osahs

阻塞性睡眠呼吸暂停综合征ObstructiveSleepApneaHypopneaSyndrome TheFristHospitalAttachedtoGuangzhouMedicalUniversityENTDepartmentJiaWang Haveyoumetthissleepconditionbefore flv DefinitionandClassification SleepApneaHypopneaSleephypoxemiaAHI Classification centralsleepapneasyndrome CSASobstructivesleepapneasyndrome OSASmixedsleepapneasyndrome MSAS Breathingwave Chestmovement Abdomenmovement ObstructiveSleepApneaHypopneaSyndrome OSAHS Airstopsflowingthroughthenoseandmouth butthoracicandabdominalbreathingeffortsareuninterrupted Itisthemostcommontypeintheclinical CentralSleepApneaSyndrome CSAS Bothoralbreathingandthoracic abdominalbreathingeffortsaresimultaneouslyinterruptedThepureCSASisfew nomorethan10 MixedSleepApneaSyndrome MSAS Usually abriefperiodofcentralapneaisfollowedbyalongerperiodofobstructiveapnea Sleepapneaisaconditioninwhichbreathingstopsformorethan10secondsduringsleep Definition Hypopneaisaconditioninwhicha50 reductioninthoracic abdominalmovementlastingfor10s associatedwithdecreasesSaO2 3 Sleephypoxemiaisaconditioninwhichcausingperiodsofapneaorhypopnea thebloodoxygenlevelswilllessthan90 AHIisanindexusedtoassesstheseverityofsleepapneabasedonthetotalnumberofcompletecessations apnea andpartialobstructions hypopnea ofbreathingoccurringperhourofsleep AHI apnea h hypopnea hAHI 5 WhatisOSAHS Sleepapnea hypopneaoccurs30ormoretimesduringa7 hourperiodofnocturnalsleep ortheAHI 5 Definition EpidemiologyofOSAHS InUSA thereismorethan4 InShanghai thereismorethan3 6 about50millionpatientsAmongthese Menisfourtimesthatofwomen RiskFactors Obesity BMI 25 75 9 NeckCircumference63 2 male 41cm female 38cm Male78 5 Age 35 55 66 4 Etiology Factorsandconditionsthatpromotesonringandapnea What sthecauses flv NormalBreathing ObstructedBreathing expiration inspiration Pathophysiology Onsetofsleep Muscletone oralfloor tongue pharynx auxiliaryrespiratorymuscles Pharyngeacross section Pharyngealcompliance Negativepressure oropharynx trachea thorax Airwayresistance Apnea pO2 pCO2 pH Returntosleep Centralarousal Resumptionofbreathing Bradycardia arrhythmia Pulmonaryvasoconstriction Lossofdeepsleep fragmentedsleep Erythropoiesis Systemicvasoconstriction Suddencardiacdeath Pulmonaryhypertension Systemicarterialhypertension Daytimefatigue drowsiness intellectualdeterioration Polycythemia PathophysiologyofOSAHS Theupperairwaykeepopening FallasleepCompensatoryrestoration CompensatoryreduceArousal microarousal ThetendencyfortheThoracicnegativeupperairwaytocollapsepressureincreases Apnea Hypopnea pO2 pCO2 SleepCycle NREM nonrapideyemovementsleep slowwavesleep Stage1 DrowsinessStage2 LightsleepStage3 DeepsleepStage4 Slow wavedeepsleepREM rapideyemovementsleep Nomal OSAHS SLEEPPATTERNGRAPH Signsinthepatient shistorythataresuggestiveof obstructive sleepapnea Loud irregularsnoring Periodsofapneaduringsleep witnessed Unusualdaytimesleepinessorfatigue Restlesssleep Intellectualdeterioration poorconcentrationandimpairedmemory Personalitychanges Lossoflibido impotence Nycturia enuresis Symptom ObesityShortfatneckLargetonsilsFacialabnormality Examination Adenotonsillarhypertrophy Glossoptosis Mandibularretrusion ThepatientswithOSAHSwillhaveatroublesomelife DaytimefatigueDrowsiness ThepatientswithOSAHSwillhaveatroublesomelife Disturbingthebedcompanion ThepatientswithOSAHSwillhaveatroublesomelife TrafficAccidents DiagnosisofOSAHS Clinicaldiagnosis LoudSnoring95 8 ExcessiveDaytimeSleepiness86 7 RestlessandUnrefreshingsleep40 2 Morningheadache31 4 Chokingatnight21 5 Reducedlibido26 3 PSG Polysomonography PSG ThegoldenstanderforOSAHS electroencephalogram EEG 二导脑电图 electrooculogram EOG 二导眼电图 includeelectromyogram EMG 下颌颏肌电图 electrocardiogram ECG 心电图 AirflowofthenoseandmouseThoracicandabdominalmovementsaturationofbloodoxygenbodyposition DeterminingthesiteofairwayobstructioninOSAHS FlexibletransnasalendoscopyAirwaypressuremeasurements 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 indexofapnea 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 indexmildmoderatesevereAHI5 1515 30 30SaO285 9065 85 65 TheSeverityLevelofOSAHS WhytotreattheOSAHS Survivalrate Normalperson OSAHS Years TreatmentsforOSAHS 1 BehaviourManagementBodyweightreductionSleeponthesideGoodsleephygieneAvoidalcoholandsedativeStopsmoking Generaltreatmentmeasures 2 InpatientswithseveregradesofOSAHSoranunsuccessfultrialwithsurgicaltratment CPAP BiPAP TheprincipleofCPAP Theunstableportionsoftheairwaycanbe pneumaticallysplinted bymeansoftransnasalcontinuouspositivepressureventilation thiskeepsthetissuesfromcollapsingduringsleepandobstructing OralAppliances SurgicalTratment Surgicaltreatmentrequiresverycarefulpatientselection becausemanypatientswillderivelittleornobenefitfromtheoper