Riley R W, Powell N B, Guilleminault C, Clerk A, Troell R
Stanford University Sleep Disorders and Research Center, Palo Alto, CA 94304, USA.
West J Med. 1995 Feb;162(2):143-8.
The National Commission on Sleep Disorders Research, in its report to Congress, concluded that the primary care community generally does not understand sleep disorders. Obstructive sleep apnea carries a risk of substantial morbidity and mortality. Excessive daytime sleepiness results from fragmented sleep and microarousals associated with apneic events. It causes poor work performance and increases the incidence of automobile accidents due to driving while drowsy. The commission estimates that the loss of productivity in the United States from excessive daytime sleepiness is more than $20 billion per year. Obstructive sleep apnea is strongly associated with hypertension, myocardial infarction, and stroke. Risk factors for obstructive sleep apnea include male sex, obesity, older age, craniofacial anomalies, and familial risk. Treatment is based on documenting the disorder by polysomnography. Medical management of the syndrome includes weight loss and nasal continuous positive airway pressure. A network of follow-up and support is necessary to maintain compliance. Surgical treatment is reserved for those for whom nasal airway pressure treatment fails. A surgical protocol is presented that demonstrates efficacy equal to nasal airway pressure treatment. Primary care physicians should assume the responsibility of identifying patients at risk for obstructive sleep apnea and refer them appropriately.
国家睡眠障碍研究委员会在提交给国会的报告中得出结论，初级保健群体普遍不了解睡眠障碍。阻塞性睡眠呼吸暂停会带来较高的发病和死亡风险。白天过度嗜睡是由与呼吸暂停事件相关的睡眠片段化和微觉醒引起的。它会导致工作表现不佳，并因困倦驾驶而增加汽车事故的发生率。该委员会估计，美国每年因白天过度嗜睡造成的生产力损失超过200亿美元。阻塞性睡眠呼吸暂停与高血压、心肌梗死和中风密切相关。阻塞性睡眠呼吸暂停的风险因素包括男性、肥胖、老年、颅面异常和家族风险。治疗基于通过多导睡眠图记录该疾病。该综合征的药物治疗包括减肥和鼻持续气道正压通气。需要一个随访和支持网络来维持依从性。手术治疗仅适用于鼻气道压力治疗失败的患者。本文介绍了一种手术方案，其疗效与鼻气道压力治疗相当。初级保健医生应承担识别阻塞性睡眠呼吸暂停风险患者并进行适当转诊的责任。
