Although new treatment patterns have recently been proposed, treatment methods for children remain particularly difficult and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment in children with mild OSAS with mandibular retrognathia. In addition to hypopnea, people with sleep-related breathing disorders also experience apnea, or complete pauses in breathing, during sleep.
So-called compliance refers to the proportion of time for patients to apply machine treatment according to the established pressure. This is influenced by many different factors, such as the treatment team, the degree of understanding of the disease by patients, etc. Some patients cannot tolerate or receive CPAP therapy, but OSAS is difficult to control if it is not corrected.
With ongoing research on osahs disease, it has been found that one of the main pathogenesis is caused by the anatomical features of sleep-induced upper airway obstruction. The narrowing and collapse of each aircraft can affect the ventilation of the upper respiratory tract. In recent years, with the deepening of research, the importance of upper respiratory obstruction as a source of the disease has attracted increasing attention.
Better results and better compliance with custom-made devices have been achieved [Vanderveken et al. 2008]. CPAP, compared to placebo, has been consistently shown to reduce the number of nocturnal obstructive events and the number of nocturnal awakenings, improving sleep parameters and nocturnal SaO2 from the first night of treatment. All daytime symptoms, especially daytime drowsiness, and nocturnal symptoms are reversed by CPAP [Patel et al. 2003; Stasche, 2006]. According to some reports, CPAP treatment may also help patients with neurocognitive disorders. In fact, after 3-6 months of consistent treatment, patients experience an improvement in their memory, attention, and executive function [Aloia et al. 2003; Zimmerman et al. 2006]. Untreated patients with OSA and daytime sleepiness are at increased risk of car accidents.
Because the device is implantable and automatically activated, the use of a mask is not required; However, as with any implantable device procedure, there is a risk of infection of the implant site. Self-titrating CPAP (Auto-CPAP) is a more advanced device that offers an alternative to traditional CPAP. While CPAP provides continuous fixed pressure throughout the treatment session, automatic and continuous CPAP adjusts the delivered pressure to maintain upper airway permeability after changes in airflow resistance. Such changes depend on factors such as posture, degree of nasal congestion or sleep stage. Varying the pressure administered, using specific algorithms, improves respiratory synchronization with the device and improves patient comfort. Auto-CPAP compliance is slightly higher compared to fixed CPAP, while the two modalities provide similar benefits in terms of daytime symptoms and sleep measures [Stanley et al. 2012].
When the cause is identified and effectively eliminated or controlled, hypertension can be cured or controlled. OSAS and aortitis are two common causes of secondary hypertension and OSAS is one of the leading causes of refractory hypertension. Many patients (no less than 30%) with hypertension have OSAS and the incidence of hypertension in OSAS is as high as 50-80%.
The consequences of untreated obstructive sleep apnea include growth retardation, bedwetting, attention deficit disorder, behavioral problems, poor academic performance, and cardiopulmonary disease. The most common etiology of obstructive sleep apnea is adenotonsillary Modafinil hypertrophy. The clinical diagnosis of obstructive sleep apnea is reliable; However, the gold standard evaluation is nocturnal polysomnography. Treatment involves the use of continuous positive airway pressure and weight loss in obese children.
By comparing preoperative and postoperative outcomes and combining subjective nasal scores filled in by patients at that time, the surgery of such patients with OSAS was performed. A relatively new surgical method of external movement of the outer wall of the nasal cavity and continuous suture of the nasal septum was proposed. The different treatments of the inferior turbinate and the surgical treatment and indications of bilateral symmetrical opening of the paranasal sinuses are summarized. In addition, light, moderate and heavy groups of SAHS are discussed via PSG study files and compared with preoperative and postoperative AHI, LSaO2 and patient filling at that time. We discussed the subjective ESS score of the nasal cavity and discussed the different effects between groups after nasal cavity expansion. We explained the reasons for the different effects between groups, indicating that some people with moderate and severe OSAS still need comprehensive multilevel treatment.
The longer mouth breathing continues and the more serious the skeletal disorders that occur in children with OSAS, the harder it is to cure SAHS. Therefore, early diagnosis of morphological analysis of UA and maxillofacial structure is crucial for pediatric OSAS. In this study protocol, CBCT will be performed from subjects both for morphological analysis of UA and for cephalometric measurements to assist in the diagnosis and evaluation of efficacy. Traditional and efficacy assessment methods commonly used in pediatric OSAS, such as PSG and the OSA-20 questionnaire, are also included in this study. The primary endpoint of the study is the mean change in AHI from baseline to primary endpoint, as PSG remains the gold standard for diagnosing OSAS.
In patients with mild to moderate OSA, nEPAP (Provent, Theravent Inc., San Jose, USA) significantly reduces snoring and AHI score and improves subjective daytime sleepiness with excellent adherence [Kryger et al. 2011]. Although this is a very well-tolerated treatment, its efficacy in patients with moderate to severe OSA is controversial [Rossi et al. 2013], and there are currently insufficient data available to include nEPAP in the recommended treatment options. Several randomized trials have evaluated the efficacy of SAM versus placebo or CPAP. Treatment with SAM has a beneficial effect on blood pressure control and determines a significant reduction in nighttime and daytime blood pressure levels [Gotsopoulos et al. 2004; Sutherland et al. 2014]. However, there is general agreement that all of these effects are milder compared to CPAP treatment.