March 21st is World Sleep Day, and this year’s theme is “Healthy Sleep, Safe Travel”. As we all know, about 1/3 of a person’s life is spent in sleep. Sleep is an important factor for our physical and mental health and happiness. With the continuous improvement of people’s living standards, the aging of the population and the gradual increase of social competition, the disease spectrum has changed significantly. In recent years, sleep disorder has gradually become one of the diseases that seriously jeopardize physical and mental health. People often say that the elderly have sleep disorders due to their age, but nowadays, not only middle-aged and elderly people, young adults, teenagers and even children have different types of sleep disorders. Snoring is one of the most common and prominent sleep disorders. Snoring is not new to everyone, but the dangers of snoring, especially moderate and heavy snoring, are not well understood. Many people wrongly believe that snoring is a sign of good sleep and good health, why? 1, hidden: what happens at night do not know, this “night mysterious killer” is ignored 2, long-term: from the initial light snoring to the later moderate and heavy snoring, and even sleep apnea and hypoventilation, is a gradual development process, a quantitative to qualitative change process. The so-called “soft knife kills without blood” is more terrible. 3, “snoring leads to multi-organ functional damage”, not only ordinary people, many doctors in related disciplines do not know or do not know enough about this disease, so many problems related to this disease can not be reasonably dealt with for a long time. Based on the above points, so today we will recognize this “night mysterious killer” —– snoring. Is snoring a good sleep? “Snoring is sleeping well”, “the louder you snore, the deeper you sleep” are words that are widely spread in daily life, but in fact, they are not. Snoring is a sign of narrowing of the upper airway, and snorers with severe narrowing of the upper airway often experience a significant increase in upper airway resistance, resulting in reduced or interrupted airflow and oxygen deprivation, which can cause harm to the body. These patients will be self-conscious about the night sleep time, sleep well, coupled with snoring, often mistaken for sleep, but in fact, due to frequent shallow sleep or sleep interruption during sleep, so that the deep sleep time is reduced, the quality of sleep is very poor, some people sleep up to a dozen hours still feel not sleep enough, some people even sleep all day. Therefore, snorers often do not sleep well, but feel sleepy and drowsy during the day. How does snoring happen? Snoring is mainly caused by the narrowing of the upper airway of the human body. The upper airway consists of three parts: nasopharyngeal cavity, oropharynx and larynx. Under normal circumstances, there is no sound in the air circulation, if any one of the three parts of the upper airway is narrowed, it will make the air in the passage of this channel is blocked or friction occurs, so that the airflow through the formation of eddy currents, blowing pharyngeal soft tissues, so that the vibration and thus make a sound, which is what we say “snoring”, the narrower the passage, the sound of snoring, the more narrow the passage, the sound of snoring, and the more narrow the passage. The narrower the passageway, the louder the snoring sound. Snoring sound will be high and low, loud and weak, with different rhythms. Why do people always snore during sleep? When a person is awake during the day, the compensatory contraction of the throat muscles will keep the airway open and will not be blocked. When people lie down to sleep, the whole body muscles, including the pharyngeal soft tissue relaxation, the root of the tongue will naturally fall back, resulting in the airflow can not be free to pass through the pharyngeal airway, so that the airflow through the limitation of the vortex, resulting in the pharyngeal soft tissue vibration and lead to snoring. There is no such problem when you lie on your side. When people are very tired or drunk, it will make the muscles of the upper respiratory tract relax, which will also block the airway, thus tiredness and drunkenness are also easy to cause snoring. Is snoring a disease? There are many reasons for snoring, and we cannot generalize that snoring is a kind of disease. Simple snoring (benign snoring): if there is snoring sound during sleep, the snoring rhythm is regular, there is no apnea and obvious hypoxia symptom, and the lowest arterial oxygen saturation level is more than 90%, then it is simple snoring, especially when people are drinking alcohol, fatigue, taking sedative drugs, or have a cold or nasal congestion, which will cause temporary