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肥胖儿童和成人阻塞性睡眠呼吸暂停的危险因素及治疗

Risk factors and treatment for obstructive sleep apnea amongst obese children and adults.

作者信息

Kohler Mark

机构信息

Discipline of Paediatrics, University of Adelaide, Women's and Children's Hospital, South Australia, Australia.

出版信息

Curr Opin Allergy Clin Immunol. 2009 Feb;9(1):4-9. doi: 10.1097/ACI.0b013e32831d8184.

Abstract

PURPOSE OF REVIEW

The purpose of this review is to summarize the evidence for the association between obesity and obstructive sleep apnea (OSA), as well as predisposing risk factors and treatment strategies for OSA amongst obese patients.

RECENT FINDINGS

Recent findings highlight a number of factors including sex, age, upper airway structure and ethnicity, which may predispose patients to OSA when obese. Both invasive and noninvasive weight-reduction strategies also show positive signs of being an effective means to reduce or remediate OSA amongst obese adults and children.

SUMMARY

In view of recent findings, a direct association between body mass and upper airway obstruction should be viewed with caution. Obesity may play a more significant role in the predisposition to OSA amongst particular subgroups of the population, such as adults, and those with particular craniofacial and upper airway morphology. Healthcare prioritization and requirements may be more substantial for such groups. Further, commonly used treatment methods for OSA (such as adenotonsillectomy for children and continuous positive airway pressure for adults) may be less effective for obese individuals. Weight-reduction strategies appear important for an optimal outcome, and such strategies may be more or less invasive depending on the severity of obesity, OSA or both, and other patient complications.

摘要

综述目的

本综述旨在总结肥胖与阻塞性睡眠呼吸暂停(OSA)之间关联的证据,以及肥胖患者中OSA的易感风险因素和治疗策略。

最新发现

最新发现突出了一些因素,包括性别、年龄、上呼吸道结构和种族,这些因素可能使肥胖患者易患OSA。侵入性和非侵入性减重策略也显示出有望成为减少或改善肥胖成人和儿童OSA的有效手段。

总结

鉴于最新发现,体重与上呼吸道阻塞之间的直接关联应谨慎看待。肥胖可能在特定人群亚组(如成年人以及具有特定颅面和上呼吸道形态的人群)易患OSA方面发挥更重要作用。此类人群的医疗保健优先级和需求可能更高。此外,常用的OSA治疗方法(如儿童的腺样体扁桃体切除术和成人的持续气道正压通气)对肥胖个体可能效果较差。减重策略对于实现最佳治疗效果似乎很重要,并且根据肥胖、OSA的严重程度或两者以及其他患者并发症情况,此类策略的侵入性程度可能有所不同。

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