中国全科医学 ›› 2020, Vol. 23 ›› Issue (9): 1189-1194.DOI: 10.12114/j.issn.1007-9572.2019.00.261
所属专题: 睡眠研究最新文章合辑; 睡眠问题专题研究
朱悦,张娜,叶开婷,肖伟迪,董佳慧,孙耕耘*
出版日期:2020-03-20
发布日期:2020-03-20
基金资助:ZHU Yue,ZHANG Na,YE Kaiting,XIAO Weidi,DONG Jiahui,SUN Gengyun*
Published:2020-03-20
Online:2020-03-20
摘要: 阻塞性睡眠呼吸暂停综合征(OSA)在人群中非常普遍,并且可以发生在任何年龄段。本文综述了OSA的诊治现状以及最新的治疗进展,分别从非手术治疗、手术治疗两部分进行系统阐述。笔者认为通过病因治疗、改善生活方式、减肥、睡眠体位干预等一般性治疗可明显改善轻中度OSA患者的症状。对于中重度OSA患者,持续气道正压通气(CPAP)治疗仍然是金标准。目前新兴的远程医疗技术(TLC)是一种很有前景的医疗模式,可以有效提高CPAP治疗患者的依从性。而对于不能耐受CPAP治疗的患者,可以尝试使用口腔矫正器、药物治疗等。当然,对于存在先天性或后天性解剖结构异常、不能耐受CPAP治疗的重度OSA患者,建议行手术治疗。
| [1]LIM D C,PACK A I.Obstructive sleep apnea:update and future[J].Annu Rev Med,2017,68:99-112.DOI:10.1146/annurev-med-042915-102623. [2]LOPEZ-JIMENEZ F,SERT KUNIYOSHI F H,GAMI A,et al.Obstructive sleep apnea:implications for cardiac and vascular disease[J].Chest,2008,133(3):793-804.DOI:10.1378/chest.07-0800. [3]中国医师协会睡眠医学专业委员会.成人阻塞性睡眠呼吸暂停多学科诊疗指南[J].中华医学杂志,2018,98(24):1902-1914.DOI:10.3760/cma.j.issn.0376-2491.2018.24.003. [4]TORRES G,SáNCHEZ-DE-LA-TORRE M,BARBé F.Relationship between OSA and hypertension[J].Chest,2015,148(3):824-832.DOI:10.1378/chest.15-0136. [5]中华医学会呼吸病学分会睡眠学组,中华医学会糖尿病学分会.阻塞性睡眠呼吸暂停与糖尿病专家共识[J].中华结核和呼吸杂志,2010,33(5):326-330. [6]WILLIAM L BROWN J,LOKE Y,KWOK C S,et al.Association of obstructive sleep apnoea(OSA)with incident stroke:a systematic review and meta-analysis[J].J Neurol Neurosurg Psychiatry,2013,84(11):e2.DOI:10.1136/jnnp-2013-306573.72. [7]YAFFE K,LAFFAN A M,HARRISON S L,et al.Sleep-disordered breathing,hypoxia,and risk of mild cognitive impairment and dementia in older women[J].JAMA,2011,306(6):613-619.DOI:10.1001/jama.2011.1115. [8]PASCUAL M,DE BATLLE J,BARBé F,et al.Erectile dysfunction in obstructive sleep apnea patients:a randomized trial on the effects of Continuous Positive Airway Pressure(CPAP)[J].PLoS One,2018,13(8):e0201930.DOI:10.1371/journal.pone.0201930. [9]KRISHNAN V,DIXON-WILLIAMS S,THORNTON J D.Where there is smoke…there is sleep apnea:exploring the relationship between smoking and sleep apnea[J].Chest,2014,146(6):1673-1680.DOI:10.1378/CHEST.14-0772. [10]KOLLA B P,FOROUGHI M,SAEIDIFARD F,et al.The impact of alcohol on breathing parameters during sleep:a systematic review and meta-analysis[J].Sleep Med Rev,2018,42:59-67.DOI:10.1016/j.smrv.2018.05.007. [11]EPSTEIN L J,KRISTO D,STROLLO P J Jr,et al.Clinical guideline for the evaluation,management and long-term care of obstructive sleep apnea in adults[J].J Clin Sleep Med,2009,5(3):263-276. [12]GALERNEAU L M,PéPIN J L,BOREL A L,et al.Acromegaly in sleep apnoea patients:a large observational study of 755 patients[J].Eur Respir J,2016,48(5):1489-1492.DOI:10.1183/13993003.01229-2016. [13]CECCATO F,BERNKOPF E,SCARONI C.Sleep apnea syndrome in endocrine clinics[J].J Endocrinol Invest,2015,38(8):827-834.DOI:10.1007/s40618-015-0338-z. [14]ISSA F G,SULLIVAN C E.Alcohol,snoring and sleep apnea[J].J Neurol Neurosurg Psychiatry,1982,45(4):353-359. [15]BOUSSOFFARA L,BOUDAWARA N,SAKKA M,et al.Tabagisme et Sévérité du syndrome d'apnées hypopnées obstructives du sommeil[J].Revue des Maladies Respiratoires,2013,30(1):38-43.DOI:10.1016/j.rmr.2012.08.009. [16]DELEANU O C,POCORA D,MIHALCUTA S,et al.Influence of smoking on sleep and obstructive sleep apnea syndrome[J].Pneumologia,2016,65(1):28-35. [17]TISHLER P V,LARKIN E K,SCHLUCHTER M D,et al.Incidence of sleep-disordered breathing in an urban adult population:the relative importance of risk factors in the development of sleep-disordered