睡眠呼吸暂停综合征Sleep apnea syndrome.docx

睡眠呼吸暂停综合征Sleep apnea syndrome.docx

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睡眠呼吸暂停综合征Sleepapneasyndrome

睡眠呼吸暂停综合征（Sleepapneasyndrome）

（I）definition

Sleepapneahypopneasyndromereferstoeverynightduringsleepapnearepeated30moretimesorsleepapneahypopneaindex（AHI）ismorethan5timesperhourandaccompaniedbyclinicalsymptomssuchaslethargy.

Apneareferstothecompletecessationofairflowinthenoseandmouthduringsleep,morethan10seconds.Hypopneaisthedecreaseintheintensityofairflowduringsleep（50%）abovethebasallevel,andisaccompaniedbyoxygensaturation

Andabasiclevelmorethan4%declineorslightlyawake;sleepapneahypopneaindexreferstoeachhourofsleepapneaintimesoflowventilation.

（two）classification

1,centraltype（CSAS）2,obstructivetype（OSAS）3,mixedtype（MSAS）

2epidemiologytoOSAHS,forexample,inthepopulationovertheageof40,theprevalencerateof2%-4%intheUnitedStates,morementhanwomen,theelderlyprevalencerateishigher,Australiaupto6.5%,China'sHongkongregion4.1%,

3.62%inShanghai,4.81%inChangchun.

Etiologyandpathogenesisofcentralrespiratorysleepapneasyndrome（CSAS）

SimpleCSASisrareandgenerallydoesnotexceed10%ofapneapatients,andonly4%havebeenreported.Patencycanbefurtherdividedintotwomajorcategories:

hypercapniaandnormalhypercapnia.Obstructivesleepapnea

Pauseventilationsyndromeoccurssimultaneouslyinmostofthelesionsofthenervoussystemormotorsystem.Thepathogenesismayberelatedtothefollowingfactors:

1.Theresponseofrespiratorycentertovariousstimuliisdecreasedduringsleep

（2）theinstabilityofrespiratoryfeedbackcausedbyhypoxemia,especiallythechangeofCO2concentrationinthecentralnervoussystem;3,theabnormalmechanismofexpirationandinspirationtransformation.

Obstructivesleepapneahypopneasyndrome（OSAHS）

ThemajorityofSAHShavefamilyclusteringandgeneticfactors,andmostofthemhavethepathologicalbasisofupperrespiratorytract,especiallynasalandpharyngealstenosis,suchasobesity,allergicrhinitis,nasalpolyps,tonsilhypertrophy,andsoft

Palatineuvularelaxation,longthick,enlargedtongue,tongueretropulsion,mandibularretrusion,temporomandibularjointdysfunctionandmicrognathia.Someendocrinediseasescanalsobecombinedwiththedisease.Itspathogenesismaybeassociatedwithsleep

Inthesleepstate,thecollapseoftheupperairwaysofttissueandmuscleincreased,andtheupperairwaymuscleduringsleepwasrelatedtothedecreaseofhypoxiaandcarbondioxidestimulation.Inaddition,itwasalsorelatedtonerves,bodyfluids,endocrineandsoon

Thecombinedeffectsofbiotin.

Clinicalmanifestations（I）clinicalmanifestationsduringtheday

1lethargy:

themostcommonsymptomsarelightdaytimeworkorstudytime,drowsinessandlethargy,eatingwhenyouareserious,talkingtopeopleandfallingasleep,andevenseriousconsequences,suchasplayingwhiledriving

Sleepinessleadstotrafficaccidents.

2,dizziness,fatigue:

duetorepeatedapneaatnight,hypoxemia,continuoussleepinterruption,increasednumberofwaking,sleepqualitydecreased,oftenslightlydifferentdizziness,fatigue,fatigue.

3,mentalandbehavioralabnormalities:

inattention,fineoperationabilitydecline,memoryandjudgmentdecline,symptomscannotworkwhensevere,elderlypeoplecanshowdementia.Nocturnalhypoxemia

Braindamageandchangesinsleepstructure,especiallyduringperiodsofdeepsleep,arethemaincauses.

4,headache:

ofteninthemorningoratnight,arare,severe,sustainable1-2hours,sometimesneedtotakepainkillerstoease,andthechangeofbloodpressure,intracranialpressureandcerebralbloodflowrelated.

5,personalitychanges:

irritability,irritability,anxiety,familyandsociallifeareaffected,duetofamilymembersandfriendsemotionalalienation,depressionmayoccur.

6,sexualdysfunction:

about10%ofpatientsmayhavesexualdesiredecline,orevenimpotence.

（two）clinicalmanifestationsatnight

1,snoring:

isthemainsymptom,snoringirregular,rangingfromheight,oftensnoring,airflow-stopwheezing-Snoringalternately,thegeneralairinterruptiontimeof20-30seconds,individualupto2minutesormore,

Thiscanoccurinpatientswithobviouscyanosis.

2,apnea:

75%oftheroomorbedwithsleepapneawerefound,oftenworryaboutbreathingisnotrestoredandpushuppatientswithapnea,breathingarousalorloudsnoringandtermination.

PatientswithOSAHShadpronouncedchestandabdominalparadoxicalbreathing.

3,suppresswaking:

apneasuddenlywakeup,oftenaccompaniedbyturningover,limbsinvoluntarymovement,orevenconvulsions,orsuddenlystart,feelflustered,chesttightnessorprecordialdiscomfort.

4,hyperactivity:

duetohypoxemia,patientsturnaroundatnightandturnmorefrequently.

