Jamil Shazia M, Shafazand Shirin, Dudley Katherine A, Lipford Melissa C, Gu Chenjuan, Jun Jonathan C, Budnick Isadore, Davis Eric M, Kent David, Stanley Jeffrey J, Quaney Rachel, Stewart Nancy H, Young Kirsten, Sullivan Shannon, McSparron Jakob I, Wang Tisha, Guzman Elizabeth, Çoruh Başak, Hayes Margaret M
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Scripps Clinic, La Jolla, California.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, California.
ATS Sch. 2021 Sep 13;2(3):484-496. doi: 10.34197/ats-scholar.2021-0027RE. eCollection 2021 Sep.
The American Thoracic Society Sleep Core Curriculum updates clinicians on important sleep topics, presented during the annual meeting, and appearing in summary here. This year's sleep core theme is sleep-disordered breathing and its management. Topics range from pathophysiological mechanisms for the association of obstructive sleep apnea (OSA) and metabolic syndrome, surgical modalities of OSA treatment, comorbid insomnia and OSA, central sleep apnea, and sleep practices during a pandemic. OSA has been associated with metabolic syndrome, independent of the role of obesity, and the pathophysiology suggests a role for sleep fragmentation and intermittent hypoxia in observed metabolic outcomes. In specific patient populations, surgical treatment modalities for OSA have demonstrated large reductions in objective disease severity compared with no treatment and may facilitate adherence to positive airway pressure treatment. Patient-centered approaches to comorbid insomnia and sleep apnea include evaluating for both OSA and insomnia simultaneously and using shared-decision making to determine the order and timing of positive airway pressure therapy and cognitive behavioral therapy for insomnia. The pathophysiology of central sleep apnea is complex and may be due to the loss of drive to breathe or instability in the regulatory pathways that control ventilation. Pandemic-era sleep practices have evolved rapidly to balance safety and sustainability of care for patients with sleep-disordered breathing.
美国胸科学会睡眠核心课程向临床医生介绍了在年会上展示并在此进行总结的重要睡眠主题。今年的睡眠核心主题是睡眠呼吸障碍及其管理。主题涵盖从阻塞性睡眠呼吸暂停（OSA）与代谢综合征关联的病理生理机制、OSA治疗的手术方式、共病性失眠与OSA、中枢性睡眠呼吸暂停以及疫情期间的睡眠习惯等。OSA已被证实与代谢综合征相关，且独立于肥胖的影响，其病理生理学表明睡眠片段化和间歇性缺氧在观察到的代谢结果中发挥了作用。在特定患者群体中，与未治疗相比，OSA的手术治疗方式已显示出可大幅降低客观疾病严重程度，并且可能有助于患者坚持气道正压治疗。针对共病性失眠和睡眠呼吸暂停的以患者为中心的方法包括同时评估OSA和失眠，并采用共同决策来确定气道正压治疗和失眠认知行为治疗的顺序及时机。中枢性睡眠呼吸暂停的病理生理学较为复杂，可能是由于呼吸驱动力丧失或控制通气的调节途径不稳定所致。疫情时代的睡眠习惯已迅速演变，以平衡对睡眠呼吸障碍患者护理的安全性和可持续性。
