David Grant USAF Medical Center Family Medicine Residency Program, Travis Air Force Base, Calif.; Uniformed Services University of the Health Sciences, Bethesda, Md.; University of California Davis School of Medicine.
David Grant USAF Medical Center Family Medicine Residency Program, Travis Air Force Base, Calif.; Uniformed Services University of the Health Sciences, Bethesda, Md.
Am Fam Physician. 2024 Jul;110(1):27-36.
Obstructive sleep apnea (OSA) is a common disorder that affects quality of life and is associated with comorbidities such as hypertension, atrial fibrillation, heart failure, coronary heart disease, type 2 diabetes mellitus, and stroke. OSA is characterized by a reduction or cessation of breathing during sleep, resulting in intermittent hypoxemia, autonomic fluctuation, and sleep fragmentation. The U.S. Preventive Services Task Force states that there is insufficient evidence to recommend routine screening for OSA in the absence of symptoms. OSA should be considered in patients with excessive daytime fatigue, unrestful sleep, persistent snoring, and nocturnal awakenings with gasping or choking. The STOP-BANG questionnaire is the most sensitive screening tool for OSA, and the diagnostic standard is polysomnography with an observed apnea-hypopnea index greater than 5 in the presence of symptoms or greater than 15 without symptoms. Home sleep apnea testing is a useful diagnostic option in patients who have symptoms consistent with moderate to severe OSA without significant cardiopulmonary comorbidities. Positive airway pressure, with a humidified nasal or facial mask, is the first-line treatment for adults with OSA. Weight loss is a beneficial adjunct to treatment through intensive lifestyle modification, medications, or bariatric surgery. Alternatives for patients intolerant of or nonadherent to positive airway pressure include changing the type of mask used, mandibular advancement devices, hypoglossal nerve stimulation, and other surgical interventions. Although many OSA therapies effectively improve daytime sleepiness and blood pressure, none have demonstrated a mortality benefit in randomized controlled trials.
阻塞性睡眠呼吸暂停（OSA）是一种常见的疾病，会影响生活质量，并与高血压、心房颤动、心力衰竭、冠心病、2 型糖尿病和中风等合并症相关。OSA 的特征是在睡眠期间呼吸减少或停止，导致间歇性低氧血症、自主波动和睡眠碎片化。美国预防服务工作组表示，在没有症状的情况下，没有足够的证据推荐常规筛查 OSA。对于白天过度疲劳、睡眠不安稳、持续打鼾以及夜间出现喘息或窒息惊醒的患者，应考虑 OSA。STOP-BANG 问卷是 OSA 最敏感的筛查工具，诊断标准是在有症状时，多导睡眠图上观察到的呼吸暂停-低通气指数大于 5，或无症状时大于 15。对于有症状且符合中重度 OSA 但无明显心肺合并症的患者，家庭睡眠呼吸暂停测试是一种有用的诊断选择。经鼻或面罩加湿的正压通气是 OSA 成人患者的一线治疗方法。通过强化生活方式改变、药物治疗或减重手术来减轻体重是治疗的有益辅助手段。对于不能耐受或不依从正压通气的患者，替代治疗方法包括改变使用的面罩类型、下颌前伸装置、舌下神经刺激和其他手术干预。尽管许多 OSA 治疗方法能有效改善白天嗜睡和血压，但在随机对照试验中，没有一种方法显示出对死亡率的益处。