snoring. This kind of snoring will not have a great impact on the body, but also reminds us to pay attention to healthy living habits. Malignant Snoring Upper Airway Resistance Syndrome: It is the result of further development of simple snoring and an intermediate state before leading to heavy snoring. It belongs to the early stage of pathological changes of heavy snoring (OSAHS). The patient’s upper airway resistance increases significantly during sleep, inducing frequent micro-arousals and leading to decreased sleep quality, and this kind of snoring is the pathological state. Heavy snoring: is the final result of the disease progression. If snoring is accompanied by breath-holding phenomenon (apnea), it suggests that you are likely to suffer from OSAHS, and this kind of snoring is even more of a manifestation of the disease, which is often accompanied by the impairment of the function of multiple organs of the body, such as 。。。。. Therefore, we have to get out of the misunderstanding that “snoring is sleeping well” and “snoring is not a disease”. Snoring is a potential sign of disease and a doctor should be consulted to find out the cause. Basic concepts Sleep apnea The cessation of nasal and oral airflow for >10S during sleep Hypoventilation The reduction of nasal and oral airflow by more than 50% from the basal level during sleep, accompanied by a decrease of oxygen saturation (Sa02) by ≥3% from the basal level Apnea Hypoventilation Index (AHI) Number of apneas and hypoventilations per hour of sleep, normal <5/hour Sleep apnea and hypoventilation syndrome (SAHS) is defined as a 7-hour period of sleep in which the patient has no sleep apnea. SAHS is defined as 30 or more apneas and hypoventilation during 7 hours of sleep at night, or AHI ≥ 5 per hour What is Obstructive Sleep Apnea Hypoventilation Syndrome (OSAHS)? It refers to apnea and hypoventilation during sleep caused by repeated collapse and obstruction of the upper airway during sleep, accompanied by snoring, sleep structure disorders, frequent oxygen desaturation, daytime drowsiness and other symptoms, and can lead to multi-organ and multi-system damages, such as hypertension, coronary heart disease, type II diabetes mellitus and so on. It is defined as more than 30 episodes of apnea or sleep apnea hypopnea index (AHI) ≥5 episodes/hour with symptoms such as drowsiness during 7 hours of sleep per night. The prevalence of sleep apnea is reported to be about 4% in adults, of which 30% are serious, and it is known as the "latent killer of life", and it is one of the most worrying sleep apnea disorders for doctors. Classification of Sleep Apnea Syndrome Obstructive Sleep Apnea is the most common type of SAHS. The cause of obstruction may be excessive fatty tissue in the upper airway or oversized tonsils, which become loose during sleep, narrowing the upper airway and leading to obstruction. In addition, the structure of the upper airway and mandible, and nasal polyps can also contribute to the development of obstructive sleep apnea. Central sleep apnea is caused by lesions of the respiratory center or obstruction of the peripheral nerve pathways. It is common in patients with congestive heart failure, stroke, or traumatic brain injury. Mixed sleep apnea Apnea occurs with both obstructive and central sleep apnea. What are the dangers of OSAHS? If OSAHS is not effectively treated for a long period of time, day after day, year after year, patients not only feel that they have never had a good night's sleep, but also because of the interruption of respiratory airflow, hypoxia and repeatedly waking up from sleep to produce a series of cardiovascular system and other vital organs of the disease manifestations. 1, cardiovascular and cerebrovascular effects: hypertension, coronary heart disease, heart failure, cerebral hemorrhage and cerebral infarction. 2, the impact of the respiratory system: induced and aggravated night asthma attacks, easy to combine with respiratory failure, pulmonary heart disease. 3, the impact of the mental system: attention, concentration, alertness, complex problem solving ability and short-term memory damage is the most obvious. These patients often complain that they often doze off while driving, sometimes crashing into trees, sometimes crashing into walls or injuring pedestrians, often having to stop the car to wake up for a while, and driving on the highway is more likely to doze off. For this reason, foreign countries have laws, coach drivers and pilots must be normal sleep test before receiving a driver's license. 4, the damage to the kidney, endocrine system: renal concentration of urine function is impaired, causing increased nocturia, can be combined with proteinuria or nephrotic syndrome, triggering renal function damage. Growth hormone secretion is reduced, children not only face bone development abnormality, but also developmental stagnation, delay, intellectual decline, often repeat the grade. 