Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case School of Medicine, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
Curr Treat Options Neurol. 2011 Oct;13(5):458-72. doi: 10.1007/s11940-011-0134-9.
Obstructive sleep apnea (OSA), a highly prevalent disorder, has historically been under-recognized. As its diagnosis and recognition increases, physicians other than sleep specialists will need to gain familiarity with the management of this disorder, which is so closely tied to increased morbidity, mortality, and an overall health care burden. Most patients with OSA have been managed primarily with positive airway pressure, which is the focus of this review. The technology of positive airway pressure devices has advanced in order to improve adherence. For example, devices are now more compact and lighter in weight, less noisy, have heated humidification capability to diminish nasal dryness and congestion, have an increased variety of mask interfaces, and have modalities to minimize issues of pressure intolerance. In our practice, a multifaceted management model consisting of behavioral modification incorporating weight loss education, sleep hygiene education, and avoidance of exacerbating factors such as alcohol is usually employed in addition to positive airway pressure. A key component to effective treatment is close follow-up with troubleshooting if positive airway pressure adherence issues arise. Observance of early adherence issues is key, so that problems can be addressed sooner and long-term compliance is assured. Also crucial in managing patients with OSA is education regarding potentially improved cardiovascular morbidity and mortality and better quality of life with improved alertness and less drowsy driving. Other therapies specific to OSA, such as oral appliances or upper airway surgery, are discussed as alternatives to positive airway pressure, but these are typically pursued only if the patient has a strong preference or if positive airway pressure therapy is unsuccessful. As current therapies improve and emerging therapies continue to develop into viable treatment strategies, the successful management of OSA will likely demonstrate further progress.
阻塞性睡眠呼吸暂停（OSA）是一种高发疾病，但过去一直未得到充分认识。随着对该病的诊断和认识不断提高，除了睡眠专家之外，其他医生也需要熟悉这种与发病率、死亡率和整体医疗负担增加密切相关的疾病的管理。大多数 OSA 患者主要通过气道正压治疗来管理，这也是本综述的重点。为了提高患者的依从性，气道正压设备的技术也在不断发展。例如，设备现在更加紧凑轻便，噪音更小，具有加热加湿功能，可减少鼻腔干燥和充血，面罩接口种类更多，还有一些模式可以最大限度减少压力不耐受的问题。在我们的实践中，除了气道正压治疗外，通常还采用包含减肥教育、睡眠卫生教育和避免酒精等加重因素的多方面管理模式，即行为修正。密切随访并解决气道正压治疗依从性问题是有效治疗的关键。密切观察早期的依从性问题非常重要，以便尽早解决问题并确保长期依从性。另外，教育患者 OSA 可能会降低心血管发病率和死亡率，并提高警觉性和减少驾驶时的困倦感，从而提高生活质量，这在管理 OSA 患者中也至关重要。针对 OSA 的其他治疗方法，如口腔器具或上气道手术，被视为气道正压治疗的替代方法，但这些方法通常仅在患者有强烈偏好或气道正压治疗无效时才会采用。随着当前治疗方法的不断改进和新兴治疗方法继续发展成为可行的治疗策略，OSA 的成功管理可能会取得进一步的进展。
