Conn Med. 2000 Aug;64(8):465-8.
Obstructive sleep apnea is a state-dependent syndrome. It is characterized by repeated collapse of the upper airway as the result of the loss of waking neuromuscular drive as the brain changes from wakefulness to sleep. This produces a state-dependent decrease in muscle tone, which, together with other predisposing factors such as obesity and anatomical narrowing of the upper airway, results in the spectrum of sleep disordered breathing. Sleep-disordered breathing describes the continuum from simple snoring (pharyngeal vibration), to flow limitation (hypopnea), to complete cessation of breathing (apnea). Obstructive sleep apnea (OSA) is the common description of what is now appreciated as the sleep apnea/hypopnea syndrome. The cardinal symptoms are snoring, observed apneas, and excessive daytime sleepiness. The immediate physical consequences are hypoxia, repeated sympathetic discharges, increased cardiac load, and repeated brain arousals. The repetitive arousals are required to restore airway patency, resulting in severely fragmented sleep and consequent sleep deprivation. The syndrome, untreated, produces significant cognitive and cardiorespiratory morbidity, and potential mortality. Compared to matched controls, patients with undiagnosed sleep apnea use twice the health resources and spend double the health-care dollars in the 10 years prior to diagnosis. Both trends are reversed by successful treatment. It is by definition a sleep-related illness and can be observed and evaluated only when the patient is asleep. Polysomnography is the laboratory procedure to study sleep and its protean dysfunctions. Multiple physiologic parameters are required to document the various types of sleep disorders as well as to establish the origin of pathologic sleep fragmentation. Complete polysomnography includes (but is not limited to) electroencephalogram (EEG), electrooculogram ((EOG), electromyogram (EMG), electrocardiogram (ECG), respiratory effort, air flow, and oxygen saturation. Treatment options for obstructive sleep apnea include continuous positive airway pressure (CPAP), oral appliances, uvulopalatal and/or maxillomandibular surgery, positional control, and weight loss. The efficacy of each depends on the individual anatomy and the severity of the sleep-disordered breathing. CPAP is accepted as the most reliable treatment regardless of anatomy and severity. It is currently the only treatment modality which can be titrated during sleep and requires simultaneous polysomnography.
阻塞性睡眠呼吸暂停是一种与睡眠状态相关的综合征。其特征是随着大脑从清醒状态转变为睡眠状态，清醒时的神经肌肉驱动力丧失，导致上气道反复塌陷。这会导致与睡眠状态相关的肌张力下降，再加上肥胖和上气道解剖结构变窄等其他易感因素，从而引发一系列睡眠呼吸障碍。睡眠呼吸障碍描述了从单纯打鼾（咽部振动）到气流受限（呼吸浅慢），再到呼吸完全停止（呼吸暂停）的连续过程。阻塞性睡眠呼吸暂停（OSA）是目前对睡眠呼吸暂停/低通气综合征的常见称谓。主要症状包括打鼾、观察到的呼吸暂停和日间过度嗜睡。直接的身体后果是缺氧、反复的交感神经放电、心脏负荷增加以及反复的脑部觉醒。需要反复觉醒以恢复气道通畅，导致睡眠严重碎片化，进而造成睡眠剥夺。该综合征若不治疗，会导致显著的认知和心肺疾病，并存在潜在的死亡风险。与匹配的对照组相比，未被诊断出睡眠呼吸暂停的患者在诊断前的10年里使用的医疗资源是对照组的两倍，花费的医疗费用也是对照组的两倍。成功治疗后，这两种趋势都会逆转。从定义上讲，它是一种与睡眠相关的疾病，只有在患者睡眠时才能观察和评估。多导睡眠图是研究睡眠及其多种功能障碍的实验室检查方法。需要多个生理参数来记录各种类型的睡眠障碍，并确定病理性睡眠碎片化的根源。完整的多导睡眠图包括（但不限于）脑电图（EEG）、眼电图（EOG）、肌电图（EMG）、心电图（ECG）、呼吸努力、气流和血氧饱和度。阻塞性睡眠呼吸暂停的治疗选择包括持续气道正压通气（CPAP）、口腔矫治器、悬雍垂腭咽成形术和/或上下颌手术、体位控制以及减肥。每种治疗方法的疗效取决于个体解剖结构和睡眠呼吸障碍的严重程度。无论解剖结构和严重程度如何，CPAP都被认为是最可靠的治疗方法。它是目前唯一一种可以在睡眠期间进行滴定并需要同时进行多导睡眠图检查的治疗方式。
