(1) Nasal cavity surgery
If there are ventilatory disorders caused by abnormal nasal anatomy and inflammatory diseases of the nasal cavity, different nasal cavity surgical treatments can be performed according to the diseased location, including: nasal septum deviation correction, nasal polypectomy, nasal cavity expansion, etc.
(1) Nasal cavity surgery alone cannot effectively reduce AHI, so it is not recommended as the first-line treatment of OSA; (2) Nasal cavity surgery can help reduce nasal resistance and improve compliance with CPAP treatment, but it is necessary to ensure the stability of the nasal stent. It is recommended After the operation, pressure titration was performed again to adjust the relevant parameters and CPAP treatment was continued.
(2) Tonsillectomy and adenoidectomy
For adult OSA patients with tonsillar hypertrophy and above, tonsillectomy alone can significantly improve the patient’s objective and subjective indicators. The short-term (1 to 6 months) surgical efficiency can reach 85%, and the short-term surgical cure rate can reach 57%. [63].
(1) It is recommended that patients with tonsillar hypertrophy whose preoperative AHI is less than 30 times/h undergo simple tonsillectomy; (2) It is recommended that patients undergo nasopharyngeal laryngoscopy, and when the adenoids are found to be significantly enlarged, it is recommended that adenoidectomy be performed at the same time .
Obesity, type 3 and type 4 tongue positions may reduce the surgical success rate of simple tonsillectomy for the treatment of adult OSA.
(3) Uvulopalatopharyngoplasty (UPPP)
UPPP is currently the most widely used surgical procedure for the treatment of adult OSA. It is suitable for obstructing the plane in the oropharynx, the mucosal tissue is thickened and the pharyngeal cavity is narrow, the uvula is hypertrophy or too long, the soft palate is too low and too long, the tonsil hypertrophy or the palate The predominantly narrow [2]. The effective rate of long-term surgery (>6 months) is 40% to 50% [30]. This surgery is not recommended for patients with scars and minors. For patients with high voice requirements, such as actors and singers, this surgery should be performed with caution.
There are many methods for predicting the efficacy of UPPP, and the Friedman classification system predicts the efficacy of UPPP surgery the most classic [64]. The system is mainly based on tonsil size, tongue position, and BMI. There are obvious differences in surgical efficacy between patients with different grades. According to the Friedman classification system, the classification standards for tonsils and tongue positions of OSA patients have been used up to now.
Tonsils scale: 0 degree: tonsils are in the tonsil fossa; 1 degree: beyond the tonsillar fossa, occupying oropharyngeal width <25%; 2 degrees: occupying 25%～<50% of the oropharyngeal width; 3 degrees: occupying the oropharyngeal width Of 50%～<75%; Degree 4: Occupies ≥75% of oropharyngeal width.
Tongue position indexing: judged when the patient tries to open his mouth without sticking his tongue out: 1 degree: the intact uvula and tonsils can be clearly observed; 2 degree: the uvula can be seen, but the tonsils are not observed; 3 Degree: The soft palate can be seen, but the uvula is not observed; Degree 4: Only the hard palate can be seen.
In recent years, with the deepening of the understanding of the airway morphology of patients with OSA, Chinese scholars have established three indicators based on the index of tonsil, the proportion of SaO2<90% of the total sleep time, and the vertical distance between the lower edge of the hyoid bone and the lower edge of the mandible. The "TCM Surgical Efficacy Scoring Prediction System" based on Chinese data. The total TCM score obtained by the scoring prediction system is 14, 17, and 22 as the critical stratification. The effective rates of surgery are 100%, 76.3%, 48.1%, and 10.0, respectively. %. The TCM surgical curative effect score prediction system inherits the tonsil indexing method in the Friedman classification system, and can obtain more accurate and detailed prediction results.
The surgical treatment of sleep apnea is a relatively complicated operation, but sleep apnea is not paid much attention to in the early stage. But we use smart watches to monitor our sleep status, and this is a very convenient way. Using smart watches to monitor sleep breathing is not only convenient, but also faster.
Sleep apnea occurs during a person's sleep period. When the human body enters the sleep state, the external perception is in a kind of closed state, and we cannot perceive it. But we can use smart watches with sleep monitoring function to monitor our sleep state, such as Veepoo watch RIG, HUAWEI watch3, Apple watch, Xiaomi, Huami and other smart watches can monitor our sleep state.
