UW Medicine Sleep Center, University of Washington, Seattle, Washington 98104, USA.
Respir Care. 2010 Sep;55(9):1155-67.
Obstructive sleep apnea (OSA) is a disorder characterized by intermittent upper-airway collapse, which impairs ventilation and disrupts sleep. Factors that contribute to upper-airway collapse include reduced upper-airway dilator muscle activity during sleep, specific upper-airway anatomical features, decreased end-expiratory lung volume, ventilatory control instability, sleep-state instability, and rostral fluid shifts in the recumbent position. The relative contributions of these factors vary between individuals with OSA, and this may have implications as to which treatments are efficacious for an individual. OSA is common in adults; males, older individuals, and the obese are at higher risk. There is uncertainty in how to measure severity of sleep-disordered breathing, what cut-off to use to demarcate abnormal, and how to define the clinical syndrome. Identifying patients at higher risk who should have a sleep study is relatively simple, involving assessment of several factors, such as snoring, witnessed apnea/self-reported gasping, hypertension, body mass index, and neck circumference. As would be expected from a disorder that causes morbidity, OSA is associated with substantial economic costs to society, including increased medical costs. A reduction in medical costs in a diverse adult patient population with OSA after therapy has not been convincingly demonstrated. Nevertheless, the results of cost-effectiveness analyses strongly support the cost-effectiveness of continuous positive airway pressure therapy in patients with moderate to severe OSA, relative to other standard medical therapies that society is willing to pay for.
阻塞性睡眠呼吸暂停（OSA）是一种以间歇性上气道塌陷为特征的疾病，会损害通气并扰乱睡眠。导致上气道塌陷的因素包括睡眠期间上气道扩张肌活动减少、特定的上气道解剖特征、呼气末肺容积减少、通气控制不稳定、睡眠状态不稳定以及卧位时颅向液体转移。这些因素对上气道塌陷的相对贡献因人而异，这可能对个体有效的治疗方法有影响。OSA 在成年人中很常见；男性、老年人和肥胖者风险更高。如何衡量睡眠呼吸障碍的严重程度、使用什么截止值来区分异常以及如何定义临床综合征存在不确定性。识别风险较高的患者并进行睡眠研究相对简单，涉及评估几个因素，例如打鼾、目击呼吸暂停/自述喘息、高血压、体重指数和颈围。由于这种疾病会导致发病，因此 OSA 给社会带来了巨大的经济成本，包括增加的医疗费用。在接受治疗后，OSA 患者的医疗费用降低并没有得到令人信服的证明。然而，成本效益分析的结果强烈支持中重度 OSA 患者持续气道正压治疗相对于社会愿意支付的其他标准医疗治疗具有成本效益。
