Research ArticleAn Exploratory Study on the Treatment of ObstructiveApnea-Hypopnea Syndrome by Nasal Cavity Expansion

Ling He 1 and Zhijin Lin 2

1Hebei Eye Hospital, Otolaryngology-Head and Neck Surgery, Xingtai 054001, China2Xingtai People’s Hospital, Doctor-Patient Communication Office, Xingtai 054001, China

Correspondence should be addressed to Zhijin Lin; 2151160410@email.szu.edu.cn

Received 1 September 2021; Revised 13 October 2021; Accepted 16 October 2021; Published 11 November 2021

Academic Editor: Fazlullah Khan

Copyright © 2021 Ling He and Zhijin Lin. -is is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work isproperly cited.

Background. Respiratory disorder is a disease with a very high incidence, in which obstructive apnea-hypopnea syndrome is themost harmful. It has become a common and frequently occurring disease, which seriously influences the health of the affectedpopulation. -e pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is numerous. With the continuousresearch on OSAHS disease, it has been found that one of its main pathogeneses is caused by the anatomical characteristics ofupper airway obstruction induced during sleep. -e narrowing and collapse of any plane can affect the ventilation of the upperrespiratory tract. In recent years, with the deepening of research, the importance of the upper respiratory tract obstruction as asource of the disease has attracted increasing attention. Nasal stenosis can cause increased nasal resistance, increased pharyngealinhalation negative pressure, soft palate collapse, and narrow pharyngeal cavity, resulting in open mouth breathing, which can bethe initiating factor of the upper airway obstruction. With the development and popularization of nasal endoscopy technology,domestic and foreign scholars have reported more on the treatment of rhinogenic OSAHS with nasal cavity expansion, but theyare different. -ere is still more controversy; the main controversy centered on the effective rate of surgical treatment and theimprovement of objective indicators. -erefore, this study performed individualized nasal cavity expansion for patients withOSAHS who are mainly rhinogenic, from subjective symptoms, objective indicators, and effective rate of surgery. Methods andPatients. Conduct research and analysis to provide references for the clinical treatment of such patients. For patients with theobstructive apnea-hypopnea syndrome with nasal congestion, individualized nasal cavity expansion was performed to study theclinical effect of nasal cavity expansion in the treatment of OSAHS.-is article mainly screens cases through big data and selects alarge hospital in China to perform individualized nasal cavity expansion surgery to treat 43 adult OSAHS patients with nasalcongestion. Results. -ere are uploaded sleep monitoring, nasal reflex, nasal resistance, and nasal symptoms before and aftersurgery. Conclusion. Spirometer examination records, along with apnea-hypopnea index and minimum arterial blood oxygensaturation, the minimum cross-sectional area of the nasal cavity, nasal cavity volume, nasal airway resistance, total nasal re-spiratory volume, and other information. Also we fill in the nasal obstruction symptom assessment scale, sleepiness scale, andstudy and analyze the surgical effect of nasal cavity expansion.

1. Introduction

-e obstructive apnea-hypopnea syndrome refers to thecollapse and obstruction of the upper airway during sleep,resulting in apnea and hypopnea. It is usually accompaniedby snoring, sleep disturbance, and decreased blood oxygensaturation. -is leads to daytime sleepiness, inattention, andother symptoms. It can also lead to multiple-organ and

multiple-systems damage such as coronary heart disease,hypertension, and type II diabetes. Apnea refers to thecessation of oral and nasal airflow during sleep, that is, adecrease of 90% or more from the baseline level and aduration of 10 seconds or more. Apnea-hypopnea indexrefers to the average number of apneas and hypopneasoccurring per hour [1]. Types of apnea events: apnea eventsare divided into three types, namely, (i) obstructive, (ii)

HindawiJournal of Healthcare EngineeringVolume 2021, Article ID 6926509, 11 pageshttps://doi.org/10.1155/2021/6926509

