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成人OSAHS危险因素及不同治疗方式研究进展
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Abstract:
阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)是一种睡眠时上气道狭窄和塌陷引起呼吸暂停和通气不足的与睡眠相关的呼吸障碍性疾病，常伴随有打鼾、睡眠结构紊乱、频繁发生血氧饱和度下降、白天嗜睡、注意力不集中等症状。OSAHS可导致许多并发症，如内分泌疾病、心脑血管疾病及认知功能障碍等。该病高风险、致死性高，对患者生存和健康产生了严重影响。因此，为了更好的制定OSAHS筛查策略和改善患者的健康状况，需要充分了解OSAHS相关危险因素及进行尽早有效的治疗。本文结合国内外最新文献，就OSAHS危险因素及治疗方式做一综述。
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a sleep-related breathing disorder caused by apnea and hypoventilation caused by narrowing and collapse of the upper airway during sleep, often accompanied by snoring, sleep structure disorders, frequent oxygen saturation drops, day-time sleepiness, and inattention. OSAHS can lead to many complications, such as endocrine diseases, cardiovascular and cerebrovascular diseases, and cognitive dysfunction. The disease is high- risk, fatal, and has a serious impact on patient survival and health. Therefore, in order to better develop OSAHS screening strategies and improve the health status of patients, it is necessary to fully under-stand the risk factors related to OSAHS and carry out early and effective treatment. This article re-views the risk factors and treatment methods of OSAHS based on the latest literature at home and abroad.
| [1] | Arnardottir, E.S., Bjornsdottir, E., Olafsdottir, K.A., Benediktsdottir, B. and Gislason, T. (2016) Obstructive Sleep Ap-noea in the General Population: Highly Prevalent but Minimal Symptoms. European Respiratory Journal, 47, 194-202.
https://doi.org/10.1183/13993003.01148-2015 |
| [2] | 徐超, 谢宇平, 康宏, 等. 中重度阻塞性睡眠呼吸暂停低通气综合征患者腭咽成形术后佩戴改良一体式阻鼾器的疗效[J]. 中华医学杂志, 2015, 95(10): 761-765. |
| [3] | Weinstock, T.G., et al. (2014) Predictors of Obstructive Sleep Apnea Severity in Adenotonsillectomy Candidates. Sleep, 37, 261-269. https://doi.org/10.5665/sleep.3394 |
| [4] | 崔志汉. 睡眠呼吸暂停综合征的诊断与治疗[J]. 家庭医学, 2008(2): 8-9. |
| [5] | Rundo, J.V. (2019) Obstructive Sleep Apnea Basics. Cleveland Clinic Journal of Medicine, 86, 2-9.
https://doi.org/10.3949/ccjm.86.s1.02 |
| [6] | Lee, Y.G., Lee, Y.J. and Jeong, D.U. (2017) Differential Effects of Obesity on Obstructive Sleep Apnea Syndrome according to Age. Psychiatry Investigation, 14, 656-661. https://doi.org/10.4306/pi.2017.14.5.656 |
| [7] | Dixon, J.B., Schachter, L.M. and O’Brien, P.E. (2003) Predicting Sleep Apnea and Excessive Day Sleepiness in the Severely Obese: Indicators for Polysomnography. Chest, 123, 1134-1141. https://doi.org/10.1378/chest.123.4.1134 |
| [8] | 沈宏华, 许轶明, 王年, 等. 经鼻CPAP结合不同强度有氧训练对OSAHS合并2型糖尿病患者的疗效[J]. 中华医学杂志, 2019, 99(28): 2187-2192. |
| [9] | 黄颖, 张丙芳, 王晓明, 等. 老年阻塞性睡眠呼吸暂停综合征与心血管疾病的研究进展[J]. 第四军医大学学报, 2008, 29(4): 376-378. |
| [10] | United Nations, Department of Economic and Social Affairs, Population Division (2019) World Popula-tion Prospects 2019. |
| [11] | Martínez-García, M., Amilibia, J., Chiner, E., Queipo, C., Díaz de Atauri, M.J., Carmona-Bernal, C., et al. (2010) [Sleep Apnoea in Patients of Elderly: Care Activity in Spain (2002-2008)]. Archivos de Bronconeumologia, 46, 502-507.
https://doi.org/10.1016/S1579-2129(11)60002-5 |
| [12] | Redline, S., Kirchner, H.L., Quan, S.F., Gottlieb, D.J., Kapur, V. and Newman, A. (2004) The Effects of Age, Sex, Ethnicity and Sleep-Disordered Breathing on Sleep Architecture. Archives of Internal Medicine, 164, 406-418.