5. Type 2 diabetes: the prevalence of diabetes in patients with OSAHS is >40%, while the prevalence of OSAHS in patients with diabetes can reach more than 23%. 6, hypogonadism: about 10% of the patients can have decreased libido, or even impotence. Examples: Snoring—High blood pressure Zhao Mou, male, 49 years old, mainly due to dizziness and headache, high blood pressure in the local hospital cardiology department, check blood pressure 150/100mmHg, 24-hour dynamic electrocardiogram shows that the morning blood pressure is high, the morning blood pressure is as high as 180/120mmHg, the doctor to give him a comprehensive physical examination, prescribed two kinds of drugs used in combination, taking two months, is still ineffective, then the doctor adjusted his medication program. He adjusted the medication program, prescribed four antihypertensive drugs, two months passed, blood pressure is still poorly controlled, and then consulted the cardiology department of our hospital, inquired about the medical history, and learned that he snored at night and had apnea, and recommended that he be consulted in our department, we again inquired about the medical history, and learned that the patient snored at night and had frequent apnea, and he was sleepy during the day, and he had a dry mouth in the morning, dizziness, headache, and increased nocturia. Physical examination: obesity, BMI=32, thick and short neck, hypertrophy of tongue, hypertrophy and low prolapse of soft palate, narrowing of pharyngeal cavity, appointment of polysomnography monitoring, the results showed that the AHI=65, 8 times/hour, the lowest oxygen saturation was 56%, the 24-hour blood pressure monitoring was typical of the antipyrine type, diagnosis of severe OSAHS with severe hypoxemia, secondary hypertension, we recommended his noninvasive assisted ventilation treatment, after the treatment, patient nighttime snoring and apnea disappeared, he was not sleepy during the day, and his nocturia was normalized. With the medication, Zhao’s blood pressure was well controlled, and after one year, there was no need to take medication and his blood pressure was completely normal. Snoring—Arrhythmia, Angina Recently introduced by a friend, a lady in her 60’s came to see me because of her throat discomfort, and I saw that she was full of tiredness, lack of spirit, and her face was dark, just like she could not wake up from sleep, so I asked her if she had any other illnesses in her body. He told me, “I have a bad heart, often have premature beats, arrhythmia, panic and shortness of breath, blood pressure is also high; night is also often suffocated anterior region of the heart, angina pectoris,” said out of his pocket with a few boxes of medicines, told me that now every day to eat a whole bunch of drugs, but the effect is not very good, looking at her not tall, body fat, and short neck, and Small jaw, I asked her “You snore when you sleep!” She was very surprised, “How do you know? I snore for more than 20 years, in recent years, often suffocated to wake up, sweating, my family also said that I have to sleep without breathing! I told her, “All these symptoms are related to your sleep snoring, you should take the time to do a sleep monitoring, according to the results and then develop a treatment plan”, in fact, this situation is still very common. Snoring and stroke Liu, 58 years old, 1 year ago due to heavy snoring, daytime sleepiness was diagnosed as OSAHS, but the doctor recommended that he use ventilator positive-pressure ventilation treatment, but he thought “snoring, can have what problem? So many people do not snore,” and thus refused treatment. 1 year later, Lao Liu night sudden large cerebral infarction, then coma. Although the doctor’s efforts to save his life, but fell paraplegia, drooling and dementia and other sequelae. This not only greatly increased their own pain and the burden of the family, but also a large amount of medical costs pressured the family breathless, Lao Liu regret, but he has no way to know his cerebral embolism “culprit” who is. Snoring and renal impairment Mr. Zhu is 58 years old, 1 meter 6 tall, but weighs 93 kilograms, can be described as a big belly. Nearly 5 years every night when the head dipped the pillow, will snore like thunder, can suffer not only his family, Mr. Zhu to the night every hour to get up to go to the toilet, which makes him suffer. In order to reduce the number of times he gets up at night, he does not drink soup at dinner and does not drink water before going to bed, but he still urinates repeatedly at night, as few as 4 or 5 