Monash Lung and Sleep, Monash Medical Centre, Clayton, Australia; The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Australia.
Monash Lung and Sleep, Monash Medical Centre, Clayton, Australia; Department of Medicine, Southern Clinical School, Monash University, Clayton, Australia.
Sleep Med Rev. 2014 Feb;18(1):7-17. doi: 10.1016/j.smrv.2013.01.005. Epub 2013 May 10.
The most striking feature of obstructive respiratory events is that they are at their most severe and frequent in the supine sleeping position: indeed, more than half of all obstructive sleep apnea (OSA) patients can be classified as supine related OSA. Existing evidence points to supine related OSA being attributable to unfavorable airway geometry, reduced lung volume, and an inability of airway dilator muscles to adequately compensate as the airway collapses. The role of arousal threshold and ventilatory control instability in the supine position has however yet to be defined. Crucially, few physiological studies have examined patients in the lateral and supine positions, so there is little information to elucidate how breathing stability is affected by sleep posture. The mechanisms of supine related OSA can be overcome by the use of continuous positive airway pressure. There are conflicting data on the utility of oral appliances, while the effectiveness of weight loss and nasal expiratory resistance remains unclear. Avoidance of the supine posture is efficacious, but long term compliance data and well powered randomized controlled trials are lacking. The treatment of supine related OSA remains largely ignored in major clinical guidelines. Supine OSA is the dominant phenotype of the OSA syndrome. This review explains why the supine position so favors upper airway collapse and presents the available data on the management of patients with supine related OSA.
事实上，超过一半的阻塞性睡眠呼吸暂停（OSA）患者可以归类为仰卧相关 OSA。现有证据表明，仰卧相关 OSA 归因于气道几何形状不利、肺容量减少以及气道扩张肌无法充分补偿导致气道塌陷。然而，觉醒阈值和通气控制不稳定性在仰卧位中的作用尚未确定。至关重要的是，很少有生理研究在侧卧位和仰卧位检查患者，因此几乎没有信息可以阐明睡眠姿势如何影响呼吸稳定性。持续气道正压通气可克服仰卧相关 OSA 的机制。关于口腔器具的效用存在相互矛盾的数据，而减肥和鼻呼气阻力的有效性仍不清楚。避免仰卧位是有效的，但缺乏长期依从性数据和强有力的随机对照试验。主要临床指南在很大程度上忽略了仰卧相关 OSA 的治疗。仰卧 OSA 是 OSA 综合征的主要表型。本综述解释了为什么仰卧位如此有利于上气道塌陷，并介绍了有关仰卧相关 OSA 患者管理的现有数据。
