Roche N, Huchon G, Durieux P
Service de Pneumologie, Hôpital Ambroise-Paré, Boulogne.
Ann Med Interne (Paris). 1996;147(3):151-60.
Obstructive sleep apnea syndrome (OSAS) is a chronic disorder in which the subject experiences an abnormally large number of episodes of more or less complete and prolonged ventilatory arrest due to pharyngeal obstruction leading to fragmented sleep pattern and reduced arterial oxygen saturation. OSAS produces invalidating daytime symptoms and appears to be associated with cardiovascular complications and overmortality. Diagnosis is based on an exploration of the sleeping pattern with recording of ventilation function, arterial oxygen saturation, heart rate, and electrophysiological characteristics (polysomnography). Prevalence of a high apnea index (more than 5 per hour of sleep) associated with day-time somnolence may be as high as 3% of the population in the 30 to 60 year age range. Current treatment is mainly based on nasal continuous positive airway pressure given via the nasal route during sleep and pharyngeal surgery (uvulopalatopharyngoplasty). Surgery is reserved for subgroups of patients with anatomic abnormalities and free of contraindications for anesthesia. Continuous positive pressure is always effective in case of symptomatic apnea and has a favorable effect on several associated complications. It can be proposed for any patient with OSAS but its use is limited due to incomplete compliance (approximately 70%). It appears that patients with particularly severe disease benefit most. Thus the ANDEM experts recommend treatment for all symptomatic patients with 30 or more episodes of apnea or hypopnea per hour of sleep during night-time exploration. Below this threshold, electrophysiological recordings are required to eliminate another cause of fragmented sleep which could explain the symptomatology despite a moderately elevated apnea index. Once the treatment has been started, regular surveillance is recommended. In addition, general health and nutritional counselling (weight reduction, smoking cessation, interruption of alcohol consumption and use of sedatives) should be proposed but usually have minimal and transitory effect.
阻塞性睡眠呼吸暂停综合征（OSAS）是一种慢性疾病，患者由于咽部阻塞会经历大量或多或少完全且持续时间较长的通气暂停发作，导致睡眠模式碎片化和动脉血氧饱和度降低。OSAS会产生使人虚弱的日间症状，并且似乎与心血管并发症和死亡率增加有关。诊断基于对睡眠模式的探索，记录通气功能、动脉血氧饱和度、心率和电生理特征（多导睡眠图）。与日间嗜睡相关的高呼吸暂停指数（每小时睡眠超过5次）在30至60岁年龄段人群中的患病率可能高达3%。目前的治疗主要基于睡眠期间经鼻途径给予的鼻持续气道正压通气和咽部手术（悬雍垂腭咽成形术）。手术适用于有解剖学异常且无麻醉禁忌症的患者亚组。对于有症状的呼吸暂停，持续气道正压通气总是有效的，并且对几种相关并发症有良好效果。它可用于任何OSAS患者，但由于依从性不完全（约70%），其使用受到限制。似乎病情特别严重的患者受益最大。因此，ANDEM专家建议对所有在夜间检查中每小时睡眠有30次或更多次呼吸暂停或呼吸不足发作的有症状患者进行治疗。低于这个阈值，需要进行电生理记录以排除睡眠碎片化的另一个原因，尽管呼吸暂停指数适度升高，但该原因可能解释症状。一旦开始治疗，建议进行定期监测。此外，应提供一般健康和营养咨询（减轻体重、戒烟、戒酒和停用镇静剂），但通常效果甚微且持续时间短暂。