central, and (iii) mixed. (i) When obstructive breathingdisorder occurs, the patient’s chest and abdomen breathingare still present. -e diagnosis of obstructive apnea syn-drome is based on the patient having snoring during sleep,repeated apneas, accompanied by daytime sleepiness, inat-tention, mood disorders, and other symptoms. At the sametime, multichannel monitoring, apnea-hypopnea index(AHI) is greater than or equal to 5 times an hour. Whenobstructive respiratory events are the main cause, it can bediagnosed as OSAHS. -e incidence in men is higher thanthat in women. With the aging of the population and theincrease in obesity, the incidence is increasing year by year[2–4]. With people’s attention to the source effects of upperrespiratory tract obstructive diseases, the harm of OSAHShas been increasingly recognized [5]. It is often complicatedby hypertension in middle-aged and elderly people, and thesymptoms of hypoxia when blood pressure is increased. It isclosely related to the severity of sleep-disordered breathing[6]. In addition, OSAHS is also an independent risk factorfor coronary heart disease. Relevant studies have shown thatOSAHS can increase the morbidity and mortality of coro-nary heart disease. Arrhythmia caused by OSAHS is one ofthe main causes of nocturnal death [7]. OSAHS is alsoclosely related to the occurrence of type 2 diabetes and canlead to a decline in patients’ cognitive function and evenmental disorders [8, 9]. With the in-depth study of OSAHS,it is found that the pathogenesis of OSAHS is mainly thenarrowing of the upper airway anatomical plane, that is, thepartial or complete narrowing and collapse of the airwaycaused by the obstruction of different planes of the upperairway during sleep. In addition, it also includes patho-physiological mechanisms such as insufficient upper airwaydilator response, high loop gain, and low arousal thresholdduring sleep [10]. With the analysis of anatomical factors onthe plane of upper airway stenosis, nasal congestion causedby nasal cavity stenosis may become the initiating factor ofupper airway obstruction. Nasal cavity expansion technol-ogy can correct nasal anatomy abnormalities through nasalendoscopic surgery, which can improve nasal ventilationand reduce nasal resistance; its core is to increase the ef-fective ventilation volume of the nasal cavity and reduce theanterior upper airway resistance, thereby preventing orimproving the collapse of the pharyngeal cavity. It is asurgical technique for the treatment of rhinogenic OSAHS[11], as shown in Figure 1.

In the past, the evaluation of nasal congestionsymptoms has mainly relied on the subjective feelings ofpatients and the estimation of the patient’s nasal venti-lation through nasal imaging examinations. -ere is noobjective basis, and the patient’s subjective feelings areoften inconsistent with the actual nasal cavity structureabnormalities. -e individual differences of patients andthe influence of psychological factors and the existence ofnasal menstrual cycle need to objectively quantify theclinical subjective symptoms of nasal obstruction. It iscombined with effective auxiliary examinations forcomprehensive analysis, which can not only effectivelyguide clinical work, but also determine the indications forsurgery, and can provide an objective reference and

objective basis for the prognosis and evaluation of thetreatment effect. In recent years, with the continuousadvancement of medical engineering technology and thecontinuous research on the physiological functions of thenasal cavity, the nasal function diagnosis system com-posed of rhino acoustic reflex, nasal resistance meter, andnasal breath meter has gradually matured. It is beenapplied in clinical practice, providing clinicians with nasalventilation function as a basis for objective judgment.-erefore, we incorporate the objective data collectedwith big data into the objective evaluation of nasal con-gestion symptoms in patients with rhinogenic OSAHS.Although there are many reports on nasal cavity expan-sion for the treatment of rhinogenic OSAHS, detailedsubjective and objective assessment of nasal congestionand lethargy before and after surgery, a summary ofdetailed surgical methods, and compliance with contin-uous positive airway pressure (CPAP) treatment aftersurgery, there are relatively few comprehensive reports onthe improvement of sexual performance and the analysisof different degrees of OSAHS patients among groups.-erefore, through big data screening, we conducted acomprehensive study on nasal cavity expansion surgery totreat rhinogenic OSAHS patients, evaluated and com-pared various correlation checks, and discussed OSAHS ingroups according to the AHI value. We analyzed whetherthe objective effectiveness of each group was improvedafter the operation and the degree of improvement, toexplore whether nasal cavity expansion can improve thecompliance of CPAP therapy and to study the clinicaleffects of nasal cavity expansion surgery in the treatmentof OSAHS and provide references for clinical treatment ofsuch OSAHS patients.

-e major contributions of this paper are as follows:

(1) -is paper proposes the treatment of OSAHSthrough both nonsurgical and surgical treatments, aswell as its related latest treatment suggestions, and

Figure 1: Nasal cavity expansion.

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the latest treatment methods that may be applied tothe clinic.

(2) Methods related to the treatment of OSAHS patientsare discussed, including drug therapy, CPAPmethod, nasal surgery, oral appliance, uvulopalato-pharyngoplasty (UPPP), and surgery at the bonelevel.

(3) For the treatment of OSAHS patients, CPAP treat-ment was performed before the operation. -e VASscore records the patient’s acceptance of CPAPtreatment.

(4) -e efficacy of the treatment used for OSAHS pa-tients is determined.

(5) Surgical methods used for OSAHS patients are asfollows. All patients in the group underwent indi-vidualized nasal cavity expansion surgery undernasal endoscopy, including correction of nasalseptum deviation. All patients after correction ofnasal septum were subjected to continuous pene-tration suture of the (i) nasal septum, (ii) selectiveinferior turbinate surgery, (iii) selective middleturbinate surgery, and (iv) optional bilateral sym-metrical opening of the middle nasal passages andsinuses.

(6) Postoperative treatments are discussed for the pa-tients before the surgery.

(7) -e efficacy of surgery is discussed for OSAHS pa-tients. -e results show that no complications oc-curred after endoscopic nasal cavity expansion in allpatients.

