阻塞性睡眠呼吸暂停综合症.ppt

阻塞性睡眠呼吸暂停综合征 Obstructive Sleep Apnea Hypopnea Syndrome,The Frist Hospital Attached to Guangzhou Medical University ENT Department Jia Wang,Have you met this sleep condition before.flv,Definition and Classification,Sleep Apnea Hypopnea Sleep hypoxemia AHI,Classification,central sleep apnea syndrome, CSAS obstructive sleep apnea syndrome, OSAS mixed sleep apnea syndrome,MSAS,Breathing wave,Chest movement,Abdomen movement,Obstructive Sleep Apnea Hypopnea Syndrome（OSAHS）,Air stops flowing through the nose and mouth, but thoracic and abdominal breathing efforts are uninterrupted. It is the most common type in the clinical.,Central Sleep Apnea Syndrome (CSAS),Both oral breathing and thoracic-abdominal breathing efforts are simultaneously interrupted The pure CSAS is few, no more than 10%；,Mixed Sleep Apnea Syndrome (MSAS),Usually， a brief period of central apnea is followed by a longer period of obstructive apnea,Sleep apnea is a condition in which breathing stops for more than 10 seconds during sleep.,Definition,Hypopnea is a condition in which a 50% reduction in thoracic-abdominal movement lasting for 10 s, associated with decreases SaO23%.,Sleep hypoxemia is a condition in which causing periods of apnea or hypopnea, the blood oxygen levels will less than 90%.,AHI is an index used to assess the severity of sleep apnea based on the total number of complete cessations (apnea) and partial obstructions (hypopnea) of breathing occurring per hour of sleep. AHI=apnea/h + hypopnea/h AHI5。,What is OSAHS? Sleep apnea/hypopnea occurs 30 or more times during a 7-hour period of nocturnal sleep, or the AHI=5.,Definition,Epidemiology of OSAHS,In USA,there is more than 4% In Shanghai, there is more than 3.6%, about 50 million patients Among these, Men is four times that of women,Risk Factors,Obesity（BMI 25） 75.9% Neck Circumference 63.2% （male41cm，female38cm） Male 78.5% Age（3555） 66.4%,Etiology,Factors and conditions that promote sonring and apnea,Whats the causes.flv,Normal Breathing,Obstructed Breathing,expiration,inspiration,Pathophysiology,Onset of sleep,Muscle tone (oral floor, tongue, pharynx, auxiliary respiratory muscles) Pharyngea cross-section Pharyngeal compliance Negative pressure (oropharynx, trachea, thorax) Airway resistance ,Apnea,pO2 pCO2 pH ,Return to sleep,Central arousal,Resumption of breathing,Bradycardia, arrhythmia,Pulmonary vasoconstriction,Loss of deep sleep, fragmented sleep,Erythropoiesis ,Systemic vasoconstriction,Sudden cardiac death,Pulmonary hypertension,Systemic arterial hypertension,Daytime fatigue, drowsiness, intellectual deterioration,Polycythemia,?,?,Pathophysiology of OSAHS,The upper airway keep opening Fall asleep Compensatory restoration Compensatory reduce Arousal microarousal The tendency for the Thoracic negative upper airway to collapse pressure increases Apnea Hypopnea pO2 pCO2,Sleep Cycle,NREM(non rapid eye movement sleep)(slow wave sleep): Stage1_Drowsiness Stage2_Light sleep Stage3_Deep sleep Stage4_Slow-wave deep sleep REM (rapid eye movement sleep),Nomal,OSAHS,SLEEP PATTERN GRAPH,Signs in the patients history that are suggestive of (obstructive) sleep apnea, Loud, irregular snoring Periods of apnea during sleep (witnessed) Unusual daytime sleepiness or fatigue Restless sleep Intellectual deterioration (poor concentration and impaired memory) Personality changes Loss of libido, impotence Nycturia, enuresis,Symptom,Obesity Short fat neck Large tonsils Facial abnormality,Examination,Adenotonsillar hypertrophy,Glossoptosis,Mandibular retrusion,The patients with OSAHS will have a troublesome life.,Daytime fatigue Drowsiness,The patients with OSAHS will have a troublesome life.,Disturbing the bed companion.,The patients with OSAHS will have a troublesome life.,Traffic Accidents,Diagnosis of OSAHS,Clinical diagnosis: Loud Snoring 95.8 % Excessive Daytime Sleepiness 86.7% Restless and Unrefreshing sleep 40 .2 % Morning headache 31.4 % Choking at night 21.5 % Reduced libido 26.3 %,PSG,Polysomonography,PSG: The golden stander for OSAHS. electroencephalogram,EEG（二导脑电图）、 electrooculogram,EOG （二导眼电图)、 include electromyogram，EMG （下颌颏肌电图）、 electrocardiogram,ECG （心电图)、 Airflow of the nose and mouse Thoracic and abdominal movement saturation of blood oxygen body position,Determining the site of airway obstruction in OSAHS,Flexible transnasal endoscopy Airway pressure measurements,OSAHS,睡眠时上气道反复发生坍塌、阻塞引起的睡眠时呼吸暂停和通气不足，伴有打鼾、睡眠结构紊乱，频繁发生血氧饱和度下降、白天嗜睡等症状。,睡眠中呼吸暂停/低通气反复发作超过30次以上，或睡眠呼吸暂停/低通气指数（index of apnea/ hypopnea, AHI；呼吸暂停/低通气次数睡眠时间）5（次/小时）。,OSAHS的诊断标准,index mild moderate severe AHI 515 1530 30 SaO2 8590 6585 65,The Severity Level of OSAHS,Why to treat the OSAHS,Survival rate,Normal person,OSAHS,Years,Treatments for OSAHS,1. Behaviour Management Body weight reduction Sleep on the side Good sleep hygiene Avoid alcohol and sedative Stop smoking,General treatment measures,2In patients with severe grades of OSAHS or an unsuccessful trial with surgical tratment .,CPAP/BiPAP,The principle of CPAP,The unstable portions of the airway can be “pneumatically splinted” by means of transnasal continuous positive pressure ventilation; this keeps the tissues from collapsing during sleep and obstructing,Oral Appliances,Surgical Tratment,Surgical treatment requires very careful patient selection, because many patients will derive little or no ben