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[实践指南:新的S3指南“睡眠障碍 - 与睡眠相关的呼吸异常”]

[Guidelines in Practice: The New S3 Guideline "Sleeping Disorders - Sleep-Related Abnormal Breathing"].

作者信息

Gerlach M, Sanner B

机构信息

Medizinische Klinik, Agaplesion Bethesda Krankenhaus Wuppertal.

出版信息

Pneumologie. 2017 Aug;71(8):508-513. doi: 10.1055/s-0043-106349. Epub 2017 May 30.

Abstract

Sleep related breathing disorders include central sleep apnea (CSA), obstructive sleep apnea (OSA), sleep-related hypoventilation, and sleep-related hypoxia. These disorders are frequent and growing in clinical relevance. The related chapter of the S3 guideline "Non-restorative sleep/Sleep disorders", published by the German Sleep Society (DGSM), has recently been updated in November 2016. Epidemiology, diagnostics, therapeutic procedures, and classification of sleep related disorders have been revised. Concerning epidemiology, a considerably higher mortality rate among pregnant women with OSA has been emphasized. With regards to diagnostics, the authors point out that respiratory polygraphy may be sufficient in diagnosing OSA, if a typical clinical condition is given. For CSA, recommendations were changed to diagnose CSA with low apnea rates present. Significant changes for treating CSA in patients with left ventricular dysfunction have been introduced. In addition, there is now to be differentiated between sleep-related hypoventilation and sleep-related hypoxaemia. Obesity hypoventilation syndrome is discussed in more detail. This article sums up and comments on the published changes.

摘要

睡眠相关呼吸障碍包括中枢性睡眠呼吸暂停(CSA)、阻塞性睡眠呼吸暂停(OSA)、睡眠相关通气不足和睡眠相关低氧血症。这些障碍在临床上很常见且相关性不断增加。德国睡眠协会(DGSM)发布的S3指南“非恢复性睡眠/睡眠障碍”的相关章节最近于2016年11月进行了更新。睡眠相关障碍的流行病学、诊断、治疗方法和分类都已修订。关于流行病学,强调了患有OSA的孕妇死亡率显著更高。关于诊断,作者指出,如果有典型的临床情况,呼吸多导睡眠图在诊断OSA时可能就足够了。对于CSA,建议改为在低呼吸暂停率的情况下诊断CSA。对于左心室功能障碍患者治疗CSA引入了重大变化。此外,现在要区分睡眠相关通气不足和睡眠相关低氧血症。对肥胖低通气综合征进行了更详细的讨论。本文总结并评论了已发表的变化。

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