-e outline of this paper is given as follows.In section 2, Related Work, the methods related to the

treatment of OSAHS patients are discussed.In section 3, Methods, different patients with OSAHS,

methods used for the treatment of patients using the CPAP,the efficacy of the treatment used, the surgical methods usedfor its treatment, and the postoperative treatments arediscussed.

In section 4, Experiments and Discussion, the patient’sclinical data are analyzed and divided into three groups:mild, moderate, and severe, according to the preoperativePSG monitoring results, statistics of patients’ operation, thesurgical curative effect of patients, and analysis of CPAPtreatment results.

In section 5, Conclusions, a detailed comparativeanalysis of various related indicators before and after theoperation of OSAHS patients with nasal congestion throughbig data research is discussed.

2. Related Work

In recent years, the incidence of OSAHS has increased yearby year with the increasing aging of the population and theincrease in obesity [12, 13]. In addition, the etiology andpathogenesis of OSAHS are complex and individualized.-ere are many clinical treatment methods for OSAHS,including behavioral intervention, drug therapy, device

therapy, and surgical treatment. Among them, CPAPtherapy and oral treatment are the most widely imple-mented. -erefore, multidisciplinary comprehensive treat-ment should be used in the clinic according to the individualcharacteristics of the patient, and the optimal treatment planshould be selected for the patient. -is article comprehen-sively introduces the treatment of OSAHS through bothnonsurgical and surgical treatments, as well as its relatedlatest treatment suggestions, and the latest treatmentmethods that may be applied to the clinic.

Following are the methods related to the treatment ofOSAHS.

(1) Treatment of OSAHS patients by drug therapy: Drugtherapy is mostly adjuvant therapy of OSAHS. In arandomized controlled study of traditional Chinesemedicine, it was shown that the addition of phlegm-removing decoction can reduce the oxidative stressand inflammatory response of patients with OSAHS,thereby alleviating their clinical symptoms [14]. Inrecent years, the treatment of OSAHS by westernmedicine has been gradually applied to the clinic.Acetazolamide can stimulate respiratory excitementthrough metabolic acidosis. In a report of 13 patientswith OSAHS taking medication for a week, it waspointed out that its effect can reduce the loop gain by40% or so, AHI halved [15]. In addition, eszopiclonetreatment of OSAHS has also been reported suchthat it is mainly suitable for patients with low arousalthreshold and good pharyngeal muscle activity. Aftertreatment, its AHI value can be significantly reduced[16]. -e OSAHS is further classified by phenotype,and targeted drug treatment based on the individ-ualized phenotype of OSAHS patients is still thedirection of further research [17]. However, in theforeseeable future, CPAP will still be the goldstandard therapy for the treatment of OSAHS.

(2) Treatment of OSAHS patients by CPAP: At present,CPAP therapy is still the first-line treatment forOSAHS, especially for moderate to severe patients.Several rigorous clinical trials on the efficacy ofCPAP treatment have shown that the effect is good,which can significantly improve the patient’s day-time sleepiness and quality of life. It can also reducethe incidence of systemic chronic diseases, such ashypertension and cardiovascular disease, and evenreduce chronic diseases. Mortality may result fromthe acute onset of the disease [18–20]. However,many patients with CPAP treatment cannot tolerateor have a weak subjective willingness, and the degreeof acceptance is not high. -is is mostly because thecontinuous pressure of CPAP treatment causes re-spiratory discomfort and dry nose in patients.-erefore, it is more important to choose the ap-propriate treatment pressure. Titration is critical tothe compliance and efficacy of patients with subse-quent CPAP therapy [21]. At present, the CPAPtechnology itself has made many improvementsincluding the diversification of ventilation modes,

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pipe heating, and humidification, as well as theclosure and comfort of the mask, but the degree ofimprovement in patient compliance is still limited.

(3) Treatment of OSAHS patients by the oral appliance:-e oral appliance is one of the commonly usedconservative treatment options for the treatment ofOSAHS. Its therapeutic value has received more andmore clinical attention in recent years [22]. Atpresent, the common types of oral appliances aredivided into three types: (i) soft palate lifting device,(ii) tongue forward device, and (iii) lower collarforward device. One of the most commonly used isthe lower collar forward device. -e treatmentprinciple is to move the mandible forward ordownward, and the tongue moves forward to widenthe upper airway space and increase its stability.

(4) Treatment of OSAHS patients by nasal surgery: Nasalsurgery is mainly for patients with rhinogenicOSAHS. -e surgical methods mainly include three-line nasal septum reduction plasty, selective middleand inferior turbinate surgery, and selective bilateralmiddle nasal passage and sinus symmetry openingsurgery. To correct the abnormal structure of thenasal cavity, volume expansion and nasal surgery cansignificantly improve patients’ daytime sleepinessand nasal congestion symptoms, but there is nosignificant improvement in postoperative AHI.Nevertheless, domestic and foreign scholars havereported that although AHI has not improved sig-nificantly, the quality of life of patients after surgeryhas been significantly improved, and the expectedresults before surgery can be achieved [23, 24].

