Research On Simultaneous Multi Level Operation Treatment For Obstructive Sleep Apnea Hypopnea Syndrome And Changes Of Leptin Before And After Operation

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is one of the most common clinical sleep disorders. The incidence rate of this disease is high. The American epidemiological survey figured out that2%women and4%men had apnea among the people aged above50years old. With increasing pressure of life, the incidence rate of the disease also increase, and the age of the patients become more and more younger. These patients not only have sleep snoring and apnea but also daytime sleepiness and lethargy. A long time suffering of this disease can cause some complications like high blood pressure, heart disease, diabetes, cerebrovascular disease and so on.Although the pathophysiology of obstructive sleep apnea-hypopnea syndrome is not completely clear it is certain that repeated partial or complete collapse of upper airway can lead to OSASH. Collapse occurred in any level of the upper airway including the nasal cavity, pharynx (nasopharyngeal, oropharynx and hypopharynx), and laryngeal cavity can lead to OSAHS. Collapse of upper airway may be the single or more than one level. The aim of surgical treatment for OSAHS is to expand and prevent collapse of upper airway. The key of operation is to determine the obstructive level and release the corresponding narrow level.Of course, the success of the operation not only have relationship with the obstructive level and degree of obstruction, but also associates with the patients themselves. For selected patients with OSASH, the effect of operation is good and the long-term effect of operation is equal to the effect of CPAP. The surgical treatment for OSAHS develops rapidly, from initial uvulopalatopharyngoplasty, to genioglossus advancement, hyoid suspension etc. The complexity of operation also greatly increased, from a original single pharynx-palate level to multi level operation. Many OSAHS patients have multiple collapse level, specially in patients with severe OSAHS. Simultaneous multi level operation can relieve all the collapse level and the curative effect is exact. At the same time simultaneous multi level operation can avoid the pain and economic burden brought by the second operation.Obesity, especially central obesity, is recognized as one of the most important reasons leading to OSAHS. More than50%of the OSAHS patients with obesity, and about10%-20%common patients with obesity often get OSAHS. The OSAHS patients usually have bigger neck circumference, lots of parapharyngeal fat deposition, airway stenosis, and easily get airway collapse. The OSAHS patients also accompanied by visceral fat accumulation, which will lead to lung volume reduction and reduce the longitudinal pulling effect from lower airway to upper airway at the process of suction, all above increasing compliance of the pharynx wall. OSAHS patients have bigger neck circumference, waist circumference and waist to hip ratio compared with common people, which indicate more fat deposition on the OSAHS, and the fat deposites on the neck and abdomen more easily.Leptin is a hormone encoded by the obese gene and mainly secreted by white adipose cells. Leptin’s function including as follows:inhibit of appetite, decrease energy intake, regulate glucose metabolism, promote fat decomposition as well as inhibit the synthesis of fat etc. Many studies show that serum leptin concentration is higher in OSAHS than normal, and it expresses that the level increasing along with the severity of OSAHS, positively associated with AHI. Leptin concentration positively associate with body mass index, and can reflect the content of body fat. Leptin may play an important role in the pathogenesis of OSAHS, majority of patients with OSAHS have high serum leptin concentration and leptin resistance at the same time, the two often affect each other, lead to vicious circle. Serum leptin levels in OSAHS patients is elevated for many reasons, maybe caused by upper airway inflammation、increasing sympathetic nerve activity、interruption of leptin secretion rhythm. In addition, serum leptin can prevent the occurrence of respiratory depression, which is a protection mechanism. The mechanism of leptin resistance is still not clear, the possible reasons are leptin antibody or antagonist existing in blood, leptin transport channel barrier, hormone signal transduction pathway defects, hormone receptor deficiency or receptor mutation that does not play a role.This study is designed to investigate the therapeutic effects of multiple level surgery in treating obstructive sleep apnea-hypopnea syndrome,and to investigate the changes of serum leptin level in normal people and OSAHS before and after operation. In order to figure out the change that the level of serum leptin in OSAHS post operation, by the way to make a corresponding guidance for epidemic investigation and evaluation of the effect of operation.