Obstructive sleep apnea hypoventilation syndrome, also known as snoring, commonly known as snoring, is due to the upper airway narrowing, collapse, obstruction caused by apnea and insufficient ventilation, accompanied by snoring, sleep structure disorders, frequent occurrence of oxygen saturation, daytime somnolence, etc., the narrowing of the upper airway in various parts of the upper airway can lead to the occurrence of snoring, and many patients with snoring may have the nose, nasopharynx, oropharynx and hypopharyngeal cavity and other upper airway Many snorers may have multiple planes of narrowing and obstruction in the upper airway, including the nose, nasopharynx, oropharynx and hypopharynx. With the improvement of people’s living standard, the incidence of snoring is increasing year by year. According to domestic literature, the incidence of snoring is about 4-10%, and the incidence of snoring in middle-aged and old-aged people is as high as about 50%. Snoring is a kind of disease with serious potential harm to human body, and in the past 20 years, people have gradually deepened their understanding of it, and realized that it causes different degrees and aspects of harm to cardiovascular diseases, and the heavier ones can die suddenly, and often combined with metabolic syndrome, which is mainly manifested as obesity, insulin resistance or type 2 diabetes mellitus, abnormalities of lipid metabolism, hypertension, coronary heart disease and hyperuricemia, and plays a very important role in the pathogenesis of cardio-cerebral and cerebral vascular diseases. It occupies an important position in the pathogenesis of cardiovascular and cerebrovascular diseases. Because the incidence of snoring is more people, coupled with the lack of knowledge on its diagnosis and treatment, I will do a simple Q&A on popular science knowledge from the following aspects, and I hope it will be useful to you. Can breathing machine cure Obstructive Sleep Apnea Hypoventilation Syndrome (Snoring)? Ventilator cannot cure Obstructive Sleep Apnea Hypoventilation Syndrome (OSAS). Ventilator treatment is like wearing glasses for myopic eyes, it is just an auxiliary therapeutic device, continuous positive pressure in the airway after continuous wearing during sleep can prop open the soft tissue collapsed area of the upper airway, keep the upper airway open, no longer snore, hold your breath and no longer have apnea and other phenomena when you sleep, but it needs to be worn for life instead of wearing it for a period of time to be cured. However, some patients who snore for a long time, the pharyngeal cavity will have edema, may sleep apnea phenomenon is more serious, wear a respirator for a period of time, and occasionally do not wear, the symptoms will be less than before treatment. There is also a part of the patient, wear a breathing machine after the daytime mental state became better, more willing to exercise, dietary regulation, pay attention to weight loss, may wear a period of time, the weight loss to normal or even low, and finally achieve a complete cure of the phenomenon also. Second, what conditions does Obstructive Sleep Apnea Hypoventilation Syndrome (snoring) meet in order to do the surgery? First, patients with tonsillar hypertrophy that can be seen when opening the mouth, as well as patients with obvious anatomical narrowing of the airway cross-section found by fiberoptic nasopharyngoscopy or patients with obvious structural abnormality of the nasal cavity or obvious deviated septum, sinusitis and nasal polyps. Secondly, whether or not surgery can be done to monitor the severity of apnea: including the minimum blood oxygen saturation, the duration and frequency of apnea, and then conduct a comprehensive assessment. In general, the lighter the patient, the more suitable for surgery. Because there is a limit to how much surgery can change the airway, if the patient’s apnea has become so severe that surgery cannot completely eliminate it, for example, it can only eliminate apnea in the lateral position but not in the supine position; it can only eliminate apnea in light sleep, but not when the muscles are more relaxed in deep sleep, this type of patient can only get a partial cure. Third, it will not cause surgical complications. Surgery should consider whether the anatomical structure can undertake the necessary functions of the human body, and whether the bone structure can heal again. Fourth, the patient must have the desire for surgical treatment, but can accept that the surgery will not achieve the therapeutic effect that he or she expects. The patient’s requirement for a change in subjective symptoms is also important. Everyone tolerates apnea differently, and some people will wake up with even one apnea all night. If the patient demands that all apneas must be completely