Obstructive sleep apnea is generally defined as the cessation of oral and nasal airflow for 10 seconds or more per episode, accompanied by a decrease in oxygen saturation, etc. In adults, the number of episodes is often 30 or more per night during a 7-hour sleep period. There are also central sleep apnea (CSA) and mixed sleep apnea (MSA). In recent years, as various testing methods have progressed, in-depth comprehensive studies of OSA have revealed the complexity, variability, and prevalence of the disease. Therefore, OSA cannot be generally regarded as an annoying sound that interferes with the rest of the bystanders in social intercourse life, but a clinical disorder that needs to be carefully examined and can cause many serious complications. Since the anatomical site of snoring is closely related to the otorhinolaryngology, many patients often seek treatment from otorhinolaryngology first. Symptoms and signs Almost all patients have high pitched snoring after sleep, which affects the rest of the roommates. The circulatory manifestations such as snoring, breath-holding and stopping breathing are also often provided by their family members or roommates’ narratives. Patients are drowsy during the day and often fall asleep unconsciously between conversations. There is memory loss, inability to concentrate, and decreased productivity. There may also be changes in mood and behavior. Restlessness, excessive dreaming, enuresis, impotence, morning headache, etc. In children there may be a decrease in intelligence and academic performance, as well as sleepwalking and nightmares. Severe and persistent patients may be complicated by hypertension, cardiac arrhythmia, cardiopulmonary failure, etc. Disease etiology 1, from the anatomical aspect, there are 3 parts above the larynx that are prone to narrowing and obstruction, and the airflow vibrates the pharyngeal folds (such as the soft palate, wrinkled mucosa, etc.) and secretions, forming peripheral sound. These 3 areas are: the nose and nasopharynx, the oropharynx and soft palate, and the root of the tongue. Those due to laryngopharyngeal stenosis may also be seen. The nasal cavity and nasopharynx are an important part of the respiratory tract. Nasal and nasopharyngeal obstructions such as deviated septum, nasal polyps, turbinate enlargement, nasal tumors, adenoid hypertrophy and nasopharyngeal tumors often cause OSA episodes. The oropharynx and soft palate are the most common sites of obstruction during sleep, and the most obvious example is the tonsillar hypertrophy of degree IV that causes snoring, which disappears or decreases after removal of tonsils. lkamatsu (1964) measured the oropharyngeal area of snoring patients and found that 91% of them had narrow oropharynx, soft palate and long uvula. Other disorders, such as hypertrophy of the tongue, malformation of the jaw, posterior epiglottis tumor, laryngeal or cervical malformation, etc., can occur OSA symptoms. 2. Obesity is also a common cause, and the tissue in the cervicopharynx is crowded, leading to obstruction of breathing. 70% of people with severe snoring or OSA have more than normal weight. 3.Endocrine disorders, such as hypothyroidism, and mucus edema. 4.Age-related changes are also a cause. Tissue relaxation in old age. Some recent neurophysiological studies have explored the causes of peripharyngeal neuromuscular aspects of airway obstruction. Through the testing of myocardial phone movements of chin-lingual muscle, diaphragm and other muscles, it was found that the electromyographic activity of these muscles appears to be weakened before the onset of obstruction, which causes the pharyngeal wall to relax, collapse and move inward due to the weakened muscle tone, causing snoring or OSA. Pathophysiology During normal breathing, outside air enters the alveoli for gas exchange. The key to this gas exchange process is the upper airway above the larynx, which allows airflow to enter the tracheobronchial tubes smoothly. If, for some reason, this airflow is obstructed, snoring or obstructive sleep apnea will occur. In patients with severe OSA, there may be 200 or more apnea episodes per night with hypoxia. The average duration of respiratory block is 25-30 seconds and may sometimes exceed 1 minute. Pulmonary artery pressure constricts and increases in response to decreased blood oxygen, thus causing an increased right heart burden, leading to right ventricular hypertrophy and even heart failure. Diagnostic tests Polysomnography should be performed for patients with OSA. In recent years, sleep research centers have been established in units where conditions exist, and the diagnosis and treatment of OSA is one of their main research components. The research is attended by specialists in basic disciplines (e.g. physiology, pathophysiology) as well as clinicians (internal medicine, neurology, pulmonology, otorhinolaryngology). Patients receive continuous sleep observation, monitoring and automatic recording throughout the night at the study center. In addition to pulmonary function tests and cardiac monitoring, this includes electroencephalography, electrooculography, electromyography (diastasis, pharyngeal, chin muscles, etc.), and ear oxygen saturation. Through the above tests, we can understand the changes of the patient’s organism during sleep, as well as the nature (typing) and degree of sleep apnea, etc. Non-surgical treatment: mainly for some patients with mild snoring, there are many methods, which are described below. (1) Adjusting the position when sleeping, changing the supine position to the lateral position, which may reduce or eliminate snoring. (2) Weight loss. Various methods are available, such as applying drugs, controlling diet and enhancing activities to reduce weight, which can often achieve certain effect. (3) Drug treatment. Take antidepressant before bedtime, Protriptyline 30mg, which may be effective. Alcohol, sleeping pills and other central nervous system depressants should be avoided before bedtime. (4) Continuous positive pressure ventilation at bedtime, with airflow introduced through the mask and pressure maintained between 5-15cmH2O. 2.Surgical treatment: In principle, appropriate measures should be taken to remove the causative factors. For nasal polyps and deviated nasal septum, removal of nasal polyps and correction of nasal septum should be required. For those with enlarged tonsils and/or adenoids, tonsil and/or adenoidectomy can be performed, which can achieve good results. Uvulopalatopharyngoplasty or palatopharyngoplasty is one of the commonly used surgical methods for the treatment of OSA in recent years. There are some variations that are not described separately. Half of the palatoglossal arch, the mucosa at the edge of the soft palate, the uvula and the palatal arch are surgically removed, and the tonsils can be removed at the same time. After surgery, the space between the soft palate, tonsillar fossa and posterior pharyngeal wall can be increased to reduce the resistance of the upper airway. Therefore, snoring is reduced or even disappeared after surgery. However, for severe OSA, it is not always effective, especially for certain patients with poor cardiopulmonary function and low oxygen saturation, other methods of treatment must still be considered.