https://doi.org/10.1001/archinte.164.4.406 |
| [13] | Li, N., Liu, Y., Zhao, Y., Wu, X., Tong, J. and Hua, Y. (2020) Cerebrovascular Reactivity in Young and Old Patients with Obstructive Sleep Apnea. Sleep Medicine, 73, 125-129. https://doi.org/10.1016/j.sleep.2020.04.029 |
| [14] | Senartna, C.V., Perret, J.L., Lodge, C.J., et al. (2017) Prevalence of Obstructive Sleep Apnea in the General Population: A Systematic Review. Sleep Medicine Reviews, 34, 70-81. https://doi.org/10.1016/j.smrv.2016.07.002 |
| [15] | Whittle, A.T., Marshall, I., Mortimore, I.L., Wraith, P.K., Sellar, R.J. and Douglas, N.J. (1999) Neck Soft Tissue and Fat Distribution: Comparison between Normal Men and Women by Magnetic Resonance Imaging. Thorax, 54, 323-328.
https://doi.org/10.1136/thx.54.4.323 |
| [16] | Heinzer, R., Vat, S., Marques-Vidal, P., Marti-Soler, H., Andries, D., Tobback, N., et al. (2015) Prevalence of Sleep-Dis- ordered Breathing in the General Population: The Hypno Laus Study. The Lancet Respiratory Medicine, 3, 310-318.
https://doi.org/10.1016/S2213-2600(15)00043-0 |
| [17] | Huang, T., Lin, B.M., Markt, S.C., Stampfer, M.J., Laden, F., Hu, F.B., et al. (2018) Sex Differences in the Associations of Obstructive Sleep Apnoea with Epidemiological Factors. European Respiratory Journal, 51, Article ID: 1702421.
https://doi.org/10.1183/13993003.02421-2017 |
| [18] | Bonsignore, M.R., Saaresranta, T. and Riha, R.L. (2019) Sex Differences in Obstructive Sleep Apnoea. European Respiratory Review, 28, Article ID: 190030. https://doi.org/10.1183/16000617.0030-2019 |
| [19] | Sforza, E., Chouchou, F., Collet, P., et al. (2011) Sex Differ-ences in Obstructive Sleep Apnoea in an Elderly French Population. European Respiratory Journal, 37, 1137-1143. https://doi.org/10.1183/09031936.00043210 |
| [20] | Sinha, A., Jayaraman, L. and Punhani, D. (2020) Predictors of Difficult Airway in the Obese Are Closely Related to Safe Apnea Time. Journal of Anaesthesiology Clinical Pharma-cology, 36, 25-30.
https://doi.org/10.4103/joacp.JOACP_164_19 |
| [21] | Pedrosa, R.P., Drager, L.F., Gonzaga, C.C., Sousa, M.G., de Paula, L.K., Amaro, A.C., et al. (2011) Obstructive Sleep Apnea: The Most Common Secondary Cause of Hypertension Associated with Resistant Hypertension. Hypertension, 58, 811-817. https://doi.org/10.1161/HYPERTENSIONAHA.111.179788 |
| [22] | Martinez-Garcia, M.A., Navarro-Soriano, C., Torres, G., Barbe, F., Caballero-Eraso, C., Lloberes, P., et al. (2018) Beyond Resistant Hypertension. Hypertension, 72, 618-624. https://doi.org/10.1161/HYPERTENSIONAHA.118.11170 |
| [23] | Hou, H., Zhao, Y., Yu, W., Dong, H., Xue, X., Ding, J., et al. (2018) Association of Obstructive Sleep Apnea with Hypertension: A Systematic Review and Meta-Analysis. Journal of Health Global, 8, Article ID: 010405.
https://doi.org/10.7189/jogh.08.010405 |
| [24] | Young, T., Peppard, P., Palta, M., Hla, K.M., Finn, L., Morgan, B., et al. (1997) Population-Based Study of Sleep- Disordered Breathing as a Risk Factor for Hypertension. Archives of Inter-nal medicine, 157, 1746-1752.