breathing[J].JAMA,2003,289(17):2230-2237.DOI:10.1001/jama.289.17.2230. [18]HUDGEL D W,PATEL S R,AHASIC A M,et al.The role of weight management in the treatment of adult obstructive sleep apnea.an official American thoracic society clinical practice guideline[J].Am J Respir Crit Care Med,2018,198(6):e70-87.DOI:10.1164/rccm.201807-1326ST. [19]CHUNG J W,ENCISO R,LEVENDOWSKI D J,et al.Patients with positional versus nonpositional obstructive sleep apnea:a retrospective study of risk factors associated with apnea-hypopnea severity[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2010,110(5):605-610.DOI:10.1016/j.tripleo.2010.06.017. [20]CARTWRIGHT R D.Effect of sleep position on sleep apnea severity[J].Sleep,1984,7(2):110-114. [21]OKSENBERG A S.Positional therapy for sleep apnea:a promising behavioral therapeutic option still waiting for qualified studies[J].Sleep Med Rev,2014,18(1):3-5.DOI:10.1016/j.smrv.2013.08.003. [22]OKSENBERG A,GADOTH N.Positional patients(PP)and non positional patients(NPP)are two dominant phenotypes that should be included in the phenotypic approaches to obstructive sleep apnea[J].Sleep Med Rev,2018,37:173-174.DOI:10.1016/j.smrv.2017.05.004. [23]DE VRIES G E,HOEKEMA A,DOFF M H,et al.Usage of positional therapy in adults with obstructive sleep apnea[J].J Clin Sleep Med,2015,11(2):131-137.DOI:10.5664/jcsm.4458. [24]DA SILVA R P,MARTINEZ D,LOPEZ P,et al.Effect of strength training on sleep apnea severity in the elderly:study protocol for a randomized controlled trial[J].Trials,2017,18(1):489.DOI:10.1186/s13063-017-2238-3. [25]PATIL S P,AYAPPA I A,CAPLES S M,et al.Treatment of adult obstructive sleep apnea with positive airway pressure:an American academy of sleep medicine systematic review,meta-analysis,and GRADE assessment[J].J Clin Sleep Med,2019,15(2):301-334.DOI:10.5664/jcsm.7638. [26]BERRY R B,CHEDIAK A,BROWN L K,et al.Best clinical practices for the sleep center adjustment of noninvasive positive pressure ventilation(NPPV)in stable chronic alveolar hypoventilation syndromes[J].J Clin Sleep Med,2010,6(5):491-509. [27]AURORA R N,CHOWDHURI S,RAMAR K,et al.The treatment of central sleep apnea syndromes in adults:practice parameters with an evidence-based literature review and meta-analyses[J].Sleep,2012,35(1):17-40.DOI:10.5665/sleep.1580. [28]DIAZ-ABAD M,BROWN J E.Use of volume-targeted non-invasive bilevel positive airway pressure ventilation in a patient with amyotrophic lateral sclerosis[J].J Bras Pneumol,2014,40(4):443-447. [29]SUTHERLAND K,KAIRAITIS K,YEE B J,et al.From CPAP to tailored therapy for obstructive sleep Apnoea[J].Multidiscip Respir Med,2018,13:44.DOI:10.1186/s40248-018-0157-0. [30]SPICUZZA L,CARUSO D,DI MARIA G.Obstructive sleep apnoea syndrome and its management[J].Ther Adv Chronic Dis,2015,6(5):273-285.DOI:10.1177/2040622315590318. [31]GAY P,WEAVER T,LOUBE D,et al.Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults[J].Sleep,2006,29(3):381-401. [32]PATEL S R,WHITE D P,MALHOTRA A,et al.Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea:results of a meta-analysis[J].Arch Intern Med,2003,163(5):565-571. [33]SCHEIN A S,KERKHOFF A C,CORONEL C C,et al.Continuous positive airway pressure reduces blood pressure in patients with obstructive sleep apnea:a systematic review and meta-analysis with 1000 patients[J].J Hypertens,2014,32(9):1762-1773.DOI:10.1097/HJH.0000000000000250. [34]MARSHALL N S,BARNES M,TRAVIER N,et al.Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea:a meta-analysis[J].Thorax,2006,61(5):430-434.DOI:10.1136/thx.2005.050583. [35]WEAVER T E,SAWYER A.Management of obstructive sleep apnea by continuous positive airway pressure[J].Oral Maxillofac Surg Clin North Am,2009,21(4):403-412.DOI:10.1016/j.coms.2009.08.001. [36]SAWYER A M,GOONERATNE N S,MARCUS C L,et al.A systematic review of CPAP adherence across age groups:clinical and empiric insights for developing CPAP adherence interventions[J].Sleep Med Rev,2011,15(6):343-356.DOI:10.1016/j.smrv.2011.01.003. [37]WEAVER T E,GRUNSTEIN R R.Adherence to continuous positive airway pressure therapy:the challenge to effective treatment[J].Proc Am Thorac Soc,2008,5(2):173-178.DOI:10.1513/pats.200708-119MG. [38]WEAVER T E,GRUNSTEIN R R.Adherence to continuous positive airway pressure therapy:the challenge to effective treatment[J].Proc Am Thorac Soc,2008,5(2):173-178.DOI:10.1513/pats.200708-119MG. [39]CHIHARA Y,TSUBOI T,HITOMI T,et al.Flexible positive airway pressure improves treatment adherence compared with auto-adjusting PAP[J].Sleep,2013,36(2):229-236.DOI:10.5665/sleep.2378. [40]KUSHIDA C A,BERRY R B,BLAU A,et al.Positive airway pressure initiation:a randomized controlled trial to assess the impact of therapy mode and titration process on efficacy,adherence,and outcomes[J].Sleep,2011,34(8):1083-1092.DOI:10.5665/SLEEP.1166. [41]MCARDLE N,REA C,KING S,et al.Treating chronic hypoventilation with automatic adjustable versus fixed EPAP intelligent volume-assured positive airway pressure support(iVAPS):a randomized controlled trial[J].Sleep,2017,40(10).DOI:10.1093/sleep/zsx136. [42]JOHNSON K G,JOHNSON D C.Treatment of sleep-disordered breathing with positive airway pressure devices:technology update[J].Med Devices(Auckl),2015,8:425-437.DOI:10.2147/MDER.S70062. [43]SMITH C E,DAUZ E R,CLEMENTS F,et al.Telehealth services to improve nonadherence:a placebo-controlled study[J].Telemed J E Health,2006,12(3):289-296.DOI:10.1089/tmj.2006.12.289. [44]SPARROW D,ALOIA M,DEMOLLES D A,et al.A telemedicine intervention to improve adherence to continuous positive airway pressure:a randomised controlled trial[J].Thorax,2010,65(12):1061-1066.DOI:10.1136/thx.2009.133215. [45]刘月华,曾祥龙,傅民魁,等.口腔矫治器治疗阻塞性睡眠呼吸暂停综合征(附10例报告)[J].中华口腔医学杂志,1996(1):13-16. [46]HAMODA M M,KOHZUKA Y,ALMEIDA F R.Oral appliances for the management of osa:an updated review of the literature[J].Chest,2018,153(2):544-553.DOI:10.1016/j.chest.2017.06.005. [47]Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances.American Sleep Disorders Association[J].Sleep,1995,18(6):511-513. [48]RAMAR K,DORT L C,KATZ S G,et al.Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy:an update for 2015[J].J Clin Sleep Med,2015,11(7):773-827.DOI:10.5664/jcsm.4858. [49]KUHN E,SCHWARZ E I,BRATTON D J,et al.Effects of CPAP and mandibular advancement devices on health-related quality of life in OSA:a systematic review and meta-analysis[J].Chest,2017,151(4):786-794.DOI:10.1016/j.chest.2017.01.020. [50]SCHWARTZ M,ACOSTA L,HUNG Y L,et al.Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients:a systematic review and meta-analysis[J].Sleep Breath,2018,22(3):555-568.DOI:10.1007/s11325-017-1590-6. [51]SUTHERLAND K,DEANE S A,CHAN A S,et al.Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea[J].Sleep,2011,34(4):469-477. [52]ZHOU L,CHEN P,PENG Y T,et al.Role of oxidative stress in the neurocognitive dysfunction of obstructive sleep apnea syndrome[J].Oxid Med Cell Longev,2016,2016:9626831.DOI:10.1155/2016/9626831. [53]LIRA A B,DE SOUSA RODRIGUES C F.Evaluation of oxidative stress markers in obstructive sleep apnea syndrome and additional antioxidant therapy:a review article[J].Sleep Breath,2016,20(4):1155-1160.DOI:10.1007/s11325-016-1367-3. [54]ARNULF I,HOMEYER P,GARMA L,et al.Modafinil in obstructive sleep apnea-hypopnea syndrome:a pilot study in 6 patients[J].Respiration,1997,64(2):159-161.DOI:10.1159/000196661. [55]DINGES D F,WEAVER T E.Effects of modafinil on sustained attention performance and quality of life in OSA patients with residual sleepiness while being treated with nCPAP[J].Sleep Med,2003,4(5):393-402. [56]AVELLAR A B,CARVALHO L B,PRADO G F,et al.Pharmacotherapy for residual excessive sleepiness and cognition in CPAP-treated patients with obstructive sleep apnea syndrome:A systematic review and meta-analysis[J].Sleep Med Rev,2016,30:97-107.DOI:10.1016/j.smrv.2015.10.005. [57]BAYAZIT Y A,YILMAZ M,CIFTCI T,et al.Association of the -1438G/A polymorphism of the 5-HT2A receptor gene with obstructive sleep apnea syndrome[J].ORL J Otorhinolaryngol Relat Spec,2006,68(3):123-128.DOI:10.1159/000091216. [58]BAYAZIT Y A,YILMAZ M,CIFTCI T,et al.Association of the -1438G/A polymorphism of the 5-HT2A receptor gene with obstructive sleep apnea syndrome[J].ORL J Otorhinolaryngol Relat Spec,2006,68(3):123-128.DOI:10.1159/000091216. [59]张宝泉,黄席珍,高孟林,等.CO2激光悬雍垂软腭成形术[J].中华耳鼻咽喉头颈外科杂志,1996,31(5):42-44. [60]POIRIER J,GEORGE C,ROTENBERG B.The effect of nasal surgery on nasal continuous positive airway pressure compliance[J].Laryngoscope,2014,124(1):317-319.DOI:10.1002/lary.24131. [61]FUJITA S,CONWAY W,ZORICK F,et al.Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome:uvulopalatopharyngoplasty[J].Otolaryngol Head Neck Surg,1981,89(6):923-934.DOI:10.1177/019459988108900609. [62]KWON M,JANG Y J,LEE B J,et al.The effect of uvula-preserving palatopharyngoplasty in obstructive sleep apnea on globus sense and positional dependency[J].Clin Exp Otorhinolaryngol,2010,3(3):141-146.DOI:10.3342/ceo.2010.3.3.141. [63]VILASECA I,MORELLó A,MONTSERRAT J M,et al.Usefulness of uvulopalatopharyngoplasty with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea[J].Arch Otolaryngol Head Neck Surg,2002,128(4):435.DOI:10.1001/archotol.128.4.435. [64]黄先旭,王文忠.外科治疗成人阻塞性睡眠呼吸暂停低通气综合征[J].国际耳鼻咽喉头颈外科杂志,2016,40(3):186-190.DOI:10.3760/cma.j.issn.1673-4106.2016.03.014. HUANG X X,WANG W Z.Advances in surgical treatment of obstructive sleep apnea-hypopnea syndrome in adults[J].International Journal of Otolaryngology-Head and Neck Surgery,2016,40(3):186-190.DOI:10.3760/cma.j.issn.1673-4106.2016.03.014. [65]陈雄,孔维佳.OSAHS患者个性化治疗[J].临床耳鼻咽喉头颈外科杂志,2016,30(6):437-441.DOI:10.13201/j.issn.1001-1781.2016.06.004. CHEN X,KONG W J.Individualized threatment of patients with obstructive sleep apea-hypopnea syndrome[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2016,30(6):437-441.DOI:10.13201/j.issn.1001-1781.2016.06.004. [66]VAN DE HEYNING P H,BADR M S,BASKIN J Z,et al.Implanted upper airway stimulation device for obstructive sleep apnea[J].Laryngoscope,2012,122(7):1626-1633.DOI:10.1002/lary.23301. [67]STROLLO P J Jr,SOOSE R J,MAURER J T,et al.Upper-airway stimulation for obstructive sleep apnea[J].N Engl J Med,2014,370(2):139-149.DOI:10.1056/NEJMoa1308659. [68]GILLESPIE M B,SOOSE R J,WOODSON B T,et al.Upper airway stimulation for obstructive sleep apnea:patient-reported outcomes after 48 months of follow-up[J].Otolaryngol Head Neck Surg,2017,156(4):765-771.DOI:10.1177/0194599817691491. |
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