Diagnose The Obstruction Plans Of The Upper-airway And Study The Different Effections Between Different Operations

Objective and BackgroundObstructive sleep apnea-hypopnea (OSAH)—is a sleep disorder that under thecircumstance of the existence of hard breathing, the airflow of upper-airway is obviouslydecreasing or creasing. It is the most common type of sleep-disordered breathing (SDB)and is characterized by reduplicative decrease of oxyhemoglobin saturation, light sleep andsleepy at daytime.【1】These episodes are associated with recurrent oxyhemoglobindesaturations and arousals from sleep and excessive daytime sleepiness. The pathogenesisof OSAHS is not very clearly now, but it is known that the shape of upper-airway and themuscle tissue compliance of the pharynx are the main causes[2][3]. Muscle fatigue, fattyinfiltration, decompensated muscle hyperplasia and the disorders of nervous functionscaused by long-term low oxygen, are the main causes that can affect the muscle tissuecompliance.Pharyngeal soft tissue is the most common position of upper-airway obstruction,because of the lack of bone's support. Tongue-mast, and suffix at the sleep time also cancause upper-airway obstruction. The position and level of the obstruction is different fromeach patient, so the definition of the exact position is very important for the furthertherapeutic measures. We can use X-ray, CT, MRI or telescope to check the patients, andall of these cut both ways.It has advantage to analyzing and estimating the exact position ofobstruction that compare OSAHS patient's upper-airway and the soft tissue around it andintimate the collapse at each extent of illness with electronic nasopharyngolarygnoscopeand MRI. When the position and level is clear, the multiple planes surgery method couldbe chosen. At present, the UPPP, UPPP﹠GAHM and UPPP﹠Repose system tongue-basesuspension are the common methods, but these are lack of the comparison and observationof the subjective and objective long time curative effect.At the meantime, the study of the relationship between the composition and alterationof the patient's palatopharyngeus and it's MHC type, the percentage of the muscle fiberand connective tissue, and these index's relationship between the extent of obstruction andsurgery effect, has not yet been reported in China.In our research we plan to solve these questions below: First, diagnose thestraitness of the upper-airway and the obstruction planes of the OSAHS patients. Second,discuss the relationship between the composition and alteration of the OSAHS patient's palatopharyngeus and OSAHS. Third, comprehensively evaluate the short-term andlong-term curative effect of the UPPP, UPPP﹠GAHM and UPPP﹠Repose SystemTongue-base Suspension of the OSAHS patient with double-planes obstruction. Fourth,compare and evaluate the short-term and long-term curative effect in each operation,suchas the UPPP, UPPP﹠GAHM and UPPP﹠Repose System Tongue-base Suspension of theOSAHS patient with double-planes obstruction.PartⅠ The strategic positioning analysis of the constriction ofupper-airway and the obstruction planes of the OSAHS patientspreoperative.Objective: Compare each degree of the illness of the OSAHS patient with normalperson's upper-airway and the soft tissue around it, analyzing and estimating theobstruction planes which can provide reference for clinical diagnosis and treatment of theOSAHS using electronic nasopharyngolarygnoscope and MRI.Process: Check the136OSAHS patients who have been diagnosed with electronicfiber nasopharyngolarygnoscope, and calculate the degree of obstruction. Then scan andobserve the upper-airway through MRI, and detect the sectional area and the thickness ofthe pharynx wall of the Retropalatal region[RP], the Retroglossal region[RG] and theEpiglottal region[EPG]. Other twenty healthy person has been chosen as the reference andbeen checked as the same age.Result: Checking by the Muller Experiment, the OSAHS patients have obviousdifference between the control group on the collapse degree of Retropalatal region and theRetroglossal region. Under the checking of MRI, in the medium and severe group thesectional area of the OSAHS patient's airway of soft palate and tongue boot are all greatersmaller than the control group. The difference has statistical significance. The lateralpharyngeal wall tissues thickness of every planes of upper-airway of the OSAHS group areobviously bigger than the control group. Beside the mild group of the OSAHS, the area,length and thickness of patient's soft palate in each group are all greater than the controlgroup. The anteroposterior diameter of airway area of soft palate and tongue boot ofOSAHS groups are all smaller than the control group. All the differences have statisticalsignificance. The difference between the transverse diameter of upper-airway of soft palateand tongue boot of sever OSAHS group and the same area of the control group havestatistical significance. Conclusion: Through this research, from the observation of electronicnasopharyngolarygnoscope and MRI, the medium and sever OSAHS groups have theobstruction of several planes, and the common areas are the upper-airway of soft palateand tongue boot.Part Ⅱ Discussion on the relationship between thestructural and MHC change of Upper airway palatopharyngealmuscle morphology and the obstruction of upper airway ofOSAHS patients.Purpose: Through studying OSAHS patients with different degrees of changes ofupper airway and palatopharyngeal muscle MHC isoform composition and changes ofmuscle fiber, collagen fiber in order to discuss the relationship between these changes andthe degree of upper airway obstruction.Methods: Take51samples with OSAHS and UPPP resection of thepalatopharyngeal muscle specimens as the experimental group. Take the cases of whichthe patients are of light,medium and severe degree.And there are17samples for eachdegrees. Take17chronic tonsillitis patients as the control group. Among them,thepatients have no history of OSAHS. Then take their palatopharyngeal muscle specimensfor comparison. Under light microscope,the specimens is stained by masson andobserved how the structures