夜晚咳不停 或鼻水倒流

咳嗽未必是嚴重的健康問題，但經常咳個不停卻也不好受，而不少人更試過日間活動時正常，但每每躺在床上準備睡覺時，咳嗽就特別嚴重，以致整晚無法安睡。原來，睡覺時我們的氣管會因為肌肉放鬆而較日間為窄，故容易受到刺激；有些人則是因為有鼻水倒流 (post-nasal drip)，刺激氣管產生咳嗽反應，於是每次躺臥在床便咳嗽不斷。 鼻水即是鼻涕，主要是用作濕潤及暖化空氣，一般都會經由鼻孔流出或進入食道消化，但有時傷風感冒，或鼻敏感發作 (allergic rhinitis)，鼻水分泌大量增加，在日間病人會用紙巾吸走鼻水，惟晚上躺臥時，鼻水受地心吸力影響後流向入氣管，刺激氣管誘發咳嗽，假如鼻道有阻塞，病人可能日間也會有鼻水倒流的情況。對於睡覺時有咳嗽或咳嗽變嚴重的病人，醫生可以利用鼻內窺鏡 (nasal endoscopy) 檢查細看，便可以知道病人是否有鼻水倒流。 受咳嗽問題困擾的病人，求醫當然想立即止咳，但有時也得容許醫生花一點時間，找出咳嗽的成因才能有效止咳，例如鼻敏感導致鼻水倒流引起的咳嗽，就要好好控制鼻敏感，方能令咳嗽消失，否則即使天天吃咳藥也不能根治問題。 Chronic cough is a common problem facing ENT physicians every day. Its etiology is often multifactorial, making diagnosis difficult. Common causes in the upper airway (nose, throat, pharynx, larynx) include but not limited to allergic and non-allergic rhinitis, post-nasal discharge, laryngopharyngeal reflux disease, chronic tonsillitis, and chronic laryngitis. We as ENT physician can perform a simple in-office procedure called fiberoptic nasopharyngoscopy to evaluate for these upper airway pathologies. Sources: http://the-sun.on.cc/cnt/news/20121030/00410_014.html

Obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common health problems affecting both adults and children. It is often under diagnosed especially in female and senior population. Snoring presents in almost all patients with OSA. Additional symptoms include daytime somnolence, sleep disturbances, decreased work performance and concentration. If untreated, it can lead to cardiopulmonary complications such as hypertension and pulmonary hypertension. In children it is often related to adenotonsillar hypertrophy, hence tonsillectomy and adenoidectomy are curative. Patients can also present with nasal obstruction and narrowing of the nasal passages due to deviated septum, nasal polyps, hypertrophic nasal turbinates, or sinusitis. Sleep study remains the gold standard for diagnosing OSA. It measures the duration and frequency of pauses of breathing, as well as oxygen concentration and other abnormal brain activities. In young children, parental observation is often recommended due to difficulties of obtaining a meaningful sleep study. Mainstay of treatment for OSA in adult population is CPAP device. It provides positive pressure ventilation to "re-open" the collapsed airway. Sleep surgery is considered for patients who are unable to tolerate CPAP and severe cases involving jaw advancement or definitive tracheostomy airway. Weight loss management is also paramount for improving the severity of OSA. Excerpt from Community health talk at the Sunset Church of San Francisco. March 15, 2013.