Shrivastava Deepak
University of California, Davis, CA, USA; Division of Sleep Medicine, Pulmonary and Critical Care, SJGH Sleep Center, 500, West Hospital Road, French Camp, CA 95231, USA.
Sleep Med. 2014 Jul;15(7):733-41. doi: 10.1016/j.sleep.2014.01.002. Epub 2014 Feb 22.
Sleep-disordered breathing (SDB) is a major public health problem. Various anatomic, pathophysiologic, and environmental changes contribute to SDB. The successful treatment of SDB reverses many of these abnormal processes. The present article discusses the current clinical evidence that supports the reversibility and its potential application in the management of SDB. Continuous positive airway pressure reduces angiogenesis and inflammatory edema, increases pharyngeal size, and improves surrogate markers of vascular inflammation and tongue muscle fiber types. Mandibular advancement devices lead to favorable maxillary and mandibular changes, increase pharyngeal area, and improve hypertension. Uvulopalatopharyngoplasty increases posterior airway space and pharyngeal volume, reduces nasal and oral resistance, and lowers response to high CO2. Weight loss reduces nasopharyngeal collapsibility, critical closing pressure of the airway, apnea-hypopnea index, and improves oxygen saturations. Potential clinical benefits of these changes in the management of SDB and patient compliance with treatment are discussed.
睡眠呼吸障碍（SDB）是一个重大的公共卫生问题。多种解剖学、病理生理学和环境变化导致了SDB。SDB的成功治疗可逆转许多这些异常过程。本文讨论了支持可逆性的当前临床证据及其在SDB管理中的潜在应用。持续气道正压通气可减少血管生成和炎症性水肿，增加咽部尺寸，并改善血管炎症和舌肌纤维类型的替代标志物。下颌前移装置可导致上颌和下颌产生有利变化，增加咽部面积，并改善高血压。悬雍垂腭咽成形术可增加后气道空间和咽部容积，降低鼻腔和口腔阻力，并降低对高二氧化碳的反应。体重减轻可降低鼻咽部可塌陷性、气道临界关闭压、呼吸暂停低通气指数，并提高血氧饱和度。本文还讨论了这些变化在SDB管理中的潜在临床益处以及患者对治疗的依从性。
