Patient: March 1, 2013 sleep monitoring report, apnea + hypoventilation (A+H) 68.4/h; average oxygen saturation 87.1%, minimum oxygen saturation 75%:apnea longest time 75. 9s. no time because of work, temporarily did not start treatment History: 37 years old more than 10 years snoring history, now poor daytime spirit Xiangya suggested hospitalization for 10 days or so, surgery treatment. However, I understand that some hospitals also treat snoring with U.S. DNR plasma cryoablation, which requires only local anesthesia and can be completed in about 30 minutes, with little postoperative bleeding, no pain, no edema, and no hospitalization. What is the effect of plasma cryoablation for snoring? Doctor: There are three ways of surgery for OSAHS: 1. Soft tissue reduction surgery, such as ablation of soft palate, turbinate and tongue root, UPPP and so on. This type of surgery is mainly for patients with significant hypertrophy of soft tissues around the upper airway, such as tonsil III hypertrophy, adenoid hypertrophy or masses; or patients with mild to moderate OSAHS. The results are incomplete or poor in patients without significant occupancy. This type of surgery is performed to remove the occupancy to gain space, so the larger the mass, the better the outcome. In patients without significant occupancy, the procedure is not ideal because it is performed at the expense of the function of the corresponding soft tissue in exchange for increased upper airway space. For example, a person living in a small space, in order to obtain enough space to move, take the approach of reducing or throwing furniture to obtain space, unless that occupying thing is completely useless (such as a mass or enlarged tonsils, otherwise a certain degree of sacrifice is required. 2, craniomaxillofacial framework surgery, that is, cut open the craniomaxillofacial skeleton, through the forward transverse expansion and so on to increase the space, such as orthognathic surgery of the upper and lower jaws, traction osteogenesis surgery, etc.. This type of surgery is mainly for: (1) patients with craniomandibular deformity with OSAHS; (2) patients with poor or failed soft tissue reduction surgery. Bone framing surgery can effectively and stably expand the upper airway space, so the surgery is effective and is a more thorough and effective method, but the surgery is relatively traumatic and can also cause facial changes (movement of the craniofacial skeleton in a certain range can cause changes in facial shape, but still not to the point of deformity, only changes in facial shape). Similar to the above analogy, in order to increase the space, it can also be done through the method of expansion, this method has little impact on the function and the space obtained is very secure, but it needs to knock down the wall and rebuild, the project is a bit bigger. 3, bariatric surgery, that is, through the abdominal cavity of the gastrointestinal rerouting to reduce food intake, digestion and absorption, through weight loss to achieve soft tissue volume reduction. This type of method is mainly used for patients with severe obesity whose body mass index is greater than 33 or 35 and where conservative weight loss methods are ineffective. The weight loss effect of this type of surgery is better and more stable, but it will change the gastrointestinal function and have certain complications. From your sleep report, you have severe OSAHS. In our experience, unless you have a significant upper airway occupancy (e.g., Grade III enlarged tonsils), either plasma ablation or partial soft tissue resection for volume reduction is incomplete or ineffective in treating severe OSAHS. It may feel “effective” for 3 or 5 months after the procedure, but after 6 months, the OSAHS remains the same. The reason for this “effectiveness” is that the surgery has increased the tone of the upper airway opening muscles, and we know that the space of the upper airway is related to three factors: 1) the size of the craniomaxillofacial skeleton, 2) the amount of soft tissue in the frame, and 3) the tone of the muscles that keep the upper airway open. So once the surgical wound is completely healed, the pain, the weakening of local scar stimulation disappears, and the stimulation of the muscles is lost, the excessive opening of the upper airway due to surgical stimulation is ended and the narrowing or obstruction of the upper airway returns. Strictly speaking, this is not a relapse, it is uncured. Methods that can effectively treat your severe OSAHS: 1. positive pressure ventilation therapy (preferred for patients with non-occupying or no skeletal deformities). 2. craniomandibular framework surgery (e.g. maxillary and mandibular advancement, if not tolerated or treated with positive pressure ventilation). 3. bariatric (if obesity is evident). 4. combination of various methods, such as soft tissue reduction surgery + oral appliances + bariatric/positive pressure ventilation therapy. The choice of surgery needs to be made carefully, and the location (localization), nature (characterization) and degree of obstruction of the upper airway need to be clarified before surgery. Different sites and degrees of obstruction require different surgeries.