times and as many as 7 or 8 times. For this reason, he visited a number of hospitals, urologists said he was “prostate hyperplasia”, after taking medication, the effect is not obvious. Traditional Chinese medicine doctor said he is “kidney deficiency”, kidney medicine ate a basket, the night is still urinating. Once Mr. Zhu learned from the health information that snoring can be polyuria, kidney damage. He came to our clinic with the mindset of trying to do polysomnography and found that Mr. Zhu had more than 500 times of sleep apnea, with an average of more than 70 times of apnea per hour, and the longest apnea in the night was more than 1 minute. There was severe hypoxia during sleep. Mr. Zhu was diagnosed with severe OSAHS, and his sleep improved dramatically on the first day of treatment, with only one nighttime wake-up call, and no more nighttime urination on the second day, which made him feel that “it was amazing!” He felt “amazing!”, all the happiness is written on the face covered with smiles. Snoring – diabetes Huang, male, 40 years old, physical examination found high blood glucose, high blood lipids, high blood pressure, after endocrine doctor diagnosed as diabetes, patients with obesity and diabetes, recommended that its sleep apnea monitoring, the results show that the AHI is 45 times / hour, the lowest blood oxygen 67%, diagnosed as severe OSAHS, non-invasive assisted ventilation treatment is recommended, but the patient does not accept the treatment to control diet and insulin glucose-lowering therapy is mainly used to control the diet. Insulin hypoglycemic treatment, the results found how to adjust the insulin dosage, blood glucose control is still unsatisfactory, fasting up to 10 mmol / L, and poor daytime spirit, drowsiness, snoring at night is serious, and sometimes will be chest tightness and shortness of breath, and then consult our department, after the line of the respiratory pressure titration after the wearing of the ventilator treatment, Huang the next day the spirit of doubly refreshing, the head also does not dizziness, and does not doze off, long-term wear, the Blood sugar control is good, insulin dosage has been significantly reduced, and weight loss has been achieved. Who is susceptible to OSAHS? People with the following characteristics are susceptible to OSAHS: 1. Age: The incidence of OSAHS increases with age. This may be due to a decrease in pharyngeal muscle tone as various organ functions decline with age. The incidence of sleep disordered breathing is generally considered to be about 4% in the general adult population. The incidence of children is also high. 2, obesity: more than 60% of OSAHS patients are obese. bmi ≥ 24kg/m2 overweight, ≥ 28kg/m2 obesity, obese patients with increased pharyngeal wall fat leads to pharyngeal cavity volume shrinkage and increase in the negative pressure of the upper airway, the neck fat on the pharyngeal direct compression and obesity leads to a reduction in lung function residual air volume and the occurrence of OSAHS. Including children. 3, neck circumference: male greater than 43cm, female greater than 38cm; 4, gender: as the saying goes: “ten men nine snoring”. According to the survey, the incidence of male is about 2~3 times that of female. Individual reports of male-female ratio is as high as (8~10): 1. Current research believes that it is related to sex hormones, and estrogen has a potential protective effect on women. Therefore, pre-menopausal women have a low incidence of OSAHS, while the incidence of OSAHS in post-menopausal women increases significantly. 5.Genetic: OSAHS occurs with family clustering and racial variability. Obesity has a family tendency, while non-obese people may have abnormal maxillofacial structure (congenital micrognathia, mandibular deformity, etc.), upper airway stenosis and hypertrophy of the uvula and other problems. What are the signs of OSAHS? Let’s talk about the daytime symptoms: 1, drowsiness: it is the most common symptom, the light manifested as sleepy in a quiet situation or study, serious people doze off regardless of time and occasions, and they can’t help but go to sleep and snore loudly during meetings and lectures, and even serious consequences, such as dozing off while driving, which leads to traffic accidents. Because this kind of excessive drowsiness is very easy to recur regardless of time and occasions, this kind of patients are not suitable for drivers, high-altitude work, mechanical work, otherwise it is likely to cause major accidents or even accidental death. There is a company president, just turned 50 years old this year, the appearance of white and chubby, but often listen to his complaints are full of disease, hypertension is often poorly controlled, diastolic blood pressure is