Christian Guilleminault, MD, DBiol Stanford Sleep Medicine Clinic, 450 Broadway Street, Pavilion C, 2nd Floor, Redwood City, CA 94063, USA.
Curr Treat Options Neurol. 2009 Sep;11(5):358-67. doi: 10.1007/s11940-009-0040-6.
Sleep apnea is a major public health problem that afflicts 9% of women and 24% of men 30 to 60 years of age. It is highly treatable, but when untreated, it has been associated with (but not necessarily linked to) increased probability of cerebral and coronary vascular disease, congestive heart failure, metabolic dysfunction, cognitive dysfunction, excessive daytime sleepiness, motor vehicle accidents, reduced productivity, and decreased quality of life. The gold standard for treatment in adults is positive airway pressure (PAP) therapy: continuous PAP (CPAP), bilevel PAP, autotitrating CPAP, or autotitrating bilevel PAP. Measures to increase compliance with PAP therapy include medical or surgical treatment of any underlying nasal obstruction, setting appropriate pressure level and airflow, mask selection and fitting, heated humidification, desensitization for claustrophobia, patient and partner education, regular follow-up with monitoring of compliance software, and attendance of support groups (eg, AWAKE). Adjunctive treatment modalities include lifestyle or behavioral measures and pharmacologic therapy. Patients with significant upper airway obstruction who are unwilling or unable to tolerate PAP therapy may benefit from surgery. Multilevel surgery of the upper airway addresses obstruction of the nose, oropharynx, and hypopharynx. A systematic approach may combine surgery of the nose, pharynx, and hypopharynx in phase 1, whereas skeletal midface advancement or tracheotomy constitutes phase 2. Clinical outcomes are reassessed through attended diagnostic polysomnogram performed 3 to 6 months after surgery. Oral appliances can be used for patients with symptomatic mild or moderate sleep apnea who prefer them to PAP therapy or for whom PAP therapy has failed or cannot be tolerated. Oral appliances also may be used for patients with severe obstructive sleep apnea who are unable or unwilling to undertake PAP therapy or surgery. For children, the main treatment modality is tonsillectomy and adenoidectomy, with or without turbinate surgery. Children with craniofacial abnormalities resulting in maxillary or mandibular insufficiency may benefit from palatal expansion or maxillary/mandibular surgery. PAP therapy may be used for children who are not surgical candidates or if surgery fails.
睡眠呼吸暂停是一个重大的公共卫生问题，影响 9%的女性和 24%的 30 至 60 岁男性。它是高度可治疗的，但如果未经治疗，它与（但不一定与）大脑和冠状动脉血管疾病、充血性心力衰竭、代谢功能障碍、认知功能障碍、白天过度嗜睡、机动车事故、生产力下降和生活质量下降的可能性增加有关。成人治疗的金标准是正压通气（PAP）治疗：持续 PAP（CPAP）、双水平 PAP、自动滴定 CPAP 或自动滴定双水平 PAP。增加 PAP 治疗依从性的措施包括治疗任何潜在的鼻腔阻塞、设置适当的压力水平和气流、选择和适配面罩、加热加湿、对幽闭恐惧症脱敏、患者和伴侣教育、定期监测依从性软件的随访以及参加支持小组（例如，AWAKE）。辅助治疗方法包括生活方式或行为措施和药物治疗。不愿意或不能耐受 PAP 治疗的有明显上气道阻塞的患者可能受益于手术。上气道的多水平手术解决了鼻腔、口咽和下咽的阻塞。系统方法可以在第一阶段结合鼻、咽和下咽的手术，而骨骼面中部推进或气管切开术构成第二阶段。通过在手术后 3 至 6 个月进行的有监督的诊断性多导睡眠图重新评估临床结果。口腔器具可用于有症状的轻度或中度睡眠呼吸暂停的患者，他们更喜欢口腔器具治疗而不是 PAP 治疗，或者对于 PAP 治疗失败或无法耐受的患者。口腔器具也可用于无法或不愿意接受 PAP 治疗或手术的严重阻塞性睡眠呼吸暂停患者。对于儿童，主要的治疗方式是扁桃体切除术和腺样体切除术，伴或不伴鼻甲手术。由于上颌或下颌不足导致颅面畸形的儿童可能受益于腭扩张或上颌/下颌手术。对于不能手术或手术失败的儿童，可以使用 PAP 治疗。
