Hudgel D W
Case Western Reserve University, Cleveland, Ohio.
Clin Chest Med. 1992 Sep;13(3):383-98.
Research efforts to date have determined that both anatomic and physiologic variables may contribute to the pathophysiology of OSA. Whether specific factors within either of these two categories will be shown to predominate remains to be seen. Surely, experience with sleep apnea patients teaches us that different variables are important in different OSA patients. However, even those patients who initially appear to have predominantly an anatomic or physiologic cause of their OSA often fail to respond to specific treatment. Treatment failure implies the following: (1) The initial impression of the importance of a given variable was wrong. This may happen in the patient who has a narrow transpalatal airway and fails to respond to uvulopalatopharyngoplasty. In this individual, physiologic variables such as pharyngeal collapsibility or periodic breathing may need to be addressed. Of course, the reverse may occur; patients may be treated pharmacologically for an assumed physiologic mechanism and important anatomic factors may have been overlooked. Our ability to differentiate the importance of these different variables is poor. Therefore, our diagnostic acumen needs further refinement. (2) Of course, it is likely that the proper diagnosis was made, but the therapy chosen was imperfect. In the area of anatomy, investigators are just beginning to try surgical approaches designed specifically for the pharyngeal site of obstruction. In other words, uvulopalatopharyngoplasty is not the best approach for everyone. In physiology, treatments beyond continuous positive airway pressure will be needed. It is hoped that advances in the pharmacology of sleep disorders will establish more convenient and successful therapies. It is likely that OSA is a heterogenous disease process. We must realize that a treatment that helps one patient may not be applicable to the next individual. Through a better understanding of the pathophysiology of OSA, better treatment modalities should be developed, resulting in improved quality of life for OSA patients.
迄今为止的研究工作已经确定，解剖学和生理学变量都可能导致阻塞性睡眠呼吸暂停（OSA）的病理生理过程。这两类变量中的特定因素是否会被证明占主导地位，还有待观察。当然，对睡眠呼吸暂停患者的治疗经验告诉我们，不同的变量在不同的OSA患者中起着不同的作用。然而，即使是那些最初似乎主要由解剖学或生理学原因导致OSA的患者，也常常对特定治疗没有反应。治疗失败意味着以下几点：（1）对给定变量重要性的初步判断是错误的。这可能发生在经腭气道狭窄但对悬雍垂腭咽成形术没有反应的患者身上。对于这类患者，可能需要解决诸如咽部可塌陷性或周期性呼吸等生理变量问题。当然，反之也可能发生；患者可能因假定的生理机制而接受药物治疗，而重要的解剖学因素可能被忽视了。我们区分这些不同变量重要性的能力很差。因此，我们的诊断敏锐度需要进一步提高。（2）当然，很可能诊断是正确的，但所选择的治疗方法并不完美。在解剖学领域，研究人员刚刚开始尝试专门针对咽部阻塞部位设计的手术方法。换句话说，悬雍垂腭咽成形术并非对所有人都是最佳方法。在生理学方面，除了持续气道正压通气之外，还需要其他治疗方法。希望睡眠障碍药理学的进展能够建立更方便、更成功的治疗方法。OSA很可能是一个异质性疾病过程。我们必须认识到，一种对一名患者有效的治疗方法可能不适用于下一个患者。通过更好地理解OSA的病理生理学，应该开发出更好的治疗方式，从而改善OSA患者的生活质量。
