Bonekat H W, Krumpe P E
University of California, Davis, Department of Internal Medicine, Sacramento 95817.
Clin Rev Allergy. 1990 Summer-Fall;8(2-3):197-213. doi: 10.1007/BF02914445.
The diagnosis of obstructive sleep apnea is frequently made by taking a meticulous history coupled with a high index of suspicion. Snoring and hypersomnolence are clinical features common to individuals with sleep apnea. Since snoring is said to be a "disease of listeners," it is not uncommon that bed partners reported an increased incidence of depression and marital displeasure. It is for this reason that the spouse or bed partner should be interviewed, since the patient may not be aware of any sleeping problems. Physicians should also be alert to complaints of excessive daytime somnolence, because studies have shown that patients with obstructive sleep apnea are at increased risk for automobile crashes. It has been estimated that approx 58,000 motor vehicle accidents involving people with sleep apnea will occur in the US each yr. By proper diagnosis and treatment, the physician is in a unique position to prevent at least some of the automobile accidents that result from falling asleep while driving. Polysomnography is the only definitive way to obtain a diagnosis of sleep apnea. This allows the physician not only to diagnosis the disorder, but also helps in the evaluation of the severity of the syndrome and selection of therapy. An ENT evaluation is also important in ruling out anatomic disorders that can cause upper airway obstruction. Certain factors, such as alcohol and sedative ingestion, may aggravate the condition in a person predisposed to sleep apnea, and subtle changes, such as unexplained hypertension, polycythemia, and cor pulmonale, should lead one to investigate the possibility of sleep apnea as the etiology.
阻塞性睡眠呼吸暂停的诊断通常通过详细询问病史并结合高度怀疑来做出。打鼾和嗜睡是睡眠呼吸暂停患者常见的临床特征。由于据说打鼾是“听众的疾病”，因此床伴报告抑郁和婚姻不满发生率增加的情况并不少见。正是出于这个原因，应该询问配偶或床伴，因为患者可能没有意识到任何睡眠问题。医生还应警惕白天过度嗜睡的主诉，因为研究表明，阻塞性睡眠呼吸暂停患者发生车祸的风险增加。据估计，美国每年约有58,000起涉及睡眠呼吸暂停患者的机动车事故。通过正确的诊断和治疗，医生处于独特的地位，至少可以预防一些因驾驶时入睡而导致的车祸。多导睡眠图是获得睡眠呼吸暂停诊断的唯一确定方法。这不仅使医生能够诊断该疾病，还有助于评估综合征的严重程度和选择治疗方法。耳鼻喉科评估对于排除可导致上呼吸道阻塞的解剖学疾病也很重要。某些因素，如饮酒和服用镇静剂，可能会使易患睡眠呼吸暂停的人病情加重，而一些细微变化，如不明原因的高血压、红细胞增多症和肺心病，应促使人们调查睡眠呼吸暂停作为病因的可能性。
