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Obstructive sleep apnea hypopnea syndrome related scientific knowledge Kit (Part 1) original 2016-02-15 Peng Yikun audiology and otolaryngol


Obstructive sleep apnea hypopnea syndrome related scientific knowledge Kit (Part 1) original 2016-02-15 Peng Yikun audiology and otolaryngology head and neck surgery

Thanks to the author

Original author: Peng Yikun

Guizhou People's Hospital, deputy director of Otolaryngology Head and neck surgery physician

Obstructive sleep apnea hypopnea syndrome is commonly known as snoring, snoring, is due to upper respiratory tract stenosis, collapse and obstruction caused by apnea and hypoventilation, accompanied by snoring, sleep disorder, the frequent occurrence of oxygen desaturation, daytime sleepiness and other symptoms, the various parts of the upper airway stenosis can lead to snoring happen, many snoring patients may have the nose, nasopharynx, oropharynx and hypopharynx and upper airway stenosis and occlusion of a plane. With the improvement of people's living standard, the incidence rate is rising year by year, domestic literature statistics, the incidence of snoring rate is about 4%-10% in the elderly population, the incidence rate of up to 50%.

Snoring is a serious potential hazard to human disease, nearly 20 years of the understanding of the people gradually, to realize its harm from different aspects of cardiovascular disease or death, and often associated with metabolic syndrome, the main clinical manifestations were obesity, insulin resistance or type 2 diabetes, dyslipidemia, hypertension, coronary heart disease and hyperuricemia, plays an important role in the pathogenesis of cardiovascular and cerebrovascular diseases. Because of more snoring disease groups, people with knowledge of the diagnosis and treatment of the deficiency, so I from several aspects to do a simple science quiz, I hope useful for everyone.

A ventilator, can cure obstructive sleep apnea hypopnea syndrome (Snoring)?

Obstructive sleep apnea hypopnea syndrome. As the ventilation in the treatment of myopia glasses, it is only an auxiliary treatment device, the sleep process continued after wearing continuous positive airway pressure in the expandable upper airway soft tissue collapse area, keep the airway open, no longer sleep snoring, shortness of breath, apnea phenomenon does not occur, but the need for lifelong wear, rather than a time to be cured. However, some long-term snoring patients with pharyngeal cavity can have oedema, sleep apnea may be quite serious, wearing a respirator after a period of time, occasionally do not wear, will reduce the symptoms than before treatment. Some patients wear respirator after mental state during the day is better, more willing to take more exercise, diet regulation, weight loss, may wear after a period of time, weight loss to normal or even low, and finally achieve the complete cure phenomenon is also.

Two, obstructive sleep apnea hypopnea syndrome (Snoring) meet the conditions to do the surgery?

1, open the mouth can see tonsil hypertrophy patients, and fiberoptic nasopharyngolaryngoscopy found airway cross section were anatomic stenosis or has obvious abnormal nasal structure or obvious deviation of nasal septum, chronic sinusitis and nasal polyps.

2, whether to do surgery to monitor the severity of apnea: including the lowest oxygen saturation, apnea time, frequency, and then comprehensive evaluation. In general, the lighter the patient is more suitable for surgery. Because of the change of airway surgery is limited, if the patient has serious apnea to surgery can not be completely eliminated, for example, can remove the lateral position of apnea, cannot eliminate supine apnea; only the elimination of shallow sleep apnea, cannot eliminate the muscles more relaxed when deep sleep apnea, the patients can only obtain some effect.

3, will not cause complications. Surgery to consider whether the anatomical structure of the human body can bear the necessary function, consider the bone structure can not heal and other issues.

4, the patient wants to have the desire of operation cure, but can accept operation not to achieve the treatment effect that oneself expect. It is also important for patients to change their subjective symptoms. Each person is not the same as the degree of tolerance for apnea, some people even if only once a night apnea, will be awakened. If the patient requires that all apnea must be completely eliminated, it is necessary to assess whether the surgery can be performed. The degree of change of the airway and the severity of the disease should be considered together.

Three, low blood oxygen saturation can also surgery? Or before surgery need to wear a respirator in order to re operation?

Because of low blood oxygen saturation in patients with the best not to rush to surgery, because such patients generally longer apnea time. If the blood oxygen saturation is very low, the patient can be awakened, indicating that his central regulation is poor. Surgical treatment of central not, although the postoperative airway, but not the central command of the diaphragm and intercostal muscles movement, patients still can not breathe. Not only affect the surgical results, but also to bring the risk of surgery. Such patients do surgery, you need to wear a period of time, usually three months to six months, preferably six months. Of course also had the lowest oxygen saturation as low as 20% of the patients in the clinical work, without wearing the respirator treatment have also given surgical treatment, and postoperative effect is very good, is very high for this kind of practice operation risk, the key to the patients to receive it.

Four, what kind of obstructive sleep apnea hypopnea syndrome (Snoring) patients with ventilator effect is good?

The majority of patients with sleep apnea, if in a regular hospital to do a diagnosis and ventilator pressure test, in accordance with the doctor's prescription to wear a respirator, more than 90% of the use of good results. However, there are some patients with the initial adjustment of the pressure of the respiratory pressure is not good, you need to re do manual titration, and then wear a respirator.

In addition, patients with a ventilator to check the airway. Some patients have a very heavy breathing, but his own airway is very wide, but in the evening to sleep collapsed into a completely closed cavity; some patients with a very narrow airway, sleep will collapse to the closed. The two patients were monitored, and the severity of apnea was found to be the same, but who was more suitable for wearing a respirator? A patient with a clear airway.

The width of the airway patients, the collapse of the organization is loose, the ventilator pressure can make these tissue displacement; patients with narrow airway tissue displacement, the space is very small, only the degree of swelling hyperemia after squeeze a little, it may have some venous return to the head of the interference, in such patients is not suitable for wear the ventilator, more suitable for the operation, the narrow airway widening. Patients with severe airway obstruction but easy to shift, the most suitable for wearing a respirator.

Five, obstructive sleep apnea hypopnea syndrome (Snoring) check what needs to be done and ready before the surgery?

The first is polysomnography, which is called PSG.

The second is a three-dimensional CT scan of the paranasal sinuses, upper airway CT or MRI, to assess the structure of the upper airway, including the soft tissue and bony structure, to help select the surgical approach. Can scan the nasal cavity, pharynx, soft palate and other parts of the upper airway CT, then reconstruct the scan results, observe the reconstruction of airway stenosis surgery according to where, where is the nasal plane, soft palate or tongue is, want to move mandibular bone structure of the palate, narrow narrow, tonsils to etc.. This check is done during hospitalization.

The third is the fiber laryngoscope examination, through a mirror to see the nasal cavity, nasopharynx and throat cross-sectional area.

Fourth conditions can do a nasal function, to understand the resistance of the nasal cavity, this check is done before hospitalization.

Another often do check is esophageal manometry, the main evaluation of airflow obstruction in which the plane is still under the obstruction of the upper airway obstruction, obstruction or soft palate is nasopharyngeal obstruction, help the selection of surgical methods. In addition, some patients may need to do a pulmonary function test, so each patient's examination and treatment may be different, that is, the so-called personalized treatment.

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Audiology and otolaryngology head and neck surgery

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February 15th

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In fact, more important than the treatment of science, science and technology easier to pass more than a doctor. I like the most is to have a small snoring parents picked up the newspaper to find me, hospitalized after junior doctors to communicate with him to say "you don't have the surgery consent, I know, I believe writing science knowledge director".

February 15th


Thank the teacher Peng share learned!

February 15th

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