Adv Cardiol. 2011;46:1-42. doi: 10.1159/000327660. Epub 2011 Oct 13.
Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete and partial obstructions of the upper airway during sleep. The diagnosis of OSA requires the objective demonstration of abnormal breathing during sleep by measuring the respiratory disturbance index (RDI, events per hour of sleep), i.e. the frequency of apnea (complete upper airway obstruction), hypopnea (partial upper airway obstruction) and arousals from sleep related to respiratory efforts. OSA is defined by combining symptoms and an RDI ≥5 or by an RDI ≥15 without symptoms. The apnea-hypopnea index (AHI), the frequency of apnea and hypopnea events per hour of sleep, is widely used to define OSA (many clinical and epidemiological studies use this metric). In the general adult population, the prevalence of OSA defined by ≥5 apnea and hypopnea events per hour of sleep associated with excessive sleepiness is approximately 3-7% in men and 2-5% in women. The prevalence of OSA is much higher, e.g. ≥50%, in patients with cardiac or metabolic disorders than in the general population. Risk factors for OSA include obesity (the strongest risk factor), upper airway abnormalities, male gender, menopause and age (the prevalence of OSA associated with a higher risk of morbidity and mortality increases with age and peaks at approximately 55 years of age). OSA is associated with symptoms during sleep (snoring, choking and nocturia) and wakefulness (excessive sleepiness, fatigue and lack of energy) and with sequelae such as psychological changes, alterations in the quality of life, and social, familial and professional performance including vehicle and industrial accidents. The identification of OSA may be a difficult task for the clinician, even in populations in which OSA is highly prevalent such as patients with cardiovascular disorders because they may not present the cardinal signs of the disease, e.g. excessive sleepiness and obesity. Guidelines have been developed to tailor OSA therapy to patients according to the results of their disease evaluation and their preferences.
阻塞性睡眠呼吸暂停（OSA）的特征是睡眠期间上呼吸道反复出现完全和部分阻塞发作。OSA的诊断需要通过测量呼吸紊乱指数（RDI，每小时睡眠事件数）来客观证明睡眠期间的异常呼吸，即呼吸暂停（上呼吸道完全阻塞）、呼吸不足（上呼吸道部分阻塞）以及与呼吸努力相关的睡眠觉醒频率。OSA通过结合症状和RDI≥5来定义，或在无症状时通过RDI≥15来定义。呼吸暂停低通气指数（AHI），即每小时睡眠中呼吸暂停和呼吸不足事件的频率，被广泛用于定义OSA（许多临床和流行病学研究使用此指标）。在一般成年人群中，每小时睡眠中≥5次呼吸暂停和呼吸不足事件且伴有过度嗜睡所定义的OSA患病率，男性约为3 - 7%，女性约为2 - 5%。与一般人群相比，患有心脏或代谢紊乱的患者中OSA的患病率要高得多，例如≥50%。OSA的危险因素包括肥胖（最强的危险因素）、上呼吸道异常、男性性别、绝经和年龄（与较高发病和死亡风险相关的OSA患病率随年龄增长而增加，在约55岁时达到峰值）。OSA与睡眠期间的症状（打鼾、窒息和夜尿症）和清醒时的症状（过度嗜睡、疲劳和精力不足）以及心理变化、生活质量改变以及社会、家庭和职业表现等后遗症相关，包括车辆和工业事故。即使在OSA高度流行的人群中，如心血管疾病患者，临床医生识别OSA也可能是一项艰巨的任务，因为他们可能没有该疾病的主要体征，如过度嗜睡和肥胖。已经制定了指南，以便根据疾病评估结果和患者偏好为患者量身定制OSA治疗方案。