https://doi.org/10.1001/archinte.1997.00440360178019 |
| [25] | Buda, A.J., et al. (1979) Effect of Intrathoracic Pres-sure on Left Ventricular Performance. The New England Journal of Medicine, 301, 453-459. https://doi.org/10.1056/NEJM197908303010901 |
| [26] | Somers, V.K., Dyken, M.E., Clary, M.P. and Abboud, F.M. (1995) Sympathetic Neural Mechanisms in Obstructive Sleep Apnea. Journal of Clinical Investigation, 96, 1897-1904. https://doi.org/10.1172/JCI118235 |
| [27] | O’Brien, L.M. and Gozal, D. (2005) Autonomic Dysfunction in Children with Sleep-Disordered Breathing. Sleep, 28, 747-752. https://doi.org/10.1093/sleep/28.6.747 |
| [28] | Zhou, X., Lu, Q., Li, S., Pu, Z., Gao, F. and Zhou, B. (2020) Risk Factors Associated with the Severity of Obstructive Sleep Apnea Syn-drome among Adults. Scientific Reports, 10, Article No. 13508.
https://doi.org/10.1038/s41598-020-70286-6 |
| [29] | Lavie, P., Herer, P. and Hoffstein, V. (2000) Obstructive Sleep Apnoea Syndromeas a Risk Factor for Hypertension: Population Study. BMJ, 320, 479-482. https://doi.org/10.1136/bmj.320.7233.479 |
| [30] | Nieto, F.J., Young, T.B., Lind, B.K., Shahar, E., Samet, J.M., Red-line, S., et al. (2000) Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Communi-ty-Based Study. Sleep Heart HealthStudy. JAMA, 283, 1829-1836. https://doi.org/10.1001/jama.283.14.1829 |
| [31] | Dong, J.Y., Zhang, Y.H. and Qin, L.Q. (2013) Obstructive Sleep Apnea and Cardiovascular Risk: Meta-Analysis of Prospective Cohort Studies. Atherosclerosis, 229, 489-495. https://doi.org/10.1016/j.atherosclerosis.2013.04.026 |
| [32] | Strausz, S., Havulinna, A.S., Tuomi, T., Bachour, A., Groop, L., Makitie, A., et al. (2018) Obstructive Sleep Apnoea and the Risk for Coronary Heart disease and Type 2 Dia-betes: A Longitudinal Population-Based Study in Finland. BMJ Open, 8, e022752. https://doi.org/10.1136/bmjopen-2018-022752 |
| [33] | Seicean, S., Kirchner, H.L., Gottlieb, D.J., Punjabi, N.M., Resnick, H., Sanders, M., et al. (2008) Sleep-Disordered Breathing and Impaired Glucosemetabolism in Normal-Weight and Overweight/Obese Individuals: The Sleep Heart Health Study. Diabetes Care, 31, 1001-1006. https://doi.org/10.2337/dc07-2003 |
| [34] | Fang, H., Zhao, T., Walsh, T., et al. (2019) Effects of Adenotonsillectomy on the Growth of Children with Obstructive Sleep Apnoea-Hypopneasyndrome (OSAHS): Protocol for a Systematic Review. BMJ Open, 9, e030866.
https://doi.org/10.1136/bmjopen-2019-030866 |
| [35] | 铁剑华, 黄晓波. 阻塞性睡眠呼吸暂停低通气综合征患者代谢紊乱的研究[J]. 宁夏医科大学学报, 2011, 33(9): 823-825. |
| [36] | 张菊红, 李南方, 索菲娅阿布利克木, 等. 高血压合并阻塞性睡眠呼吸暂停综合征患者的糖代谢紊乱及胰岛素抵抗[J]. 中华高血压杂志, 2014, 22(4): 375-379. |
| [37] | Jin, S., Jiang, S. and Hu, A. (2018) Association between Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Sleep Breath, 22, 841-851. https://doi.org/10.1007/s11325-018-1625-7 |
| [38] | 刘卿雪. 阻塞性睡眠呼吸暂停低通气综合征临床诊治进展[J]. 中华中西医杂志, 2007, 30(6): 846-847. |