eliminated, an assessment needs to be made as to whether surgery can do this. The degree of alterability of the airway and the severity of the condition have to be considered together. Fourth, can surgery be performed even if oxygen saturation is low? Or do I need to wear a ventilator before surgery before I can operate again? It is better not to rush to surgery for patients with low oxygen saturation because such patients usually have a longer period of apnea. If the oxygen saturation is so low that it takes a long time to wake this patient up, it means that his central regulation is poor. Surgery cannot treat the central problem. Although the airway is open after surgery, the center cannot command the diaphragm and intercostal muscles to move, and the patient still cannot breathe. This both affects the outcome of the surgery and poses a risk to the surgery. When such a patient undergoes surgery, he needs to wear a ventilator for a period of time first, usually three months to six months, preferably six months. Of course, in our clinical work, we also encountered the lowest oxygen saturation as low as 20% of the patients, in the case of no ventilator treatment is also given to the surgical treatment, and the effect of the surgery is very good, for this approach to the surgical risk is very high, the key must be accepted by the patient to do. Fifth, what kind of obstructive sleep apnea hypoventilation syndrome (snoring) patients with ventilator effect? Most of the patients with sleep apnea, if they have been diagnosed and tested with ventilator pressure in regular hospitals, and wear ventilator according to the doctor’s prescription, more than 90% of them will have good results. However, there are some patients whose initial ventilator pressure titration is not well adjusted, and they need to repeatedly redo the manual titration before wearing the ventilator. It is also important to check the airway in patients who wear a ventilator. Some patients have heavy apnea, but his own airway is wide and just collapses into a completely airtight cavity at night while he sleeps; others have a narrow airway that collapses to airtight even while they sleep. Monitoring these two types of patients will reveal that the severity of apnea is the same, but who is better suited for a ventilator? Obviously the patient with the wide airway. The patient with a wide airway, the collapsed tissues are loose, and the air pressure of the ventilator can displace these tissues; the patient with a narrow airway, there is little room for the tissues to be displaced, and can only squeeze the blood vessels a little bit less swollen after congestion, which may still have some interference with the venous return to the head, so such patients are not suitable for ventilators, and are more suited for surgery to widen the narrow airway. Patients with severe airway obstruction but easy displacement of tissues are most suitable for wearing a ventilator. Sixth, what examinations and preparations are needed before surgery for Obstructive Sleep Apnea Hypoventilation Syndrome (Snoring)? The first one is polysomnography, which is also known as PSG examination; at present, our hospital usually needs to make an appointment and queue up for it, so you can only give you a check request form to go to the 9th floor of the Department of Respiratory Medicine to make an appointment by yourself on the same day, and the cost is RMB 400 yuan. The second is a 3D CT of the sinuses, CT or MRI of the upper airway to assess the structure of the entire upper airway, including soft and bony structures, to help choose a surgical procedure. Upper airway CT can scan the nasal cavity, pharyngeal cavity, soft palate and other parts of the body, and then 3D reconstruction of the scanning results to observe where the reconstructed airway is narrowed, and where the surgery is targeted: is it the plane of the nasal cavity, is it the soft palate or the tongue, should we move the lower jaw, are the bony structures of the hard palate narrowed or not, are the tonsils removed or not, and so on. This test is done when you are hospitalized. The third is fiberoptic nasopharyngoscopy, through a mirror to see the cross-sectional area of the pharyngeal cavity, this examination can be completed on the same day of the visit, the cost of 160 yuan. The fourth is a nasal function test, which is done at the time of hospitalization, to find out the resistance of the nasal passages. Another common test is esophageal manometry, which assesses the plane of airflow obstruction, whether it is upper or lower airway obstruction, nasopharyngeal obstruction or soft palate obstruction, and helps to choose a surgical procedure. At present, our hospital has not carried out this examination. What is the effect of nasal surgery in treating obstructive sleep apnea and hypoventilation syndrome (snoring)? Applicable people: patients with obvious abnormal nasal structure or deviated nasal septum or chronic sinusitis or nasal polyps or patients with nasal symptoms need surgery. 