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诊治阻塞性睡眠呼吸暂停合并肥胖患者。

Approach the Patient With Obstructive Sleep Apnea and Obesity.

作者信息

Meyer Emily Jane, Wittert Gary Allen

机构信息

Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.

Endocrine and Diabetes Services, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia.

出版信息

J Clin Endocrinol Metab. 2024 Feb 20;109(3):e1267-e1279. doi: 10.1210/clinem/dgad572.

Abstract

Obstructive sleep apnea (OSA) and obesity are highly prevalent and bidirectionally associated. OSA is underrecognized, however, particularly in women. By mechanisms that overlap with those of obesity, OSA increases the risk of developing, or having poor outcomes from, comorbid chronic disorders and impairs quality of life. Using 2 illustrative cases, we discuss the relationships between OSA and obesity with type 2 diabetes, dyslipidemia, cardiovascular disease, cognitive disturbance, mood disorders, lower urinary tract symptoms, sexual function, and reproductive disorders. The differences in OSA between men and women, the phenotypic variability of OSA, and comorbid sleep disorders are highlighted. When the probability of OSA is high due to consistent symptoms, comorbidities, or both, a diagnostic sleep study is advisable. Continuous positive airway pressure or mandibular advancement splints improve symptoms. Benefits for comorbidities are variable depending on nightly duration of use. By contrast, weight loss and optimization of lifestyle behaviors are consistently beneficial.

摘要

阻塞性睡眠呼吸暂停(OSA)与肥胖症高度流行且存在双向关联。然而,OSA尤其是在女性中未得到充分认识。通过与肥胖症重叠的机制,OSA增加了并发慢性疾病的发生风险或导致不良后果,并损害生活质量。我们通过2个实例,讨论OSA与肥胖症在2型糖尿病、血脂异常、心血管疾病、认知障碍、情绪障碍、下尿路症状、性功能及生殖障碍方面的关系。文中强调了男性与女性OSA的差异、OSA的表型变异性以及并发睡眠障碍。当因持续症状、合并症或两者兼而有之导致OSA可能性较高时,建议进行诊断性睡眠研究。持续气道正压通气或下颌前移矫治器可改善症状。对合并症的益处因每晚使用时长而异。相比之下,体重减轻和生活方式行为的优化始终有益。

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