Snoring - Ventilator or Surgery? Experts tell you!

The main harm of obstructive sleep apnea syndrome (OSAHS) is that frequent sleep apnea and hypopnea lead to a decrease in blood oxygen saturation during long-term sleep, which triggers a series of changes in human endocrine and eventually causes high blood pressure. Blood pressure, diabetes, coronary heart disease, cerebrovascular accident, etc. At the same time , due to drowsiness during the day, people suffering from OSAHS are particularly prone to traffic accidents when driving .

At present, the treatment of choice for OSAHS at home and abroad is positive airway pressure therapy (CPAP), that is, ventilator therapy . According to foreign data, the effective rate of CPAP treatment has reached more than 80%. However, since the patient has to wear a ventilator to sleep, the long-term compliance is not good. Therefore, surgery is still an important treatment for OSAHS.

Diagnosis depends on sleep monitoring

The examination of OSAHS mainly includes: body mass index (weight/height square), development of maxillofacial region, whether nasal cavity has turbinate hypertrophy, nasal polyps, deviated nasal septum, whether there are residual adenoids and tumors in nasopharynx, oral Whether there is hypertrophy of the tonsils in the pharynx, whether there is hypertrophy of the soft palate and pharyngeal lateral cord, whether there is hypertrophy of the tongue, and whether the hypopharyngeal glottis is present. Generally, after the above physical examination, the cause of OSAHS and the blocking site can be preliminarily understood.

Polysomnography, or sleep apnea monitoring, is a necessary test for the diagnosis of OSAHS. Sleep apnea monitoring can detect the number of apnea and hypopnea that occur during the patient's sleep. The diagnostic criteria for adult OSAHS at home and abroad is that there are more than 30 repeated episodes of apnea and hypopnea during 7 hours of sleep per night, or AHI (sleep apnea hypopnea index) is greater than or equal to 5 times per hour. Sleep apnea monitoring can also differentiate whether the cause of the apnea is obstructive, central, or mixed.

Sleep can clarify the lesion

After a clear diagnosis, the most important thing is to determine the cause of OSAHS and the location of the obstruction, that is, localization diagnosis. Localization diagnosis is also an important preoperative examination, and different surgical methods are used for different blocked parts. At present, the most widely used positioning examination at home and abroad is electronic or fiber optic nasopharyngoscopy. This examination is a non-invasive examination and is easily accepted by patients.

For electronic or fiberoptic nasopharyngoscopy under induced sleep, the anesthesiologist injects a certain amount of inducing anesthetic drugs intravenously to induce the patient to sleep, and at the same time performs ECG blood oxygen monitoring and sleep depth monitoring. When the patient falls asleep and reaches the physiological sleep depth, observe whether there is snoring or suffocation, and record the blood oxygen saturation at the same time. Then enter the nasopharyngoscope from the nasal cavity, check the nasal cavity, nasopharynx, oropharynx and hypopharynx in sequence, and observe the snoring and vibration parts of the upper airway and the obstruction. The inspection process can be synchronized with video and audio recording.

In addition, CT and MRI examinations can also be used to objectively evaluate the location and degree of obstruction in OSAHS. However, due to the radioactivity in CT, MRI examinations are time-consuming, and both are difficult to perform while the patient is sleeping, so they are rarely carried out.

Another positioning method recently developed clinically is esophageal manometry. A catheter equipped with several pressure transducers is inserted through the subject's nasal cavity into the esophagus. When the subject experiences airway obstruction during sleep, the sensor at the corresponding part will generate a pressure signal, which will be transmitted to the computer for recording and analysis, and a positioning diagnosis can be made.


Surgical methods vary from person to person

There are many surgical methods, and the specific surgical plan needs to be individually formulated according to the patient's condition. Usually, different surgical methods are selected according to the location of upper airway obstruction.

Nasal plane obstruction can be determined based on relevant preoperative examinations to determine whether there are nasal polyps, turbinate hypertrophy, and deviated nasal septum, and perform corresponding operations, such as nasal polypectomy, turbinate radiofrequency ablation, and nasal septum correction.

Soft palate and oropharyngeal plane obstruction The most common obstruction site in OSAHS is the soft palate plane. American otolaryngology experts have recently created a soft palate braided fiber implant technology, by implanting 3 to 5 matchstick-shaped implants in the soft palate to increase the rigidity of the soft palate and eliminate the vibration and snoring that occur when the airflow passes . This method is effective for simple snorers, but less effective for OSAHS patients. On the basis of foreign soft palate implant technology, we have improved and created a minimally invasive surgery for soft palate support fixed on the hard palate. The operation is to design and manufacture a medical titanium alloy plate or nickel-titanium alloy support body with appropriate rigidity and elasticity according to the anatomical characteristics of the patient's hard and soft palate. One end of the support is fixed on the hard palate, and the other end is implanted in the soft palate. The soft palate support is generally implanted in two pieces, with a certain curvature, and can be adjusted after implantation. It can not only support the soft palate, keep the airway unobstructed, but also allow the soft palate to properly close when eating and speaking. This new method can not only reduce the vibration of the soft palate to eliminate snoring, but also improve the ventilation of the patient during sleep. The operation is simple and minimally invasive. There is almost no foreign body sensation in the pharynx after operation, and there are no complications such as nasopharyngeal reflux or pronunciation changes. This soft palate support body and implantation method have applied for a Chinese invention patent and are applying for an international patent.

Oropharyngeal plane obstruction is usually caused by tonsil hypertrophy and pharyngeal lateral mucosal hypertrophy. Generally, tonsils can be removed surgically, and hypertrophic mucosal folds can be trimmed. It can also be treated with radiofrequency ablation.

Hypopharyngeal plane obstruction Tongue hypertrophy and tongue base hypertrophy are also common causes of obstruction, especially in obese patients. There are also a variety of surgeries for the tongue and hypopharynx, including radiofrequency ablation of the base of the tongue, partial resection of the tongue body, suspension of the tongue muscle, and advancement of the upper and lower jaws. Various surgical methods have achieved certain curative effects in clinical practice, but it is necessary to choose the appropriate surgical method according to the specific conditions of the patient.

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