(5) Treatment of OSAHS patients by uvulopalatophar-yngoplasty (UPPP): Surgery at the velopharyngeallevel includes uvulopalatopharyngoplasty (UPPP)and its modified UPPP, as well as hard palatetruncation and soft palate advancement. TraditionalUPPP surgery has been continuously improved since1981 and has gradually developed into a commonlyused surgical procedure for the treatment of OSAHS[25]: surgical removal of the narrow uvula, part ofthe soft palate, and bilateral tonsils. However, thereare complications such as pharyngeal hemorrhage,nasopharyngeal reflux, and postoperative acute air-way obstruction. -e success rate of UPPP alone isonly 40% [26]. Laser-assisted uvulopalatoplasty(LAUP), soft palate radiofrequency ablation, oper-ation is to reduce the abnormal breathing caused bythe vibration and blockage of the soft tissue of thesoft palate by reducing the soft tissue of the uvula andpalatal sail. LAUP surgery can improve the com-pliance of patients with continuous positive airwaypressure therapy (CPAP), but there are differentreports on whether it can reduce AHI [27].

(6) Treatment of OSAHS patients by surgery at the bonylevel: Surgery at the bony level of the oculus mainlyincludes the advancement of the upper and lowercollar bones and the treatment of OSAHS by

expanding the volume of the bony airway. -etherapeutic effect of this type of surgery on OSAHS iscomparable to that of CPAP [28]. A meta-analysisalso pointed out that osteoarthritis can be used as areoperation option for most patients with high re-sidual AHI after the failure of OSAHS surgery [29],given in Table 1.

3. Methods

In this section, in the research materials, different patientswith OSAHS, methods used for the treatment of patientsusing the CPAP, the efficacy of the treatment used, thesurgical methods used for its treatment, and the postoper-ative treatments used are discussed below.

3.1. Research Material

(1) -e study subjects selected 43 adult OSAHS patientswho were hospitalized in a large hospital in China inJuly 2019 and underwent individualized nasal cavityexpansion surgery, including 39 males and 4 females,with an average age of 40.8± 8.6 years. (i) Enrollmentcriteria are having OSAHS symptoms: sleep at night,intermittent apnea, daytime sleepiness, inattention,nasal congestion, etc. In hospital records, PSGmonitors overnight sleep, diagnosed as OSAHS, andAHI is greater than or equal to 5 times per hour, earand nose laryngology examination. Electronic la-ryngoscope combined with Muller test, upper re-spiratory tract three-dimensional CTreconstruction,confirmed that the anatomical structure of the nosewas abnormal, with or without oropharyngeal planestenosis but no throat and throat cavity plane ste-nosis. -e symptoms of nasal congestion did notimprove after conservative treatment with drugs. (ii)Exclusion criteria: exclude chronic sinusitis with orwithout nasal polyps, nasal trauma, nasal benign andmalignant tumors, etc.; patients with obvious velo-pharyngeal stenosis due to tonsil hypertrophy; thosewith a history of the nasal cavity and sinus surgery;those with endocrine diseases; OSAHS patients, suchas acromegaly and hypothyroidism; and patientswith a history of mental illness.

(2) Main screening and recording parameters areminimum cross-sectional area of the nasal cavity,nasal cavity volume, nasal resistance value, totalnasal respiratory volume.

3.2. Research Method. All patients recorded their age,gender, and BMI index; see Table 2. CPAP treatment wasperformed before the operation. -e VAS score records thepatient’s acceptance of CPAP treatment. -e score is 0–10points. -e higher the value is, the more difficult it is toreceive CPAP treatment. Manual pressure titration recordsthe average effective treatment pressure. For score byEpworth Sleepiness Scale, see Table 3 for details, score thesleepiness symptoms of patients. For filling in the NOSE

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scale, see Table 4, simulating the specific records of nasalcongestion in patients with rhinogenic OSAHS. Screeningthe patient’s nasal acoustic reflex, nasal resistance, andnasal breath meter recording data, as well as NMCA, NCV,and NAR, VTdata represent objective evaluation indicatorsfor nasal congestion. Among them, NCV is the 0-7 cm nasalventilation volume of the nasal cavity, and NAR is the totaldouble-nasal inspiratory image. Resistance, VT, is the totalrespiratory volume of nasal breathing. In addition, thepreoperative AHI and LSaO2 data recorded by theuploaded PSG are divided into mild, moderate, and severeaccording to the diagnosis basis and curative effect eval-uation criteria of the Chinese Medical Association. Recheckthe above items 3months after the operation. -e uncuredpatients will be treated with CPAP again and the VAS scoreand the average effective treatment pressure of CPAPtreatment will be recorded. -e scoring standard is 0–10points. -e higher the score is, the more difficult it is toreceive CPAP treatment.

