阻塞性睡眠呼吸暂停的诊断和治疗:一篇综述
Daniel J Gottlieb1,2,3, Naresh M Punjabi4
1Medical Service, VA Boston Healthcare System, Boston, Massachusetts.
JAMA
|April 15, 2020
概括
阻塞性睡眠呼吸暂停 (OSA) 是常见的,并且随着肥胖而增加. 有效的治疗方法存在,但减少心血管事件的证据有限,特别是在无症状病例中.
科学领域:
- 睡眠医学
- 心血管健康
- 公共卫生
背景情况:
- 阻塞性睡眠呼吸暂停 (OSA) 影响了大量人口,与肥胖率上升有关.
- 主要症状包括白天过度的嗜睡,尽管许多患者仍然没有症状.
- OSA是心血管和代谢疾病的主要危险因素.
研究的目的:
- 提供关于阻塞性睡眠呼吸暂停 (OSA) 的诊断和治疗的最新评论.
- 突出目前对OSA对健康的影响和可用的干预措施的理解.
主要方法:
- 关于OSA诊断和治疗的当前文献的审查.
- 分析包括家庭睡眠呼吸暂停测试在内的诊断方法.
- 对OSA的各种治疗措施的评估.
主要成果:
- 家庭睡眠呼吸暂停测试对OSA诊断的灵敏度约为80%.
- 有效的治疗方法包括改变生活方式,正气道压力 (PAP),口腔器械,手术和下神经刺激.
- PAP疗法可以降低血压, 特别是在抗性高血压, 但大型试验没有显示显著的心血管事件减少.
结论:
- 睡眠障碍是一种普遍的疾病,需要有效的管理策略.
- 虽然像PAP这样的治疗可以改善症状并降低血压,但缺乏高质量的证据支持其用于预防所有OSA患者的心血管事件,特别是无症状患者.
- 对于无症状或最小症状的OSA患者,建议进行行为干预.
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