Lombard R M, Zwillich C W
Med Clin North Am. 1985 Nov;69(6):1317-35. doi: 10.1016/s0025-7125(16)30989-0.
Guidelines for the medical therapy of obstructive sleep apnea are difficult to define precisely. While some elegant investigations have been completed, most study populations have been small. Also, the long-term effects of most forms of therapy are not known. Some patients will respond to a given form of therapy or combination of therapies while others will not. In most instances the responders cannot be recognized prior to the institution of therapy and a cycle of trial and error ensues. One of the best nonsurgical approaches appears to be weight loss, albeit unsuccessful in most cases. Almost all experts would agree, however, that in nonemergent situations weight loss should be strongly suggested. Nasal CPAP appears to be the single most promising device. Protriptyline may have a role, although in our opinion its true efficacy remains to be determined. Oxygen will probably serve more an adjunctive role in therapy, and medroxyprogesterone appears to be beneficial only in the treatment of the obesity-hypoventilation syndrome. A reasonable approach to the medical treatment of the obstructive sleep apnea patient should include, first, by history, physical examination, and appropriate laboratory testing, elimination of anatomically correctable, pharmacologic, or endocrinologic causes of OSA. If apnea length, degree of desaturation, cardiac arrhythmias, or levels of hypersomnolence are so severe as to be potentially life threatening, immediate tracheostomy is suggested. In specialized centers, nasal CPAP would be used. In less severely affected patients, medical management, as discussed above, should begin. We believe that in view of the lack of controlled trials demonstrating which form of therapy is best, the clinician must recommend therapy on the basis of local clinical experience and patient acceptance. Of fundamental importance is the need for serial reevaluation so that the impact of therapeutic failure can be minimized.
阻塞性睡眠呼吸暂停的医学治疗指南很难精确界定。虽然已经完成了一些出色的研究，但大多数研究群体规模较小。此外，大多数治疗方式的长期效果尚不清楚。一些患者会对某种特定的治疗方式或多种治疗方式的组合产生反应，而其他患者则不会。在大多数情况下，在开始治疗之前无法识别出有反应的患者，随之而来的是一个反复试验的过程。最佳的非手术方法之一似乎是减肥，尽管在大多数情况下并不成功。然而，几乎所有专家都同意，在非紧急情况下，应强烈建议减肥。鼻持续气道正压通气（CPAP）似乎是最有前景的单一设备。普罗替林可能有一定作用，不过在我们看来，其真正疗效仍有待确定。氧气在治疗中可能更多地起辅助作用，而甲羟孕酮似乎仅对肥胖低通气综合征的治疗有益。对阻塞性睡眠呼吸暂停患者进行医学治疗的合理方法应首先包括，通过病史、体格检查和适当的实验室检查，排除阻塞性睡眠呼吸暂停可通过解剖学纠正、药物治疗或内分泌治疗的病因。如果呼吸暂停时间、血氧饱和度降低程度、心律失常或过度嗜睡程度严重到可能危及生命，则建议立即进行气管切开术。在专业中心，会使用鼻CPAP。对于病情较轻的患者，应开始上述的医学管理。我们认为，鉴于缺乏对照试验来证明哪种治疗方式最佳，临床医生必须根据当地临床经验和患者接受程度来推荐治疗方法。至关重要的是需要进行系列重新评估，以便将治疗失败的影响降至最低。
