Cistulli Peter A, Grunstein Ronald R
Royal North Shore Hospital, Department of Respiratory Medicine, St Leonards, NSW 2065, Australia.
Expert Rev Med Devices. 2005 Nov;2(6):749-63. doi: 10.1586/17434440.2.6.749.
Obstructive sleep apnea is increasingly being recognized as a serious public health problem, and is characterized by repetitive, complete or partial closure of the upper airway during sleep, resulting in sleep fragmentation and oxygen desaturation. The key symptoms of obstructive sleep apnea are snoring, witnessed apneas, excessive daytime sleepiness and deficits in neurocognitive function, adversely impacting on quality of life. The last 10 years have seen a steady increase in evidence linking obstructive sleep apnea to long-term cardiovascular morbidity, including hypertension, myocardial infarction and stroke, and an increased risk of motor vehicle accidents. The discovery of continuous positive airway pressure treatment, and the resultant recognition of the high prevalence of snoring and obstructive sleep apnea, and their impact on health, has spawned a new and rapidly growing global industry. Whilst diagnostic technologic advancements have evolved relatively rapidly, many questions relating to the use of such devices in clinical practice remain unresolved. Similarly, on the therapeutic front, advances in continuous positive airway pressure technology have broadened the use of such treatment, although compliance remains an important impediment to widespread treatment of this common disorder. This has prompted a search for simpler treatment alternatives, ranging from surgical, medical and dental therapies, although none have matched the efficacy of continuous positive airway pressure. Advances in our understanding of the neurobiology of sleep and respiration herald the prospect of pharmacologic treatment in the longer term.
阻塞性睡眠呼吸暂停越来越被视为一个严重的公共卫生问题，其特征是睡眠期间上呼吸道反复出现完全或部分关闭，导致睡眠片段化和氧饱和度下降。阻塞性睡眠呼吸暂停的关键症状包括打鼾、目击性呼吸暂停、日间过度嗜睡和神经认知功能缺陷，对生活质量产生不利影响。在过去十年中，越来越多的证据表明阻塞性睡眠呼吸暂停与长期心血管疾病有关，包括高血压、心肌梗死和中风，以及机动车事故风险增加。持续气道正压通气治疗的发现，以及随之而来的对打鼾和阻塞性睡眠呼吸暂停高患病率及其对健康影响的认识，催生了一个新的且迅速发展的全球产业。虽然诊断技术进步相对较快，但许多与在临床实践中使用此类设备相关的问题仍未得到解决。同样，在治疗方面，持续气道正压通气技术的进步扩大了此类治疗的应用范围，尽管依从性仍然是广泛治疗这种常见疾病的一个重要障碍。这促使人们寻找更简单的治疗选择，包括手术、药物和牙科治疗，尽管没有一种能与持续气道正压通气的疗效相匹配。我们对睡眠和呼吸神经生物学认识的进步预示着长期药物治疗的前景。