3.3. Efficacy Judgment. With AHI as the standard, thetherapeutic effect was determined by the 2009 obstructiveapnea-hypopnea syndrome diagnosis and surgical treatmentguidelines. -e patient’s subjective symptoms and changesin hypoxemia were also considered in the determination: (1)cure AHI less than 5 times per hour; (2) significantly ef-fective: AHI less than 20 times per hour and a reductiongreater than or equal to 50%; and (3) effective: AHI re-duction greater than or equal to 50%.

3.4. Surgical Method. According to all statistical objectsscreened by big data, their surgical methods are as follows.All patients in the group underwent individualized nasalcavity expansion surgery under nasal endoscopy, includingcorrection of nasal septum deviation. All patients aftercorrection of nasal septum were subjected to continuouspenetration suture of the (i) nasal septum, (ii) selectiveinferior turbinate surgery, and (iii) selective middle turbi-nate surgery, and (iv) optional bilateral symmetrical openingof the middle nasal passages and sinuses. All patients weretreated with general anesthesia under tracheal intubationafter excluding the contraindications of the operation.During the operation, the position was the supine positionwith head high and feet low about 15°, and the bilateral nasalcavity was constricted with normal saline and epinephrinecotton pads during the operation.

(1) Correction of nasal septum deflection: It is suitablefor patients with nasal septum deflection which leadsto limited nasal ventilation or airflow disturbancesand even affects the drainage of the middle nasalpassage. -e second-line nasal septum reductionplasty was performed in all operations. -e incisionwas made at the junction of the skin and mucosa ofthe nasal vestibule with an L-shaped incision andextended to the outside of the nasal base.-emucosaand mucochondrium were incised and peeled offunder the mucochondrium. Dissection of themucochondrium was performed under direct en-doscopy. -e dissection range included the lowerend of the nasal septal cartilage and its connectionwith the maxillary palatine process and the vomer,the vertical plate of the ethmoid bone, and the upperposterior part of the vomer. -ree core areas oftension formation are revealed, including the end ofthe nasal septal cartilage, the junction of the nasalseptal cartilage, and the vertical plate of the ethmoid.During the operation, three linear bone strips werebitten out according to the need for correction ofnasal septum deviation. Form the nasal septal car-tilage top connection; separate the left and rightsides; free the front, back, and bottom three sides;and classify and remove the spinous processes upand down. For those with obvious high deflection,rongeurs can be used to clamp the ethmoid verticalplate to make it fracture without being removed. Payattention to protecting the connection area of thenasal bone, nasal septal cartilage, ethmoid verticalplate, and nasal dorsal cartilage to prevent the back ofthe nose from collapsing. Causes of nasal congestion:nasal congestion is caused by the deflection of thenasal valve area, it is the narrowest part of the nasalcavity, and the nasal resistance is higher, which islikely to cause more serious OSAHS. Simply re-moving the tension curve or simply removing thecartilage strips at the end of the nasal septum car-tilage is often not enough. It is necessary to separatethe end of the nasal septum cartilage from the innerfoot of the alar cartilage and remove part of the end

Table 1: Symbol description.

English abbreviations English full nameOSAHS Obstructive apnea-hypopnea syndromeAHI Apnea-hypopnea indexCPAP Continuous positive airway pressureLAUP Laser-assisted uvuloplastyUPPP UvulopalatopharyngoplastyESS Epworth sleep scalePSG PolysomnogramVAS Visual analogue scaleNMCA -e nasal minimum cross-sectional areaNCV Nasal cavity volumeNAR Nasal airway resistanceVT Nasal total volumeLSaO2 Lowest arterial oxygen saturation

Table 2: BMI (kg/m2) guideline.

BMIclassification

WTOstandards

Chinastandard Disease risk

-in <18.5 <18.5 LowNormal 18.5∼24.9 18.5∼23.9 AverageOverweight ≥25 ≥24 IncreaseLittle obesity 25.0∼29.9 24.0∼26.9 Increase

Obesity 30.0∼34.9 27∼29.9 Moderateincrease

Severe obesity 35.0∼39.9 ≥30 Severe increase

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of the nasal septum cartilage in a wedge shape tocorrect the dislocation or subluxation of the nasalcolumella. After remodeling, it is stitched through. Ifthe combined nasal septal cartilage has deviated, youcan cut the cartilage on the convex surface severaltimes to reduce its tension. If it is a simple crista bonydeviation, a longitudinal incision can be made on thesurface of the deviated bone to protect the integrityof the contralateral mucosa by removing the cristaeand reducing the mucosa.