| [39] | Malia, D., Sanchez-Gascon, F., Ros, J.A., Gómez-Gallego, M., Castell, P., Nombela, C., Méndez, P., del Carmen Abellán, M. and Hernández, J. (2005) Factors with Influence on Sleep Ap-nea/Hypopnea Syndrome. Medicina Clínica, 125, 681-684. https://doi.org/10.1016/S0025-7753(05)72154-0 |
| [40] | 邓群繁. 阻塞性睡眠呼吸暂停低通气综合征患儿血尿酸和血脂变化分析[J]. 中国全科医学, 2011, 14(34): 3943-3945. |
| [41] | 裴俊, 王清华, 孙进, 林俊岭. 阻塞性睡眠呼吸暂停低通气综合征严重程度的危险因素[J]. 中华肺部疾病杂志(电子版), 2021, 14(1): 63-65. https://doi.org/10.3877/cma.j.issn.1674-6902.2021.01.012 |
| [42] | 张宏英, 张龙华, 陈红霞. 肥胖阻塞性睡眠呼吸暂停低通气综合征血浆同型半胱氨酸水平的研究[J]. 中外医学研究, 2019, 17(8): 1-3. |
| [43] | Sunnergren, O., Brostrom, A. and Svanborg, E. (2013) Positional Sensitivity as a Con-founder in Diagnosis of Severity of Obstructive Sleep Apnea. Sleep Breath, 17, 173-179. https://doi.org/10.1007/s11325-012-0666-6 |
| [44] | Oksenberg, A. and Gadoth, N. (2014) Are We Missing a Simple Treatment for Most Adult Sleep Apnea Patients? The Avoidance of Thesupine Sleep Position. Journal of Sleep Research, 23, 204-210. https://doi.org/10.1111/jsr.12097 |
| [45] | Jackson, M., Collins, A., Berlowitz, D., et al. (2015) Efficacy of Sleep Position Modification to Treat Positional Obstructive Sleep Apnea. Sleep Medicine, 16, 545-552. https://doi.org/10.1016/j.sleep.2015.01.008 |
| [46] | Bidarian-Moniri, A., Nilsson, M., Attia, J., et al. (2015) Mattress and Pillow for Prone Positioning for Treatment of Obstructive Sleep Apnoea. Acta Oto-Laryngologica, 135, 271-276. https://doi.org/10.3109/00016489.2014.968674 |
| [47] | Javaheri, S., Barbe, F., Campos-Rodriguez, F., Dempsey, J.A., Khayat, R., Javaheri, S., et al. (2017) Sleep Apnea: Types, Mechanisms and Clinical Cardiovascular Consequences. Journal of the American College of Cardiology, 69, 841-58. https://doi.org/10.1016/j.jacc.2016.11.069 |
| [48] | Sarkhosh, K., Switzer, N.J., El-Hadi, M., et al. (2013) The Impact of Bariatric Surgery on Obstructive Sleep Apnea: A Systematic Review. Obesity Surgery, 23, 414-423. https://doi.org/10.1007/s11695-012-0862-2 |
| [49] | Iftikhar, I.H., Kline, C.E. and Youngstedt, S.D. (2014) Effects of Exercise Training on Sleep Apnea: A Meta-Analysis. Lung, 192, 175-184. https://doi.org/10.1007/s00408-013-9511-3 |
| [50] | Miech, E.J., Bravata, D.M., Yaggi, H.K., et al. (2019) Adapting Continuous Positive Airway Pressure Therapy to Where Patientslive: A Comparative Case Study. Cureus, 11, e4078. https://doi.org/10.7759/cureus.4078 |
| [51] | Weaver, T.E. and Sawyer, A. (2009) Management of Obstructive Sleep Apnea by Continuous Positive Airway Pressure. Oral and Maxillofacial Surgery Clinics of North America, 21, 403-412.
https://doi.org/10.1016/j.coms.2009.08.001 |
| [52] | Afrashi, A. and Ucar, Z.Z. (2015) Effect of Prone Positioning in Mild to Moderate Obstructive Sleep Apnea Syndrome. Sleep and Breathing, 19, 1027-1034. https://doi.org/10.1007/s11325-014-0985-x |
| [53] | Yoshida, K. (1998) Effect of a Prosthetic Appliance for Treatment of Sleep Apnea Syndrome on Masticatory and Tongue Muscle Activity. Journal of Prosthetic Dentistry, 79, 537-544.