always very high, more than 100mmHg, taking several antihypertensive drugs is still no significant improvement. Recently, the physical examination found that the blood sugar is also a little high, plus two years before the high blood fat, fatty liver, 50 years old into the scope of the “three high” people. Originally smart and tough businessman, now do anything can not raise the spirit, always want to doze off during the day, talk about business attention is not focused, memory is not as good as a year, said before and after forgetting, which delayed a lot of business. More serious is their own driving are dozing off, sometimes waiting for the red light can fall asleep, before and after three car accidents, the most recent one is how to happen even their own do not know, and so wake up has hit someone, compensated for 20,000 dollars, thanks to the good luck, did not lead to serious disability. There is also a young man, only thirty-something, working in the factory assembly line, often fall asleep at work for no reason, and once almost twisted his hand into the machine because of napping. His mother was horrified when she heard about it and immediately asked him to quit his job and go to the hospital for treatment. After examination, both patients were diagnosed with severe OSAHS. 2, headache, dizziness and fatigue: headache often occurs in the early morning or at night, most of them are hidden pain, not intense, and can last for 1~2 hours. 3, mental behavioral anomalies: inattention, decline in the ability of fine manipulation, decline in memory and judgment, and inability to work when the symptoms are severe, and the elderly may have dementia. 4, personality changes: including impatience, extreme sensitivity, hostility, prone to misbehavior, jealousy, suspicion, anxiety and frustration, and even insanity and hallucinations. Family and social life are affected to a certain extent, often couples are separated or divorced, there are social barriers, such as patients do not dare to take the train or plane to go out on trips and business trips because of severe snoring 5, metabolic disorders: weight in recent years inexplicably rapid increase in blood pressure is difficult to control, especially diastolic blood pressure rises to wake up in the morning obviously, the blood pressure in the morning is higher than the afternoon or the evening, and the signs of blood glucose, blood lipids have risen. OSAHS patients will also have special performance at night: Snoring: Snoring, commonly known as snoring, is the main symptom, snoring is irregular, high and low. This is caused by the high speed of airflow through the narrow part of the upper airway during breathing, which vibrates the soft tissues around the airway. This snoring can sometimes be as high as 80 decibels, no less than the noise of cars on the street. 2, apnea: the same room or bed sleepers often find patients with apnea, often worried about its breathing can not be restored and push the patient awake. Respiratory arrest lasts more than 10 seconds is considered a respiratory apnea, when the oxygen in the blood is reduced, the body is in a state of hypoxia. Once I was on the night shift, there is a big fat more than 110 kilograms, is a county a village secretary, more than 50 years old, for sleep monitoring, the family members of the night bed found that the patient does not gasp for breath, in the hallway shouting for help ah, we rushed over to take a look at the patient is purple, but also unconscious, so did not say a word, go up to do cardiac tamponade, resuscitation, not for a while on the patient to send out a Not long after hearing the patient issued a “grunt” sound, the patient was finally resuscitated, but fortunately it happened in the hospital, if at home, the consequences are unimaginable. Many of these serious patients sleep and then did not wake up. 3, suffocation: the patient apnea due to hypoxemia caused by sudden suffocation wake up, often accompanied by rolling over, or even suddenly sit up, feel panic, chest tightness or precordial discomfort, sweating, have a sense of frequency of death, involuntary movement of limbs or even convulsions, patting people in the same bed, and so on, and some of them will induce epilepsy. 4.Hyperhidrosis: sweating more, obvious in the neck and upper chest, related to hypercapnia caused by respiratory exertion and apnea after airway obstruction. 5.Nocturia: some patients have increased urination at night, and individuals have enuresis, which is related to decreased renal concentrating function. What are the causes of OSAHS? Once a patient’s family on the consultation of such a problem: his father is 60 years old, nearly 5 years of sleep snoring, often sleep a breath of air can not come up, jerked and gasped, while suffering from high blood pressure. He consulted some articles, which pointed out that obesity is the most common cause of this, but his father is not fat, so is he suffering from this disease? In addition to obesity, what other reasons can cause this disease? 