(2) Continuous nasal septum suture: After correction ofnasal septum deviation, we routinely perform con-tinuous nasal septum suture, using absorbable suturewith needles, first intermittently suture the nasalseptum incision with 3 stitches, and finally leave asingle tail thread to tie the suture with the throughsuture. Fix then tie the end of the suture needle, holdthe end of the suture with the needle holder longi-tudinally, enter through the left nasal cavity, performthe first stitch through the upper part of the middleturbinate, and suture to the right nasal cavity andthen on the right side of the nasal septum. -e lowerpart of the nasal cavity is inserted into the left nasalcavity, and then the continuous suture in the shape of“bow” is performed in this way. When the nasalseptal cartilage is close to the front end of the nasalseptum, ensure that the last two sutures are aimed atthe remaining nasal septal cartilage during the op-eration. A penetrating suture is used to shape themiddle of the nasal septum, and, finally, the pene-trating suture and the indwelling suture at the frontend of the nasal septum are knotted and fixed at thebottom of the left nasal vestibule. After the opera-tion, only absorbent cotton can be used for packing.

(1) Selective inferior turbinate surgery: According tothe patient’s specific disease conditions, there arethree types of surgery. (i) -e first is the partial

submucosal resection of the inferior turbinate,which is mainly for patients with inferior tur-binate bone hyperplasia. Local infiltration an-esthesia is applied along the bottom of theinferior turbinate and a longitudinal incision ismade to protect the normal inferior turbinatemucosa and remove the hyperplastic bone. Moveout and reset the inferior turbinate. (ii) -esecond is the external transfer of inferior tur-binate fractures. It is suitable for patients withmild hypertrophy of the inferior turbinate. -ebone mass of the inferior turbinate is fracturedby the stripper and fixed externally to widen thetotal nasal passage area. (iii) -e third type isplasma submucosal ablation of the inferiorturbinate, which is suitable for the inferior tur-binate mucosa and is not thick bones. A needle-like plasma knife is used to perforate the frontend of the inferior turbinate, and the inferiorturbinate mucosa is ablated from front to back.Absorbent cotton was used to fill and shape theinferior turbinate after the operation. In the caseof submucosal resection of the inferior turbinate,absorbent cotton can be cut longitudinallyduring packing and placed in the common nasalpassage and lower nasal passage, respectively, toshape and fix the inferior turbinate.

(2) Selective middle turbinate surgery: According tothe patient’s specific disease conditions, there arethree types of surgery. (i) -e first is the partialsubmucosal resection of the middle turbinate,which is mainly for patients with bone hyper-plasia of the middle turbinate. Local infiltrationanesthesia is applied along the free edge of themiddle turbinate and a longitudinal incision ismade. (ii) Repositioning the middle turbinateinward; the second is the internal fixation of themiddle turbinate, which is suitable for patientswith mild hypertrophy of the middle turbinate orreverse curvature of the middle turbinate. Usethe stripper to directly move the middle turbi-nate inward with light pressure to widen themiddle nasal passage. (iii) -e third type is thepartial resection of the middle turbinate, which ismainly suitable for patients with the middleturbinate bubble. Use a sharp knife to puncturethe middle turbinate air chamber, resect the

Table 3: Epworth Sleepiness Scale.

Item Never drowsy Slightly drowsy Moderately drowsy Severe drowsyReading book 0 1 2 3Watching TV 0 1 2 3Sit still 0 1 2 3One hour by car 0 1 2 3Lunch break 0 1 2 3Sit and talk 0 1 2 3Lunch 0 1 2 3Tips: >6 means drowsy, >11 means over drowsy, and >16 means dangerous drowsy.

Table 4: -e NOSE scale for the evaluation of nasal obstructionsymptoms.

Item Not Slightly Moderately Serious DangerousNose airtight 0 1 2 3 4Nose stuffy 0 1 2 3 4Insomnia 0 1 2 3 4Movementdifficulties 0 1 2 3 4

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outer wall of the air chamber in a sagittal po-sition, retain the inner wall, and trim the marginand move it inward and fix it. -e turbinate fullywidens the middle nasal passage. Here for thescope of middle turbinate resection, we generallycontrol the lower edge of the middle turbinatehigher than the upper edge of the inferior tur-binate, and the front edge of the middle turbinateis located behind the frontal process of themaxillary, and the distance is generally greaterthan 5mm. -is can effectively maintain a goodshape of the middle turbinate, meet functionalrequirements, ensure drainage of the middlenasal passage, and prevent postoperative adhe-sions. After the operation, absorbent cotton wasroutinely placed on the outside of the middleturbinate for packing to ensure the shape of themiddle turbinate.

