Snoring and insomnia, can you use sedative hypnotic?

Snoring is harmful to human health.

Snoring is called obstructive sleep apnea in medicine.

It is a sleep apnea with sleep apnea and daytime sleepiness as the main clinical manifestations, the prevalence rate is 2%, 4%.

The disease can cause intermittent hypoxia, hypercapnia and sleep disorder, and can lead to hypertension, coronary heart disease, arrhythmia, cerebrovascular disease, cognitive dysfunction, type 2 diabetes mellitus and other multiple organ system damage.

Studies have shown that the mortality of untreated patients with severe OSA is 3. 8 times higher than that of the general population. Data from several hospitals in China confirm that the prevalence of hypertension in OSA patients in different countries is 49.3%, while 83% of patients with obstinate hypertension are OSA patients. Treatment of OSA has a positive effect on lowering blood pressure in these patients.

In addition, the incidence of stroke in the OSA population was 4.33 times higher than that in the control group, and the fatality rate was 1.98 times higher than that in the control group. OSA can damage multiple systems of the body and is a veritable systemic disease. Therefore, doctors, patients and society should pay more attention to the harm of OSA.


Multiple factors associated with snoring.

There are many etiological factors and risk factors of OSA, which can be summarized as follows.

1. Age and sex: the prevalence rate of OSA in adults increased with age; the prevalence rate of men and women was about 2: 1, but the prevalence rate of postmenopausal women increased significantly.

2. Obesity: obesity is an important cause of OSA, and OSA can aggravate obesity.

3. Family history: OSA had familial aggregation, the risk of disease increased 2 to 4 times in those with family history. Genetic predisposition can be expressed in maxillofacial structure, obesity, sensitivity of respiratory center and so on.

4. Anatomical abnormalities of the upper airway: including deviation of nasal septum turbinate hypertrophy nasal polyps nasal tumor and so on.

5. Alcohol and traditional sedative hypnotics: both can reduce the sensitivity of the respiratory center to hypoxia and hypercapnia, decrease the tension of the dilating muscles of the upper airway, and thus make the upper airway more prone to collapse and apnea. It can also inhibit the mechanism of central arousal and prolong the time of apnea.

6. Smoking: OSA can be caused or aggravated by chronic inflammation of upper airway and transient withdrawal effect during sleep.

7. Other related diseases, such as cerebrovascular disease, congestive heart failure, hypothyroidism, acromegaly, vocal cord paralysis and so on, can cause or aggravate OSA.

Snoring causes insomnia.

The typical symptoms of OSA are sleep snoring, accompanied by intermittent snoring and apnea, decreased sleep quality, daytime sleepiness or sleepiness, increased nocturnal urine, etc. Neuropsychiatric symptoms may occur. These include inattention loss, memory loss, irritability, anxiety or depression. At the same time, it is accompanied by cardiovascular system, endocrine system, respiratory system, genitourinary system, digestive system, nervous and mental system, blood system, eye, ear, nose and throat, oral craniofacial and other multi-system problems. Therefore, OSA patients should be treated as early as possible, early diagnosis, according to the etiology of multidisciplinary diagnosis and treatment.

OSA is often associated with other sleep disorders in clinical practice. Insomnia is the patient in the most complaints, accounting for about 39% of OSA patients, 68%. About 50% of the patients with insomnia were diagnosed as OSA by polysomnography (PSG).

Insomnia may aggravate OSA, by weakening the tension of pharyngeal muscle and OSA may also be caused by complex mechanisms such as repeated sleep fragmentation and hyperfunction of hypothalamus-pituitary-adrenal axis. Only a few patients have been diagnosed. Compared with patients with simple OSA, OSA patients with insomnia were younger and more female, with lower sleep sensation (compared with normal OSA patients), sleep disorders and sleep related daytime functional impairment were more serious. The quality of life is worse, and mental illness, cardiovascular disease and lung disease are more common.

OSA patients with insomnia use more psychiatric or sedative hypnotics than those with insomnia alone. Insomnia subtypes are mainly sleep maintenance difficulties and mixed type, the proportion of pure sleep difficulty type is small.

Drug therapy should be carried out at the same time.

The treatment of OSA with insomnia needs to give attention to both OSA and insomnia. The success of treatment depends on the nature of the relationship between insomnia and OSA. If insomnia is secondary to OSA, it can be alleviated by CPAP (continuous positive pressure ventilation) treatment. If insomnia exists on its own, CPAP is less effective in improving sleep, but other treatments for insomnia may be effective, including cognitive behavioral therapy and medication.

Non-benzodiazepine (non-BZDs) zolpidem and right zopiclone are recommended for drug therapy. Conventional doses may improve sleep quality. At the same time, the AHI (respiratory disturbance index) and the lowest SaO2 (arterial oxygen saturation) of OSA patients were not deteriorated, and the sleep quality (prolonging sleep time, increasing sleep efficiency) and CPAP compliance during CPAP titration could be improved by drug treatment of insomnia. Using benzodiazepine? (BZDs) and barbiturates may worsen OSA symptoms and should be avoided.

The use of right zopiclone before CPAP titration can improve sleep quality and reduce the number of repeated titrations. The use of dextrozopiclone at the beginning of 2 weeks of CPAP improved compliance and reduced shedding rates after half a year.

A large number of clinical data show that non-benzodiazepine drugs in snoring patients with insomnia is effective and safe, for snoring patients with insomnia to provide more treatment options.

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