Deacon Naomi L, Jen Rachel, Li Yanru, Malhotra Atul
1 Department of Pulmonary and Critical Care, School of Medicine, University of California, San Diego, San Diego, California.
2 Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and.
Ann Am Thorac Soc. 2016 Jan;13(1):101-8. doi: 10.1513/AnnalsATS.201508-537FR.
Obstructive sleep apnea (OSA) is a common sleep disorder with serious associated morbidities. Although several treatment options are currently available, variable efficacy and adherence result in many patients either not being treated or receiving inadequate treatment long term. Personalized treatment based on relevant patient characteristics may improve adherence to treatment and long-term clinical outcomes. Four key traits of upper airway anatomy and neuromuscular control interact to varying degrees within individuals to cause OSA. These are: (1) the pharyngeal critical closing pressure, (2) the stability of ventilator chemoreflex feedback control (loop gain), (3) the negative intraesophageal pressure that triggers arousal (arousal threshold), and (4) the level of stimulus required to activated upper airway dilator muscles (upper airway recruitment threshold). Simplified diagnostic methods are being developed to assess these pathophysiological traits, potentially allowing prediction of which treatment would best suit each patient. In contrast to current practice of using various treatment modes alone, model predictions and pilot clinical trials show improved outcomes by combining several treatments targeted to each patient's pathophysiology profile. These developments could theoretically improve efficacy and adherence to treatment and in turn reduce the social and economic health burden of OSA and the associated life-threatening morbidities. This article reviews OSA pathophysiology and identifies currently available and investigational treatments that may be combined in the future to optimize therapy based on individual profiles of key patient pathophysiological traits.
阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠障碍，伴有严重的相关发病情况。尽管目前有多种治疗选择，但疗效各异且患者依从性不同，导致许多患者要么未得到治疗，要么长期接受的治疗不充分。基于患者相关特征的个性化治疗可能会提高治疗依从性和长期临床疗效。上气道解剖结构和神经肌肉控制的四个关键特征在个体内部以不同程度相互作用，从而导致阻塞性睡眠呼吸暂停。这些特征包括：（1）咽部临界关闭压；（2）通气化学反射反馈控制的稳定性（环路增益）；（3）引发觉醒的食管内负压（觉醒阈值）；（4）激活上气道扩张肌所需的刺激水平（上气道募集阈值）。正在开发简化的诊断方法来评估这些病理生理特征，这有可能预测哪种治疗最适合每位患者。与目前单独使用各种治疗模式的做法不同，模型预测和初步临床试验表明，针对每位患者的病理生理特征组合多种治疗方法可改善治疗效果。从理论上讲，这些进展可以提高疗效和治疗依从性，进而减轻阻塞性睡眠呼吸暂停的社会和经济健康负担以及相关的危及生命的发病情况。本文综述了阻塞性睡眠呼吸暂停的病理生理学，并确定了目前可用的以及正在研究的治疗方法，这些方法未来可能会结合起来，根据关键患者病理生理特征的个体情况优化治疗。