(3) Selective bilateral symmetrical opening of themiddle nasal passages and sinuses: for the un-cinate hypertrophy or gasification and middlenasal passages stenosis, after treatment accordingto the shape of the middle turbinate, bilateraluncinate resection is performed, and the scope ofthe resection of the uncinate process is as follows:keep a little at the upper end, and excise the lowerend to expose the ostium of the maxillary sinus.If there is still a possibility of poor maxillarysinus drainage after uncinate process resection,bilateral maxillary sinuses should be openedsymmetrically. For those with overdevelopedethmoid vesicles or the formation of Haller aircells and nasal mound air cells, anterior sieveshould be performed opening the sinuses andopening the frontal and maxillary sinuses asappropriate to avoid occlusion of the sinus. Forpatients with nasal cavity stenosis, due to thegasification of the maxillary sinus, the nasola-crimal crypt approach is used to protect thenasolacrimal duct to remove the inferior turbi-nate bone and remove the targeted part. -ebone of the inner wall of the maxillary sinus iscombined with the middle nasal passage toremove the uncinate process. -e bilateralmaxillary sinuses are opened symmetrically, andthe inferior turbinate and outer wall of the nasalcavity is moved outward; the inferior turbinate ispushed into the upper mandibular sinus cavity toexpand the inherent nasal cavity area.

3.5. Postoperative Treatment. According to the postopera-tive treatment records of the screening subjects recorded bythe hospital, nasal spray with seawater was performed24 hours after the operation, and nasal cavity washing wasperformed 48 hours later. -e nasal cavity was observed forbleeding and infection under anterior rhinoscopy, and thetotal was cleaned on the third day after the operation. Nasalsecretions were discharged from the hospital on the 4th day

after surgery and were treated with nasal spray hormonesand oral mucus excretion agents. After 7–10 days of theoperation, the nasal cavity packing was removed by thedressing change of the nasal endoscopy, and the nasal cavitysuture was removed for the patients with nasal septumcorrection. Routine nasal endoscopy was performed 4weeks,8 weeks, and 12weeks after surgery to clean the nasal cavityand prevent intraoperative adhesions. -ree months afterthe operation, recheck and fill in the NOSE scale and ESSscale to record scores; recheck PSG to record AHI andLSaO2; recheck nasal reflex, nasal resistance, and nasalbreath meter examination; and record NMCA, NCV, NAR,and VT. CPAP treatment was performed on uncured pa-tients, and the VAS score of CPAP treatment was recordedand the average effective treatment pressure was recorded bypressure titration.

4. Experiments and Discussion

In the experiments and discussion section, the patient’sclinical data are analyzed and divided into three groupsmild,moderate, and severe according to the preoperative PSGmonitoring results. Statistics of patients’ operation, thesurgical curative effect of patients, and analysis of CPAPtreatment results are discussed.

4.1. Analysis of Patient Clinical Data. All 43 patientsscreened based on big data were grouped according to thepreoperative PSG monitoring results according to the AHIvalue and divided into three groups: mild, moderate, andsevere, including 16 cases in the mild group, 14 males and 2females; 13 cases in the moderate group, 11 males and 2females; 14 patients in the severe group, all males. -e agesbetween the three groups were mild: 34.7± 6.2, moderate:41.2± 7.2, and severe: 47.8± 6.5. BMI between the threegroups were, respectively, mild: 22.5± 1.7 kg/m2, moderate:24.8± 2.3 kg/m2, and severe: 27.6± 2.7 kg/m2. A single factoris used for the comparison of age and BMI index among thethree groups for the analysis of variance; see Table 5 andFigure 2 for age and see Table 6 and Figure 3 for the BMIindex.-e results of the single-factor analysis of variance forthe age of the three groups of patients were F� 14.26,P< 0.05, and the result of the BMI index single-factoranalysis of variance was F� 20.39, P< 0.05, indicating theseverity of OSAHS patients. -ere is a tendency to increasewith age and the severity of OSAHS increases with theincrease in BMI.

4.2. Statistics of Patient Operations. All patients underwentnasal septum deflection correction in 39 cases; middleturbinate submucosal partial bone resection was performedin 6 cases, middle turbinate internal fixation was performedin 30 cases, and middle turbinate was partially resected in 9cases; bilateral inferior turbinate was performed in 9 cases.-ere were 29 cases of partial submucosal resection, 9 casesof unilateral partial submucosal resection of the inferiorturbinate and 7 cases of inferior turbinate fractures.

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4.3. 2e Effect of Surgery. According to the record resultsshown by big data, among the 43 samples, 7 cases werecured, 8 cases were markedly effective, and 3 cases wereeffective, including 5 cases of mild OSAHS cured, 5 cases ofmarked effect, 2 cases of moderate OSAHS cured, 3 cases ofmarked effect, and severe OSAHS effect in 3 cases. -eoverall effective rate is 41.9%, as shown in Figure 4. Nocomplications occurred after endoscopic nasal cavity ex-pansion in all patients.

4.4. Analysis of CPAP Treatment Results. After nasal cavityexpansion, the NOSE score and ESS score of all patients weresignificantly decreased, and the subjective nasal congestionand drowsiness symptoms were significantly alleviated. -eobjective indicators of NMCA, NCV, VT increased signifi-cantly, and the NAR decreased significantly. Indicating thatthe patient’s nasal cavity was significantly more spaciousthan before surgery and ventilation increased; see Table 7 fordetails. Compared with preoperative patients, the VAS

scores of CPAP treatment and the average effective treat-ment pressure of CPAP treatment were significantly re-duced, and the average P< 0.05. According to the efficacy

Table 5: Statistical distribution of three groups of OSAHS patients at different ages.

