Loube D I, Loube A A, Mitler M M
Army Medical Corps, Brooke Army Medical Center, Fort Sam, Houston, Tex.
J Am Diet Assoc. 1994 Nov;94(11):1291-5. doi: 10.1016/0002-8223(94)92462-7.
Obstructive sleep apnea (OSA) is a common disorder in which upper-airway obstruction during sleep results in cessation of breathing. OSA is associated with increased morbidity and mortality and impaired daytime functioning. Upper-body obesity is a risk factor for OSA, and it is well documented that weight loss has a notable ameliorative impact on the occurrence of OSA. Nasal continuous positive airway pressure (nCPAP) during sleep is the primary treatment for OSA, and is usually effective in relieving upper-airway obstruction. However, compliance with prolonged nCPAP use has been proven problematic. Upper-airway surgeries may be efficacious for the treatment of OSA in carefully selected patients, but often are not successful for obese patients with OSA. The concomitant use of nCPAP and behavioral weight loss therapy in obese patients with OSA may result in enhanced weight loss. In moderately obese patients, modest weight reduction may alleviate the need for long-term nCPAP therapy or upper-airway surgery. Severely obese patients usually require more substantial weight loss and may be candidates for behavioral therapy in combination with gastric surgery. The role of the dietitian in the treatment of OSA cannot be overemphasized and warrants further development and study.
阻塞性睡眠呼吸暂停（OSA）是一种常见疾病，睡眠期间上呼吸道阻塞会导致呼吸停止。OSA与发病率和死亡率增加以及日间功能受损有关。上身肥胖是OSA的一个危险因素，且有充分文献证明体重减轻对OSA的发生有显著改善作用。睡眠期间使用鼻持续气道正压通气（nCPAP）是OSA的主要治疗方法，通常能有效缓解上呼吸道阻塞。然而，长期使用nCPAP的依从性已被证明存在问题。对于经过精心挑选的患者，上呼吸道手术可能对OSA治疗有效，但对于肥胖的OSA患者往往并不成功。肥胖的OSA患者同时使用nCPAP和行为减肥疗法可能会增强体重减轻效果。在中度肥胖患者中，适度减重可能会减少长期nCPAP治疗或上呼吸道手术的需求。重度肥胖患者通常需要更大幅度的体重减轻，可能适合行为疗法与胃部手术相结合的治疗方式。营养师在OSA治疗中的作用再怎么强调都不为过，值得进一步发展和研究。
