Westbrook P R
Cedars-Sinai Sleep Disorder Center, Cedars-Sinai Medical Center, Los Angeles, California.
Otolaryngol Clin North Am. 1990 Aug;23(4):727-43.
The OSA syndrome, described over 100 years ago, was rediscovered in 1966. It is a common disorder, especially among fat, middle-aged men. Stentorian snoring and diurnal somnolence are the cardinal manifestations and should always lead to an examination during sleep. That examination (polysomnography) can demonstrate the pathognomonic events--repetitive apneas occurring in sleep--which signal the failure of the sleeping brain to maintain the patency of the supraglottic airway. All evidence points to the problem being an abnormal pharyngeal airway, one which has a shape or size or compliance that allows inspiratory collapse as the normal loss of pharyngeal dilator muscle tone occurs with sleep. The apneas are asphyxic events terminated by arousals which fragment sleep continuity and lead to the daytime sleepiness. Because the snoring occurs during sleep, the arousals are unremembered, and the sleepiness can develop so gradually that the patient may forget what normal alertness is like. It is important to interview the patient's spouse or partner. Besides obesity and maleness, other risk factors for OSA are diseases that have an impact on the configuration or effective compliance of the pharyngeal passageway. Recent studies support the clinical intuition that sleep apnea is undesirable. Sleepiness leads to accidents. The hypoxemia occurring during apnea can lead to potentially fatal cardiac dysrhythmias. A number of reports suggest that snoring and sleep apnea are associated with an increased risk of stroke, myocardial ischemia, and infarction. Finally, there are now two papers showing a significantly decreased probability of 5-year survival in patients with symptomatic sleep apnea. The good news is that treatment with tracheostomy or NCPAP improves mortality rates to normal. Approximately 90 per cent of patients can tolerate a night's initial trial with CPAP. Long-term acceptance of CPAP has now been reviewed in a number of studies, and it appears to be about 65 to 70 per cent.
阻塞性睡眠呼吸暂停综合征在100多年前就有描述，1966年被重新发现。它是一种常见疾病，尤其在肥胖的中年男性中多见。响亮的鼾声和日间嗜睡是主要表现，应始终促使进行睡眠检查。该检查（多导睡眠图）可显示特征性事件——睡眠中反复出现的呼吸暂停，这表明睡眠中的大脑无法维持声门上气道通畅。所有证据都表明问题在于异常的咽部气道，其形状、大小或顺应性使得随着睡眠中咽部扩张肌张力正常丧失，吸气时气道会塌陷。呼吸暂停是窒息性事件，由觉醒终止，这会破坏睡眠连续性并导致日间嗜睡。由于打鼾发生在睡眠期间，觉醒不被记住，嗜睡可能逐渐发展，以至于患者可能忘记正常警觉状态是什么样的。询问患者的配偶或伴侣很重要。除了肥胖和男性性别外，阻塞性睡眠呼吸暂停的其他危险因素是对咽部通道结构或有效顺应性有影响的疾病。最近的研究支持了睡眠呼吸暂停有害的临床直觉。嗜睡会导致事故。呼吸暂停期间发生的低氧血症可导致潜在致命的心律失常。一些报告表明打鼾和睡眠呼吸暂停与中风、心肌缺血和梗死风险增加有关。最后，现在有两篇论文显示有症状睡眠呼吸暂停患者5年生存率显著降低。好消息是气管切开术或鼻持续气道正压通气治疗可将死亡率提高到正常水平。大约90%的患者能够耐受一晚的持续气道正压通气初始试验。现在多项研究对持续气道正压通气的长期接受情况进行了评估，接受率似乎约为65%至70%。