https://doi.org/10.1016/S0022-3913(98)70175-1 |
| [54] | Johal, A., Gill, G., Ferman, A., et al. (2007) The Effect of Mandibular Advancement Appliances on Awake Upper Airway and Masticatory Muscle Activity in Patients with Ob-structive Sleep Apnoea. Clinical Physiology and Functional Imaging, 27, 47-53. https://doi.org/10.1111/j.1475-097X.2007.00714.x |
| [55] | Kurtulmus, H., Cotert, S., Bilgen, C., et al. (2009) The Ef-fect of Amandibular Advancement Splint on Electromyographic Activity of the Submental and Masseter Muscles in Pa-tients with Obstructive Sleep apnea. The International Journal of Prosthodontics, 22, 586-593. |
| [56] | Sutherland, K., Deane, S.A., Chan, A.S., et al. (2011) Comparative Effects of Two Oral Appliances on Upper Airway Structure in Ob-structive Sleep Apnea. Sleep, 34, 469-477. https://doi.org/10.1093/sleep/34.4.469 |
| [57] | 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版) [J]. 中华结核和呼吸杂志, 2012, 35(1): 9-12. |
| [58] | He, M., Yin, G., Zhan, S., Xu, J., Cao, X., Li, J. and Ye, J. (2019) Long-Term Efficacy of Uvulopalato-Pharyngoplasty among Adult Patients with Obstructive Sleep Apnea: A Systematic Review and Me-ta-Analysis. Otolaryngol. Otolaryngology-Head and Neck Surgery, 161, 401-411. https://doi.org/10.1177/0194599819840356 |
| [59] | John, C.R., Gandhi, S., Sakharia, A.R. and James, T.T. (2018) Maxillomandibular Advancement Is a Successful Treatment for Obstructive Sleepapnoea: A Systematic Review and Me-ta-Analysis. International Journal of Oral & Maxillofacial Surgery, 47, 1561-1571. https://doi.org/10.1016/j.ijom.2018.05.015 |
| [60] | Giralt-Hernando, M., Valls-Onta？ón, A., Guijarro-Martínez, R., Masià-Gridilla, J. and Hernández-Alfaro, F. (2019) Impact of Surgicalmaxillomandibular Advancement upon Pharyngeal Airway Volume and the Apnoea-Hypopnoea Index in the Treatment of Obstructive Sleep Apnoea: Systematic Review and Meta-Analysis. BMJ Open Respiratory Research, 6, e000402. https://doi.org/10.1136/bmjresp-2019-000402 |
| [61] | Zaghi, S., Holty, J.E., Certal, V., Abdullatif, J., Guilleminault, C., Powell, N.B., Riley, R.W. and Camacho, M. (2016) Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea: A Meta-Analysis. JAMA Otolaryngology-Head & Neck Surgery, 142, 58-66. https://doi.org/10.1001/jamaoto.2015.2678 |
| [62] | White, D.P. (2005) Pathogenesis of Obstructive and Central Sleep Apnea. American Journal of Respiratory and Critical Care Medicine, 172, 1363-1370. https://doi.org/10.1164/rccm.200412-1631SO |
| [63] | Barbe, F., Duran-Cantolla, J., Sanchez-de-la-Torre, M., Martinez-Alonso, M., Carmona, C., Barcelo, A., et al. (2012) Effect of Continuous Positive Airway Pressure on the In-cidence of Hypertension and Cardiovascular Events in Nonsleepy Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. JAMA, 307, 2161-2168.
https://doi.org/10.1001/jama.2012.4366 |
| [64] | Vanderveken, O.M. (2016) The Challenges of Advancing the Evi-dencefor the Long-Term Effectiveness of Oral Appliance Therapy for Sleep Apnea. Sleep Medicine, 19, 128-130. https://doi.org/10.1016/j.sleep.2015.08.011 |
| [65] | Liu, H.T., Lin, Y.C., Kuan, Y.C., et al. (2016) Intranasal Cortico-steroidtherapy in the Treatment of Obstructive Sleep Apnea: A Meta-Analysis of Randomized Controlled Trials. Ameri-can Journal of Rhinology & Allergy, 30, 215-221.
https://doi.org/10.2500/ajra.2016.30.4305 |
| [66] | Winslow, D.H., Bowden, C.H., Di Donato, K.P., et al. (2012) A Randomized, Double-Blind, Placebo-Controlled Study of an Oral, Extended-Release Formulation of Phenter-mine/Topiramate for the Treatment of Obstructive Sleep Apnea in Obese Adults. Sleep, 35, 1529-1539. https://doi.org/10.5665/sleep.2204 |
| [67] | 赵娜, 鲁海平. 低温等离子手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征疗效分析[J]. 中国临床医生杂志, 2021, 49(1): 111-114. |
| [68] | McEvoy, R.D., Antic, N.A., Heeley, E., Luo, Y., Ou, Q., Zhang, X., et al. (2016) CPAP for Prevention of Cardiovascular Events in Obstructive Sleepapnea. The New England Journal of Medicine, 375, 919-931. |
| [69] | Carter, L.P., Henningfield, J.E., Wang, Y.G., et al. (2018) A Ran-domized, Double-Blind, Placebo-Controlled, Crossover Study to Evaluate the Human Abuse Liability of Solriamfetol, a Selective Dopamine and Norepinephrine Reuptake Inhibitor. Journal of Psychopharmacology, 32, 1351-1361. https://doi.org/10.1177/0269881118796814 |
| [70] | Abad, V.C. and Guilleminault, C. (2018) Solriamfetol for the Treatment of Daytime Sleepiness in Obstructive Sleep Apnea. Expert Review of Respiratory Medicine, 12, 1007-1019. https://doi.org/10.1080/17476348.2018.1541742 |