1, nasal diseases: congenital anomalies of the nose and nasal passages, hypertrophic rhinitis, nasal tumors, rhinitis tumors, nasal polyps, nasal septum deviation 2, oral and pharyngeal diseases: enlarged tonsils, hypertrophy of the uvula,, adenoid hypertrophy, hypertrophy and hyperplasia of the tongue root, giant vocal polyps, laryngeal masses 3, facial diseases: small jaw deformity (i.e., a small chin), jaw retraction (commonly known as the sky, as opposed to the ground) 4, neck diseases : short neck (often described as head and neck or short neck), head and neck deformities, neck tumors, goiter 5, metabolic and endocrine disorders: hypothyroidism, acromegaly 6, old age 7, neurological disorders: stroke, encephalitis Parkinson’s disease, myelopathy The first 5 causes narrow the upper airway and increase the negative pressure in the upper airway during sleep, whereas the 6th and 7th causes can lead to a sleep with upper airway The first 5 causes narrow the upper airway and increase the negative pressure in the upper airway during sleep, while the 6th and 7th causes can lead to a decrease in upper airway dilator muscle tone during sleep, resulting in frequent collapse of the upper airway and sleep apnea. If a patient is diagnosed with OSAHS, the doctor will make a diagnosis of the etiology and formulate a treatment plan based on his physical examination and auxiliary examination results. Facing snoring is very harmful, what should be done? How to diagnose OSAHS? Self-assessment You are likely to suffer from OSAHS if you have the following manifestations: Sleep snoring, open-mouth breathing, frequent apnea Repeatedly suffocating awakening from sleep, restless sleep Unrelieved sleep, daytime sleepiness, drowsiness, elevated blood pressure after sleep, or intractable hypertension Type 2 diabetes mellitus and insulin resistance, nocturnal angina pectoris, intractable complex arrhythmia and refractory heart failure Shallow sleep, Post-sleep headache, dry mouth Nocturnal sleep enuresis, increased nocturia Alzheimer’s disease, impotence, and decreased libido Polysomnography results (PSG) should be performed to clarify the diagnosis. Polysomnography is the current gold standard method for diagnosing OSAHS. 1.According to the medical history, the main symptoms are snoring and apnea 2.Special physical signs Abnormal morphology of pharynx and maxillofacial region 3.Polysomnography results (PSG) Clinically, OSAHS is diagnosed when there are typical snoring and irregular breathing at night during sleep, excessive sleepiness during daytime, and when sleep apnea plus hypoventilation episodes occur more than 30 or more than equal to or greater than 5 times/hour in the course of 7 hours of sleep during the night as shown by sleep apnea monitoring. Of course, the diagnosis will be based on the type and severity of the disease, as well as an assessment of the damage it causes to the organs of the body. What is polysomnography (PSG)? PSG is the most accurate instrument to diagnose OSAHS. It records the patient’s sleep parameters such as electroencephalogram (EEG), electrocardiogram (ECG), electromyogram (EMG), electrooculogram (EMG), oculomotorgram (EMG), thoracic and abdominal respiratory movements, snoring, nasal and oral airflow, oxygen saturation, and body position. By recording and analyzing the above parameters, OSAHS is diagnosed and the patient’s sleep quality, number of apneas and degree of hypoxia can be determined, and finally the severity of the condition can be determined. What can polysomnography tell us? Type of sleep apnea-hypopnea AHI index Nocturnal sleep hypoxia Sleep structure Make a management plan based on the above results How to treat snoring? The current consensus is that there is no single treatment for OSAHS that can be easily accomplished and accepted by all patients. Nonetheless, OSAHS should be considered a treatable condition What does treatment address? Elimination of apnea and restoration of normal breathing; Prevention and treatment of complications; Improvement of clinical manifestations and reduction of mortality What are the treatment options? Non-surgical treatment: including: general treatment oral appliances Ventilator treatment (positive pressure ventilation treatment) Surgical treatment General treatment Weight loss Many patients with mild-to-moderate OSAHS have significant reductions in sleep apnea after successful weight loss, and may even be able to do without other treatment. As for patients with severe OSAHS, appropriate