Grouping Number Age F PMild 16 34.7± 6.2

14.26 <0.05Moderate 13 41.2± 7.2Severe 14 47.8± 6.5

60

50

40

30

20

10

0Cases number Age

Item

Num

bers

MildModerateSevere

Figure 2: -e number and age distribution of the three groups of OSAHS patients.

Table 6: One-way variance of BIM in three groups of OSAHSpatients.

Grouping Cases number Age F PMild 16 34.7± 6.2

14.26 <0.05Moderate 13 41.2± 7.2Severe 14 47.8± 6.5

35

30

25

20

15

10

5

0

Num

bers

Numbers of people BIMItem

MildModerateSevere

Figure 3: -e number of OSAHS patients in each group and BIMindex in the three groups.

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evaluation standard of the Chinese Medical Association, inthis study, after the treatment of nasal cavity expansionsurgery, the AHI of the mild and intermediate OSAHSpatients decreased, and the LSaO2 increased, P< 0.05. Al-though the AHI of the severe group OSAHS patients de-creased, the LSaO2 increased, P> 0.05; see Table 8.

5. Conclusions

-is study conducted a detailed comparative analysis ofvarious related indicators before and after the operation of

OSAHS patients with nasal congestion through big dataresearch. By comparing the preoperative and postoperativeresults and combining the subjective NOSE scores filled inby the patients at the time, the operation of such OSAHSpatients was carried out. -e postnasal congestion wasanalyzed subjectively and objectively. A relatively novelsurgical method of external movement of the outer wall ofthe nasal cavity and continuous suture of the nasal septumwas proposed. -e different treatments of the inferior tur-binate and the surgical treatment and indications of thebilateral symmetrical opening of the sinuses are

25

20

15

10

5

0Number Cured Markedly effective Effective Invalid

Item

Num

ber

MildModerateSevere

Figure 4: Statistics chart of surgical curative effect of patients with different degrees.

Table 7: Congestion and lethargy before and after surgery.

Check index Before surgery After surgery T PNOSE 12.4± 2.86 4.5± 1.77 19.83 <0.001ESS 12.7± 2.21 7.6± 2.14 23.69 <0.001NMCA (cm2) 0.5± 0.11 1.5± 0.26 −41.18 <0.001NCV (cm3) 8.9± 0.83 18.2± 3.26 −19.56 <0.001NAR (kPa•s/L) 0.5± 0.04 0.2± .0.03 50.79 <0.001VT (L) 5.2± 0.47 8.7± 1.54 −18.67 <0.001

Table 8: Comparison of AHI and LSaO2 of patients before and after surgery.

Grouping Check index Before surgery After surgery t P

Mild AHI 10.8± 2.7 6.3± 2.34 6.92 <0.001LSaO2 76.4± 2.6 82.0± 2.80 −12.45 <0.001

Moderate AHI 24.4± 4.4 17.4± 6.51 6.03 <0.001LSaO2 70.9± 3.2 73.9± 3.29 −8.88 <0.001

Severe AHI 055.4± 14.5 53.4± .19.8 0.81 0.436LSaO2 65.9± 4.62 66.9± 3.30 −1.33 0.210

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summarized. In addition, the light, moderate, and heavygroups of OSAHS are discussed through the PSG exami-nation records and compared with the preoperative andpostoperative AHI, LSaO2, and the patient’s filling in at thetime. -e subjective ESS score of the nasal cavity was dis-cussed, and the different effects between the groups afternasal cavity expansion were discussed. -e reasons for thedifferent effects between the groups were explained, indi-cating that some moderate and severe OSAHS patients stillneed multilevel comprehensive treatment. -e above are allclinical work, providing more meaningful reference data. Inaddition, through the questionnaires filled out by patients, itis found that the patient’s subjective acceptance of CPAPtreatment and objective CPAP effective treatment pressureare summarized in two aspects. Nasal cavity expansionsurgery can improve compliance with CPAP treatment.However, this study also has some shortcomings, such as therelatively short research time and the small number of re-search samples. In addition, the inconsistency betweensubjective symptoms and objective indicators requires fur-ther in-depth research. -erefore, the research results of thispaper still need follow-up long-term field visits and furtherobservation and research.

Data Availability

-e datasets used and analyzed during the current study areavailable from the corresponding author upon reasonablerequest.

Disclosure

Ling He and Zhijin Lin are co-first authors.

Conflicts of Interest

-e authors declare that they have no conflicts of interest.

Authors’ Contributions

Ling He and Zhijin Lin contributed equally.

Acknowledgments

-is study was funded by the Hebei Province Key Scienceand Technology Research Plan (20190138).

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