change,especially the muscle fiber morphology, density andarrangement of state. And the intermuscular connective tissue were observed. The result isanalyzed by semi quantitative analysis method. Stain the MHC-Ⅰ,MHC-Ⅱa, MHC-Ⅱb by immunofluorescence and analyze the difference between MHC phenotype in mRNAlevel by greal-time polymerase chain reaction (RT-PCR).Results: Masson staining showed: in the control group, the muscle fiber is arrangedneatly. And they are connected closely and formed neatly. Compared with control group,palatopharyngeal muscle fiber of the OSAHS group is arranged irregular, elastic fiberincrease and degeneration occurs. Compared with the control group, severe group showsthat the proportion of muscle fiber is reducing, and the collagen fiber proportion isincreasing. The result of Palatopharyngeal muscle tissue by immunofluorescence stainingand quantitative statistics and muscle tissue of MHC-I, MHC-I a MHC-II b mRNA RT–PCR shows: the proportion of MHC-IIa type of palatopharyngeal muscle fiber is higher and MHC-I,MHC-II b type is lower than that of the control group.And the proportion willincease if the disease becomes worse.Conclusion: Pathological change occurs from the collagen to the muscle uvulaof an OSAHS patient obviously. and it will become worse when the degree of OSAHS getsmore serious.Tips for pathological change of palatopharyngeal muscle tissue is related tothe occurrence of OSAHS and its development. The proportion of the MHC-IIa type fiberratio of upper airway dilator muscles of OSAHS patients increase and MHC–I,MHC-IIbb type decrease. And the changes become more significance when the disease become moreseverity. When the OSAHS degree become more serious and the upper airway inspiratoryresistance increases, the upper airway muscle adaptability to change, as the representativeof a type of MHC-II fast-twitch increase and adapt to the increase in inspiratoryresistance.These changes may increase the contractile force and open the upper airway.Thereduce of OSAHS patients's palate pharyngeal muscle MHC-I types decreasing theendurance to support the upper airway open and upper airway become more susceptible tocollapse.PartⅢ Evaluation the comprehensive effect of the surgery inthe short-term and long-term of multi-plane obstruction inOSAHS patientsObjective: Evaluation the short-term and long-term effect for OSAHS patientswith the UPPP, UPPP﹠GAHM and UPPP﹠Repose System Tongue-base Suspension.Method: By PSG monitoring confirmed, located by parallel electronic fiberlaryngoscope and MRI,77examples of OSAHS who are all blocked with multi-planeobstruction, moderate and severe patients.They are put into different surgical operationgroups.27of them are treated by the UPPP,24of them are treated by the UPPP﹠GAHM.26of them are treated by UPPP﹠Repose System Tongue-base Suspension.Inorder to evaluate the short-term and long-term clinical effect, polysomnography, snoringscale, OSAHS Quebec sleep questionnaire and Epworth Sleeping Scale and electronic fiberlaryngoscope,MRI have been done preperative, postoperative3months and12monthsrespectively.Result: After UPPP,the snoring score,ESS score and PSG indicators have a certainimprovement. GAHM surgery and Repose joint surgery improved snoring, ESS score,QSQ and sleep structure indicators to some extent, and a marked increase in the soft palate and tongue plane anteroposterior diameter and cross-sectional area. The differences havestatistical significance (P <0.05). These play an important role to improve the ventilation ofthe upper airway.Conclusion: In some cases, UPPP surgery can improve the AHI index, lowestoxygen saturation and life quality index. GAHM surgery and Repose joint surgery canimprove AHI index, sleep lowest oxygen saturation, snoring, patients quality of life andsleep structure indicators also showed some improvements. Repose surgery for a markedincrease in the anteroposterior diameter,the transverse diameter and cross-sectional area ofthe soft palate level and lingual postzone level, improved ventilation of the upper airway.However, patients with multi-plane blocking, which operation is better need thoroughresearch..Part Ⅳ Evaluation the effect among the surgery in theshort-term and long-term of multi-plane obstruction in OSAHSpatientsObjective: We investigate to using different manners of operation to treat OSAHSand investigate different effect between different operation.Method: By PSG monitoring confirmed, located by parallel electronic fiberlaryngoscope and MRI,77examples of OSAHS who are all blocked with multi-planeobstruction, moderate and severe patients.They are put into different surgical operationgroups.27of them are treated by the UPPP,24of them are treated by the UPPP﹠GAHM.26of them are treated by UPPP﹠Repose System Tongue-base Suspension.Inorder to evaluate the short-term and long-term clinical effect among different surgery,polysomnography, snoring scale, OSAHS Quebec sleep questionnaire and EpworthSleeping Scale and electronic fiber laryngoscope,MRI have been done preperative,postoperative3months and12months respectively.Result:3and12monthes after GAHM and Repose surgery, subjective indicators scoresand PSG Monitoring data are significant improved, compared with UPPP. They havestatistical significance (P <0.05).3and12monthes after Repose joint and GAHM surgerysleep S3stage significantly increased compared with UPPP surgery, the differences havestatistical significance (P <0.05). Comparison the three kinds of surgical postoperativeeffect:3and12monthes after GAHM and Repose surgery, total efficiency and most of the subjective, objective indicators of improvement is greater than the UPPP surgery's, theyhave statistical significance (P <0.05).Conclusion: According the controlled study, UPPP surgery can improve part of themulti-plane obstruction patients's narrow in the soft palate level,but ineffective in improvethe tongue postzone level's narrow. GAHM and Repose joint surgery can significantchanges the soft palate and tongue postzone level's narrow and the effect of Repose jointsurgery is better. Multi-plane blocking patients need to do joint intervention planes surgery.