weight loss and weight control is very important although it cannot fully achieve the therapeutic purpose. It can improve the body condition, reduce the severity of sleep apnea, and lay the foundation for other treatments. Two examples (Lao Guo, classmate’s wedding banquet) Stop drinking and smoking; Stop sedative-hypnotic drugs; Sleep in side-lying position; Maintain good sleeping habits Strengthen physical exercise What is oral appliance therapy? Dental appliances made of different materials such as polypropylene plastic, resin, silicone, etc., which are placed on the upper and lower arches of the teeth like boxing mouth guards, suitable for patients with simple snoring and mild to moderate OSAHS Contraindications: suffering from mandibular arthritis or dysfunction; periodontal disease Advantages: non-invasive, low price; Disadvantages: the effect varies due to the different performance of the orthodontic appliances and the different tolerance of different patients. Ventilator therapy 1. Continuous positive airway pressure (CPAP) Preventing collapse of the upper airway is a very effective treatment for OSAS. CPAP involves delivering a continuous positive airflow into the airway while the patient sleeps by wearing a mask, thus providing a physiologic pressure to support the upper airway to keep it open during sleep. Understanding of ventilators and their applications (usual use and pre- and post-surgical use) 2. Bi-level positive airway pressure (BiPAP) has the ability to synchronize with the patient’s breathing, thus increasing comfort. AutoCPAP adjusts the positive pressure provided by the CPAP machine in a timely manner, thus reducing side effects and improving patient compliance Surgery 1. Surgery is an important part of the treatment of OSAHS, and is used to relieve structural stenosis of the upper airway and/or to reduce the collapsibility of the soft tissues of the upper airway. 2. Surgical plans are formulated according to the site of the obstruction. For those with definite upper airway stenosis, the appropriate surgical treatment should be determined according to the indications 3. The key to efficacy lies in accurately determining the site of obstruction and surgical feasibility What are the basic principles of surgical treatment? Emphasize comprehensive treatment for OSAHS Release the structural narrowing factors in the upper airway Determine the surgical plan according to the site of obstruction, and staged surgery can be performed for patients with multiplanar stenosis It is recommended that preoperative CPAP treatment or tracheotomy be performed for severe patients, and that severe patients be sent to the ICU after surgery Surgical plan Nasal surgery Surgery at palatopharyngeal level Surgery at glottopharyngeal level Surgery at maxillofacial level Surgery Tracheotomy Surgical treatments What are the surgical treatment means? Nasal endoscopic surgery Adenoid and tonsillectomy Uvulopalatopharyngoplasty (UPPP) Laser-assisted palatoplasty (LAUP) Low-temperature plasma radiofrequency therapy Anterior chin and tongue muscle advancement Anterior mandibular advancement surgery Are all snorers suitable for surgical treatment? Patient’s age <55 years old Patient's weight/BMI (kg/m2) <35kg/m2 Degree of respiratory tract structural abnormality Severity of the disease as monitored by PSG Patient's anticipation of surgical improvement Patient's awareness of the disease Summary: Snoring - a mysterious killer in the night time 1, the incidence of OSAHS is high, and it can occur in all ages 2, it is a serious harm, which involves not only all organs of the body of the individual, but also the family. OSAHS is not only harmful to all organs of the body, but also brings serious influence and harm to the family and society. Care for yourself, care for your family, pay attention to the people around us. 3.The treatment of snoring starts from improving the understanding of the disease, snoring is not scary, what is scary is not enough to recognize, the method is not right, healthy life starts from healthy lifestyle. 4.The treatment of snoring is a comprehensive treatment, there is no one method that can solve the problem once and for all! Often need more than one discipline joint, collaboration. The focus is on early diagnosis, rational treatment, avoiding the occurrence of systemic complications and improving the quality of life of OSAHS patients. 5.Healthy life needs to be taken care of for a lifetime, today is the World Sleep Day, I hope that today's lecture can give you a better understanding of the disease of snoring, and I hope that all of you and all of our society will have a healthy sleep, I wish you all can really do a good sleep, sleep well, and sleep a healthy body, and have a healthy and beautiful life!