阻塞性睡眠呼吸暂停综合症

阻塞性睡眠呼吸暂停综合征

Obstructive

SleepApneaHypopneaSyndromeTheFristHospitalAttachedtoGuangzhouMedicalUniversityENTDepartmentJiaWangHaveyoumetthissleepconditionbefore.flvDefinitionandClassificationSleepApneaHypopneaSleephypoxemiaAHIClassificationcentralsleepapneasyndrome,CSASobstructivesleepapneasyndrome,OSASmixedsleepapneasyndrome,MSASBreathingwaveChestmovementAbdomenmovementObstructiveSleepApneaHypopneaSyndrome（OSAHS）

Airstopsflowingthroughthenoseandmouth,butthoracicandabdominalbreathingeffortsareuninterrupted.Itisthemostcommontypeintheclinical.

CentralSleepApneaSyndrome

(CSAS)

Bothoralbreathingandthoracic-abdominalbreathingeffortsaresimultaneouslyinterrupted

ThepureCSASisfew,nomorethan10%；MixedSleepApneaSyndrome

(MSAS)

Usually，abriefperiodofcentralapneaisfollowedbyalongerperiodofobstructiveapnea

Sleepapnea

isaconditioninwhichbreathingstopsformorethan10secondsduringsleep.

DefinitionHypopneaisaconditioninwhicha50%reductioninthoracic-abdominalmovementlastingfor10s,associatedwithdecreasesSaO2≥3%.Sleephypoxemiaisaconditioninwhichcausingperiodsofapneaorhypopnea,thebloodoxygenlevelswilllessthan90%.AHIisanindexusedtoassesstheseverityofsleepapneabasedonthetotalnumberofcompletecessations(apnea)andpartialobstructions(hypopnea)ofbreathingoccurringperhourofsleep.AHI=apnea/h+hypopnea/hAHI≥5。WhatisOSAHS?Sleepapnea/hypopneaoccurs30ormoretimesduringa7-hourperiodofnocturnalsleep,ortheAHI>=5.DefinitionEpidemiologyofOSAHSInUSA,thereismorethan

4%InShanghai,thereismorethan3.6%,about50millionpatientsAmongthese,MenisfourtimesthatofwomenRiskFactorsObesity（BMI≥25）75.9%NeckCircumference63.2%

（male≥41cm，female≥38cm）Male

78.5%

Age（35—55）66.4%

EtiologyFactorsandconditionsthatpromotesonringandapneaWhat'sthecauses.flvNormalBreathingObstructedBreathingexpiration

inspiration

PathophysiologyOnsetofsleep

Muscletone↓

(oralfloor,tongue,pharynx,auxiliaryrespiratorymuscles)Pharyngeacross-section↓Pharyngealcompliance↓Negativepressure↑

(oropharynx,trachea,thorax)Airwayresistance↑

Apnea

pO2↓

pCO2↑pH↓ReturntosleepCentralarousalResumptionofbreathing

Bradycardia,arrhythmia

Pulmonaryvasoconstriction

Lossofdeepsleep,fragmentedsleep

Erythropoiesis↑

Systemicvasoconstriction

Suddencardiacdeath

Pulmonaryhypertension

Systemicarterialhypertension

Daytimefatigue,drowsiness,intellectualdeteriorationPolycythemia??PathophysiologyofOSAHSTheupperairwaykeepopening

↙↖Fallasleep

Compensatoryrestoration

↙↖CompensatoryreduceArousal\microarousal

↘↗ThetendencyfortheThoracicnegativeupperairwaytocollapsepressureincreases

↘↗Apnea\Hypopnea→pO2↓

pCO2↑

SleepCycleNREM(nonrapideyemovementsleep)(slowwavesleep):Stage1_DrowsinessStage2_LightsleepStage3_DeepsleepStage4_Slow-wavedeepsleepREM(rapideyemovementsleep)

NomalOSAHSSLEEPPATTERNGRAPH

Signsinthepatient’shistorythatare

suggestiveof(obstructive)sleepapnea

•Loud,irregularsnoring•Periodsofapneaduringsleep(witnessed)•Unusualdaytimesleepinessorfatigue•Restlesssleep•Intellectualdeterioration(poorconcentrationandimpairedmemory)•Personalitychanges•Lossoflibido,impotence•Nycturia,enuresis

SymptomObesity

Shortfatneck

Largetonsils

Facialabnormality

Examination

AdenotonsillarhypertrophyGlossoptosisMandibularretrusionThepatientswithOSAHSwillhaveatroublesomelife.DaytimefatigueDrowsinessThepatientswithOSAHSwillhaveatroublesomelife.Disturbingthebedcompanion.ThepatientswithOSAHSwillhaveatroublesomelife.TrafficAccidentsDiagnosisofOSAHSClinicaldiagnosis:•

LoudSnoring 95.8%

•

ExcessiveDaytimeSleepiness 86.7%

•

RestlessandUnrefreshingsleep40.2%

•

Morningheadache

31.4%

•

Chokingatnight

21.5%

•

Reducedlibido

26.3%

PSGPolysomonography,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)、

AirflowofthenoseandmouseThoracicandabdominal

movementsaturationofbloodoxygen

bodypositionDeterminingthesiteofairwayobstructioninOSAHSFlexibletransnasalendoscopyAirwaypressuremeasurementsOSAHS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indexmildmoderatesevere

AHI5—15 15—30 >30

SaO285—9065—<85 <65

TheSeverityLevelofOSAHSWhytotreattheOSAHSSurvivalrateNormalpersonOSAHSYearsTreatmentsforOSAHS

1.BehaviourManagement

Bodyweightreduction

Sleepontheside

Goodsleephygiene

Avoidalcoholandsedative

StopsmokingGeneraltreatmentmeasures2．InpatientswithseveregradesofOSAHSoranunsuccessfultrialw