90% of people have deviated nasal septum, some of them are related to physiological development, some of them are not corrected after bumping and hurting when they were young. Not everyone with a deviated septum needs surgery, but only when it affects normal ventilation and life. Generally, the ventilation will be significantly improved after surgery. Turbinate reduction surgery is rarely done alone. Removing the turbinates may affect the function of the entire nasal cavity, resulting in a dry nose or other discomfort. Generally, in the treatment of nasal septum deviation, nasal polyps or snoring surgery, the enlarged nasal turbinate will be treated together, I usually take the turbinate fracture displacement or submucosal turbinate osteotomy to deal with it, and some medical institutions use radiofrequency ablation to deal with it, but I usually do not do the ablation surgery, the reason is that if the treatment is not done correctly it is easy to cause injury to the mucous membrane of the turbinate and affect the normal function of the turbinate in heating and humidifying, causing dry nasal cavity and discomfort complications. The reason is that improper treatment may cause damage to the turbinate mucosa, affecting the normal heating and humidifying function of the turbinate mucosa, and causing complications such as nasal dryness. Nasal dilatation treatment effect: Nasal dilatation can not cure sleep apnea, but after nasal dilatation, patients generally feel better about themselves. When snoring surgery is done for sleep apnea, if the nasal turbinates are enlarged, it will be treated together, so that the nasal cavity will be more spacious and the whole airway will be better. There are also some patients who have nasal dilatation done for the purpose of wearing a ventilator, some patients who have poor nasal passages do not have an airway that is easy to blow open, and too much pressure on the ventilator will be uncomfortable, or the pressure will not be given directly. Some of them need nasal dilatation only when they have to be intubated through the nasal cavity for pharyngeal surgery. Treating snoring or sleep apnea purely by nasal dilatation will not have significant effect. Risks of treatment: It is generally very safe. Pain and Recovery: Nasal surgery will be more painful if you have to fill in the hemostatic material after the operation, and the degree of pain is related to the filling material to a certain extent, generally the pain will be more obvious for three days after the operation, and there will be some pain in changing the medication for 24~48 hours after the operation, and you need to stick the endoscope into the nostril to suck the secretion clean while the patient is awake, and the pain will be gradually reduced after changing the medication. Hospitalization time: 5~7 days. Total cost of hospitalization: generally around 15,000 yuan. VIII. What is the effect of modified uvula palatopharyngoplasty? At present, the most common surgery for sleep apnea is uvulopalatopharyngoplasty, and academician Han Demin of Peking Tongren Hospital has improved the traditional “uvulopalatopharyngoplasty”. In the earliest surgery, part of the soft tissue of the soft palate, tonsils and uvula were cut off, but without the obstruction of the “little tongue”, the patient would choke on food after the surgery, especially when drinking water and eating liquid food, and choked out of the nose easily, and had a nasal sound when speaking. Palatopharyngoplasty with preserved uvula preserves the uvula on the basis of the original surgery, so that the function of the uvula is still there, and by cutting off the surrounding soft tissues, the uvula is suspended, which is higher than the original one, and if the uvula is still too long, the lower part of the uvula will be cut off some more. Indications for modified uvulopalatopharyngoplasty: patients with loose soft palate and soft tissues, particularly enlarged tonsils, and patients with narrowing of the posterior space of the soft palate. The surgery removes the tonsils and removes excess tissue from the soft palate. In other words, patients whose soft tissues of the pharyngeal cavity cause obstruction are suitable for this surgery. Treatment outcome: Patients who are assessed as suitable for the surgery prior to the operation have a good outcome. Surgical Risks: An important risk common to pharyngeal cavity surgery is bleeding. If the bleeding is not stopped well during the operation, the pharyngeal cavity area may bleed when you first get off the operating table, and when the anesthesia is not yet fully recovered, the blood will