fact, it was specially developed to use in sleep apnea cases.

6.Surgery
Surgery to remove excess tissue from the nose or that causes snoring and/or is blocking the upper air passages causing sleep apnea.

Snoring may cause morning headaches, here are some reasons :

• sleep apnea

snoring may causes  sleep apnea, Sleep apnea is a very dangerous condition wherein someone actually stops breathing for a few moments because of restricted airflow. They then wake up just long enough for the body to force itself to start breathing again and are typically not awake long enough to even know that their sleep has been interrupted.

When caused by sleep apnea the connection between these and snoring is because the brain is literally starved of needed oxygen over and over again throughout the night. If left unchecked this condition can actually cause slight brain damage so it’s no wonder that a person would get morning headaches from this! Sleep apnea is very common in persons who are overweight as this excess body fat puts undue pressure on the neck and cuts off the airway.

• head hurting

Another reason that these are connected is because if a person snores very loudly or deeply, they are actually hurting their own head. That constant vibration of the dry tissue of the throat can cause damage to the entire back of the neck and head giving a person a headache.

• too little sleep

Studies show that both too little and too much sleep may causing morning headaches. Obviously, snoring can cause sleep reducing.

Most persons who have it do not even know that they have sleep apnea. Considering how dangerous it is, if you have morning headaches and snoring problems, and especially if you are overweight, you may want to talk to your doctor immediately about medical intervention or treatment options.

Disease Overview:

Obstructive sleep apnea syndrome(OSAS), was due to some reason which led to airway obstruction, stop breath from time to time during sleep, accompanied by hypoxia, snoring, daytime sleepiness and other more complex symptoms. Any parts of the upper respiratory tract obstructive lesions can be caused  OSAS.

OSAS showed snoring loudness is greater than 60dB, prevent those people who sleep in the same room. Accompanied with sleep apnea, and apnea index greater than 5 above; Night-time low oxygen saturation measured values, in the sleep apnea period, the thoracic and abdominal breathing movements can be seen forced, at the end of breath holding can be heard a snoring sound, and exhaled an outbreak of a long-winded。

The treatment of  obstructive sleep apnea syndrome should be based on severity of symptoms, the number of clinical complications, causes of airway obstruction and patients physical condition, using different treatment. The most common surgical method for the OSAS is uvulopalatopharyngoplasty operation.