Medical Service, VA Boston Healthcare System, Boston, Massachusetts.
Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA. 2020 Apr 14;323(14):1389-1400. doi: 10.1001/jama.2020.3514.
Obstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA.
The most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold increased risk of cardiovascular and metabolic disease. In many patients, OSA can be diagnosed with home sleep apnea testing, which has a sensitivity of approximately 80%. Effective treatments include weight loss and exercise, positive airway pressure, oral appliances that hold the jaw forward during sleep, and surgical modification of the pharyngeal soft tissues or facial skeleton to enlarge the upper airway. Hypoglossal nerve stimulation is effective in select patients with a body mass index less than 32. There are currently no effective pharmacological therapies. Treatment with positive airway pressure lowers blood pressure, especially in patients with resistant hypertension; however, randomized clinical trials of OSA treatment have not demonstrated significant benefit on rates of cardiovascular or cerebrovascular events.
OSA is common and the prevalence is increasing with the increased prevalence of obesity. Daytime sleepiness is among the most common symptoms, but many patients with OSA are asymptomatic. Patients with OSA who are asymptomatic, or whose symptoms are minimally bothersome and pose no apparent risk to driving safety, can be treated with behavioral measures, such as weight loss and exercise. Interventions such as positive airway pressure are recommended for those with excessive sleepiness and resistant hypertension. Managing asymptomatic OSA to reduce cardiovascular and cerebrovascular events is not currently supported by high-quality evidence.
阻塞性睡眠呼吸暂停（OSA）在美国影响 17%的女性和 34%的男性，在其他国家也有类似的患病率。本综述提供了 OSA 的诊断和治疗的最新信息。
OSA 最常见的表现症状是过度嗜睡，尽管在普通人群中，只有 15%到 50%的 OSA 患者报告有这种症状。OSA 与心血管和代谢疾病的风险增加 2 到 3 倍相关。在许多患者中，家庭睡眠呼吸暂停测试可以诊断 OSA，其敏感性约为 80%。有效的治疗方法包括减肥和运动、正压通气、在睡眠期间保持下颌向前的口腔器具，以及对上呼吸道的咽软组织或面骨进行手术修改以扩大上呼吸道。舌下神经刺激在体重指数小于 32 的特定患者中有效。目前尚无有效的药物治疗方法。正压通气治疗可降低血压，尤其是在难治性高血压患者中；然而，OSA 治疗的随机临床试验并未显示在心血管或脑血管事件发生率方面有显著益处。
OSA 很常见，随着肥胖症患病率的增加，其患病率也在增加。白天嗜睡是最常见的症状之一，但许多 OSA 患者无症状。对于无症状或症状轻微且对驾驶安全没有明显风险的 OSA 患者，可以采用行为措施进行治疗，如减肥和运动。对于有过度嗜睡和难治性高血压的患者，建议采用正压通气等干预措施。目前，没有高质量的证据支持将无症状 OSA 管理用于降低心血管和脑血管事件的风险。