not be able to be swallowed by the patient, and suffocation will occur if it chokes in the airway. However, the chances of this happening are very low, and I have not encountered it so far. In terms of long-term effects, some patients feel that their voice has changed after the operation because the pharyngeal cavity has been enlarged, but it usually recovers six months after the operation. Some patients also feel a little bit choked when they eat after the surgery because they are not used to swallowing after the pharyngeal cavity is widened all of a sudden, which usually disappears one week after the surgery. Pain and recovery: The pain is more obvious in the first three days after surgery. The eye of the throat is such a big place, twenty to thirty stitches, must be painful, and eating, drinking, talking will use this place, or a little painful. After one week, the pain will basically be reduced, you can eat soft food, do not eat too hard or fried food, 3-4 weeks later you can resume a normal diet. There will be edema in the pharyngeal cavity when the surgery is just done, and you may snore worse than before the surgery, which will gradually improve after 3-5 days with the reduction of edema at the postoperative wound. Hospitalization time: 5-7 days Treatment cost: about 15,000, if you do not go to the intensive care unit may be 10,000 is enough. IX. Can surgery cure Obstructive Sleep Apnea Hypoventilation Syndrome (Snoring)? Is it easy to recur? Some of the patients can be cured, especially the early patients or the patients with milder sleep monitoring check. For example, tonsil and adenoid surgery in children is very effective and almost 90% are cured. This is because children’s bone structure is still developing and there are no secondary disorders such as central hypoxia. There are also some young patients with severe structural changes, but with less central decompensation, who may be cured. What is the likelihood of recurrence after surgery? Obstructive sleep apnea hypoventilation syndrome is a long-term chronic condition and must be managed with the concept of long-term management. Seventy to eighty percent of the causes of structural changes in the airway are obesity, and only a small percentage of the factors are muscle relaxation due to aging. Surgery is usually a bit of “overkill”, for example, if the airway is enlarged by one centimeter, it will not close, but if the function permits, it may be enlarged by two centimeters, and the airway will not close even if the muscles are a little bit more relaxed. The decline in muscle function associated with aging is slow, but if you become more obese after surgery, the likelihood of recurrence is high. Therefore, weight control, diet control and changes in your eating habits such as smoking and drinking are very important to maintain the efficacy of the surgery. If you cannot ensure weight control, then the surgery should not be done. For cured patients, that is, patients who are able to return to near-normal level after the surgery, and at the same time strictly control their weight, the possibility of recurrence is very small; for partially cured patients, that is, patients who still have part of the apnea after the surgery, and cannot control their weight well, or combined with bony structural stenosis, the possibility of recurrence is very high. Generally after six months of surgery can assess the efficacy of the operation, if the operation is not in accordance with the requirements of weight control, if the recurrence may be around three – five years. X. Can I have surgery again after recurrence? It is usually difficult unless a more extensive surgery is done. It is important to have regular checkups after surgery and put the ventilator on immediately when there is a slight tendency of recurrence. Since the airway has been changed, it is easy to improve the symptoms by adjusting your lifestyle and losing weight. XI. Which is better, surgery or ventilator? The effect of wearing a ventilator is very direct and can be seen immediately. Surgery requires a recovery period, and the effect can be stabilized only after half a year or so, at which time the patient can be evaluated whether he/she is completely cured or not. Generally speaking, patients need to come for follow-up examinations one month, three months and six months after the surgery, and according to the situation of each review, we will consider whether to carry out respiratory intervention or not, and after six months, we will carry out sleep monitoring, and only according to the effect at this time can we evaluate the efficacy of the surgery. If it’s for an individual, ventilators and surgery work differently for different people. My recommendation is to add a ventilator for 1-3 months immediately after surgery, which is probably the most effective.