Atlanta School of Sleep Medicine and Technology, 1100 Johnson Ferry Road, Suite 580, Atlanta, GA, 30342, USA.
Adv Ther. 2009 Mar;26(3):295-312. doi: 10.1007/s12325-009-0016-7. Epub 2009 Apr 3.
INTRODUCTION: Collapsibility of the upper airway in obstructive sleep apnea (OSA) causes repeated arousals from sleep, decreased oxygen saturation of the blood, and excessive sleepiness (ES). Patients with OSA are at increased risk of cardiovascular and cerebrovascular disease, and experience occupational and vehicular accidents more frequently than the general population. Furthermore, the life expectancy of patients with untreated OSA is significantly reduced. METHODS: A MEDLINE search of articles published between 2003 and 2008 was conducted using the search terms: obstructive sleep apnea [ti/ab] AND treatment; obstructive sleep apnoea [ti/ab] AND treatment; and excessive sleepiness [ti/ab] AND treatment. Searches were limited to articles in English; clinical trials; meta-analyses; practice guidelines; randomized, controlled trials; and reviews. RESULTS: Continuous positive airway pressure (CPAP) is the reference-standard treatment for patients with OSA. CPAP addresses the symptoms of OSA and reduces the risk of heart disease and depression associated with this sleep disorder. However, the efficacy of CPAP is contingent on patient adherence, and >or=4 hours of therapy per night are required for patients with OSA to experience significant clinical benefits. However, reports of nonadherence to CPAP therapy range from 29% to 83%. Other therapies are available for patients who refuse or cannot adhere to CPAP treatment, including dental devices and surgery, but these treatments are generally considered to be less efficacious. A significant number of patients continue to experience residual ES despite CPAP treatment. Pharmacologic therapies, eg, modafinil and armodafinil, may be of use in patients with OSA to improve tolerance with CPAP or to address residual ES. CONCLUSION: There are a variety of treatments available for patients with OSA. Successful treatment involves encouraging patient compliance with CPAP or oral appliances. Primary-care physicians play a crucial role in recognizing this disorder and ensuring the best possible outcome through support and education.
简介：阻塞性睡眠呼吸暂停（OSA）患者的上气道塌陷会导致睡眠反复中断、血氧饱和度降低和过度嗜睡（ES）。OSA 患者发生心血管和脑血管疾病的风险增加，且比一般人群更容易发生职业和车辆事故。此外，未经治疗的 OSA 患者的预期寿命显著缩短。 方法：使用以下搜索词在 2003 年至 2008 年期间发表的文章进行 MEDLINE 搜索：阻塞性睡眠呼吸暂停[ti/ab] AND 治疗；阻塞性睡眠呼吸暂停[ti/ab] AND 治疗；以及过度嗜睡[ti/ab] AND 治疗。搜索仅限于英语文章、临床试验、荟萃分析、实践指南、随机对照试验和综述。 结果：持续气道正压通气（CPAP）是 OSA 患者的标准治疗方法。CPAP 可治疗 OSA 症状，并降低与这种睡眠障碍相关的心脏病和抑郁风险。然而，CPAP 的疗效取决于患者的依从性，OSA 患者需要每晚至少治疗 4 小时才能获得显著的临床益处。但是，CPAP 治疗不依从的报告比例在 29%至 83%之间。对于拒绝或不能坚持 CPAP 治疗的患者，还有其他治疗方法可用，包括牙科设备和手术，但这些治疗方法通常被认为效果较差。尽管接受了 CPAP 治疗，但仍有相当数量的患者持续存在残留 ES。对于 OSA 患者，药物治疗，如莫达非尼和阿莫达非尼，可能有助于提高 CPAP 的耐受性或解决残留 ES。 结论：有多种治疗方法可用于 OSA 患者。成功的治疗需要鼓励患者遵守 CPAP 或口腔器具的使用。初级保健医生在识别这种疾病方面发挥着至关重要的作用，他们通过支持和教育确保了最佳的治疗效果。
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