5,sweat:

sweatmore,totheneck,chest,andairwayobstructionafterrespiratoryeffortandapneacausedbyhypercapnia.

6,nocturia:

somepatientscomplainedofnocturnalenuresisincreasedfrequencyofurination,theemergenceofindividual.

7,sleepbehaviordisorder:

forfear,screaming,raving,noctivagant,phonism.

（three）themanifestationsofsystemicorgandamage

OSAHSisoftenthefirstsymptomandsignofabnormalcardiovascularsystem.Itcanbeanindependentriskfactorforhypertensionandcoronaryheartdisease.1.Hypertension:

theincidenceofhypertensioninOSAHSpatientsis45%,

Antihypertensivedrugswerenoteffective.

2coronaryheartdisease:

manifestedasvarioustypesofarrhythmia,nocturnalanginaandmyocardialinfarction.Twentybecauseofhypoxiainducedcoronaryarteryendothelialdamage,lipiddepositionintheintima,andredbloodcells

Increasedbloodviscosity.

3,varioustypesofarrhythmia.

4,pulmonaryheartdiseaseandrespiratoryfailure.

5,ischemicorhemorrhagiccerebrovasculardisease.

6,mentaldisorders:

suchasmanicpsychosisordepression.

7diabetes.

5laboratoryandotherexaminations

（1）bloodtest:

longdurationofillness,hypoxemia,severe,redbloodcellcountandhemoglobinmayhavevaryingdegreesofincrease.

（two）arterialbloodgasanalysis:

severeorcomplicatedwithpulmonaryheartdiseaseandrespiratoryfailuremayleadtohypoxemia,hypercapniaandrespiratoryacidosis.

（three）chestX-rayexamination:

whenaccompaniedbypulmonaryhypertension,hypertensionandcoronaryheartdisease,itcanincreasetheimageoftheheart,andhighlightthecorrespondingsymptomsofpulmonaryarterysegment.

（four）pulmonaryfunctiontest:

whentheconditionisserious,pulmonaryheartdiseaseandrespiratoryfailure,therearedifferentdegreesofventilationdysfunction.

（five）electrocardiogram:

whenhypertensive,coronaryheartdisease,appearventricularhypertrophy,myocardialischemiaorarrhythmiachange.

Diagnosis

Accordingtotypicalclinicalsymptomsandsigns,itisnotdifficulttodiagnoseSAHS.Thediagnosisandunderstandingoftheseverityandtypeofthediseaseneedtobecheckedaccordingly.

（1）clinicaldiagnosis:

accordingtosleepsnoring,apnea,daytimesleepiness,bodyfat,neckcircumferenceandotherclinicalsymptoms,clinicaldiagnosiscanbemade.

（two）polysomnography:

PSGmonitoringisthegoldstandardforthediagnosisofSAHS,anditcandeterminethetypeandseverityofthedisease.

（three）etiologicaldiagnosis:

routinediagnosisofSAHS,nose,larynxandmouth,andlocalanatomyanddysplasia,hyperplasiaandtumorwereobserved.Radiographsoftheheadandneck,CTandMRImeasurements

Thetransversesectionalareaofthepharynxcanbeusedasanarrowlocation.Theendocrinesystemcanbemeasuredinsomepatients.

differentialdiagnosis

（a）simplesnoring:

thereisobvioussnoring,PSGexaminationdoesnotmeetthediagnosisofupperairwayobstructionsyndrome,noapneaandhypoventilation,nohypoxemia.

（two）upperairwayresistancesyndrome:

increasedairwayresistance.

（three）narcolepsy:

excessivedaytimesleepiness,cataplexyattack.Haveafamilyhistory.

Treatment

（I）treatmentofcentralsleepapneasyndrome:

1,thetreatmentofprimarydiseases:

suchasnervoussystemdiseases,congestiveheartfailuretreatment.

2,respiratorystimulantdrugs:

mainlytoincreasetherespiratorycenterofthedrivingforce,improveapneaandhypoxemia.Use:

Amiethreetriazine（50mg,2-3/day）,acetazolamide（125-250mg,3-4/min

Ortake250mgbeforegoingtobed）andtheophylline（100-200mg,2-3times/day）.

3,oxygentherapy:

cancorrecthypoxemia,forsecondarytocongestiveheartfailurepatients,canreducethenumberofapneaandhypoventilation,neuromusculardiseasemayexacerbatehypercapnia,butifcombined

AndOSAHSmayexacerbateobstructiveapnea.

4、auxiliaryventilationtreatment:

forseverepatients,mechanicalventilationcanenhancespontaneousbreathing,noninvasivepositivepressureventilationandinvasivemechanicalventilationcanbeused.

（two）treatmentofobstructivesleepapneahypopneasyndrome

1,generaltreatment:

（1）weightloss:

dietcontrol,drugsandsurgery.

（2）sleeppositionchange:

lateralsleep,raisingthebedside.（3）quitsmokingwineandavoidtakingsedatives.

2,drugtreatment:

theeffectisnotcertain.Tryacetazolamide.Modafiniltoimprovedaytimesleepiness,usedtoimprovethesymptomsofsleepinessafterCPAPtherapyinpatientswithobvious,haveacertaineffect.

3.Medicaltreatment:

（1）nasalcontinuouspositiveairwaypressure（nasal-continuous,positive,airway,pressure,CPAP）;

Indications:

AHImorethan15timesperhourinpatients.AHI<15times/hour,butthedaytimesleepinessandotherobvioussymptoms.Surgicaltreatmentfailureorrecurrenceofpatients.Unabletotolerateothertreatmentmethods.

Contraindications:

coma,bullae,hemoptysis,pneumothorax,an