Multidisciplinary team to overcome OSAHS

  As a physician, you may not be unfamiliar with OSAHS (Obstructive Sleep Apnea Syndrome), which refers to more than 30 recurrent episodes of apnea during 7 hours of sleep per night, or more than 5 episodes of sleep apnea index (AHI, i.e., average number of apnea + hypoventilation per hour of sleep). The disease can lead to multi-organ damage: e.g. diabetes, hypertension, coronary heart disease, cerebral infarction, Alzheimer’s disease, etc. Because of the diversity of its clinical manifestations, these patients may be first seen in cardiology, neurology, endocrinology and other departments. However, have you ever noticed the following data: more than 30% of hypertensive patients have OSAHS, 35-45% of coronary artery disease patients have OSAHS, almost 30% of angina pectoris patients have OSAHS, 35-45% of atrial fibrillation patients have OSAHS, 23% of diabetic patients have OSAHS, and 50% of cerebrovascular accident patients have OSAHS? If these patients are not treated for the cause, they are often poorly treated and not easily controlled. In the case of these diseases secondary to OSAHS, the secondary organ damage will be significantly improved after active treatment of OSAHS and improvement of nocturnal apnea and hypoventilation and hypoxia symptoms. We clinically observed that hypertensive patients with OSAHS recovered normal blood pressure soon after surgery, while patients with severe nocturnal arrhythmias could recover normal rhythm after treatment with CPAP. When an internist is faced with nocturnal episodes of arrhythmia, refractory hypertension, unexplained right and left heart failure, angina pectoris, or cerebral infarction, perhaps a consultation about nocturnal sleep and a PSG (polysomnography) test in a suspicious patient may shed light on his or her diagnosis and treatment. This also reminds us that when we encounter some cross-disciplinary diseases, we may get twice the result with half the effort by broadening our clinical thinking and treating the cause.  For the treatment of OSAHS, there are conservative treatment (mainly continuous positive pressure ventilation ventilator-assisted respiratory therapy) and surgical treatment, and this has been a major difference in treatment between internists and otolaryngologists. Everyone will always assume that the treatment option they choose is the best. Although each option has its own indications, as the I Ching says, there is yin in yang and yin in yang, and the two treatments are not opposing but sometimes complementary. In patients with severe OSAHS, CPAP therapy is needed perioperatively to improve hypoxia and reduce the risk of surgery. A significant number of patients who cannot tolerate CPAP treatment due to nasal obstructive disease can achieve satisfactory results after surgical relief of nasal disorders (nasal polyps, deviated septum, chronic hypertrophic rhinitis). Therefore, in the treatment of this disease, according to the severity of the patient’s condition, the location of the obstruction plane and different treatment intentions, we should fully communicate with the patient to choose a personalized treatment that is most suitable for the patient is the real way to round off.  Surgical treatment includes surgery for each obstruction plane. Throughout the development of surgical treatment, there is a growing trend toward minimally invasive and fully functional tissue preservation. Low-temperature plasma-assisted surgical treatment is a popular minimally invasive procedure in recent times. Because of its low temperature, the maximum temperature does not exceed 70 degrees, so the tissue damage is light, the patient’s pain is light, the postoperative recovery is fast, and the intraoperative bleeding is very small, less than 10 ml, changing the course of the previous battle in a pool of blood. Cryo-plasma-assisted surgery is very effective for patients with mild to moderate OSAS. Our department has used low-temperature plasma technology for nasal plane, oropharyngeal plane and linguopharyngeal plane surgery with good clinical efficacy. At present, the department has two projects related to the treatment of OSAHS with low-temperature plasma, which are “Clinical study on the treatment of obstructive sleep apnea syndrome with the assistance of low-temperature plasma” and “Comparison study of tonsillectomy with the assistance of low-temperature plasma and conventional method” of Yangpu District Health Bureau. In addition, a special snoring clinic is held every Friday morning to conduct more in-depth research on the disease and to provide timely education and treatment to patients with the disease, so as to successfully relieve the disease.  Since OSAHS is not a single disease, but a syndrome involving multiple diseases, it is necessary to deepen the clinical understanding of the disease, and it is necessary for the department of otolaryngology, neurology, cardiology, endocrinology, pediatrics and other departments to work together to diagnose and treat OSAHS, so as to provide accurate and rapid diagnosis and personalized treatment for OSAHS patients and better help them recover.