osahs

阻塞性睡眠呼吸暫停綜合征ObstructiveSleepApneaHypopneaSyndrome TheFristHospitalAttachedtoGuangzhouMedicalUniversityENTDepartmentJiaWang Haveyoumetthissleepconditionbefore flv DefinitionandClassification SleepApneaHypopneaSleephypoxemiaAHI Classification centralsleepapneasyndrome CSASobstructivesleepapneasyndrome OSASmixedsleepapneasyndrome MSAS Breathingwave Chestmovement Abdomenmovement ObstructiveSleepApneaHypopneaSyndrome OSAHS Airstopsflowingthroughthenoseandmouth butthoracicandabdominalbreathingeffortsareuninterrupted Itisthemostcommontypeintheclinical CentralSleepApneaSyndrome CSAS Bothoralbreathingandthoracic abdominalbreathingeffortsaresimultaneouslyinterruptedThepureCSASisfew nomorethan10 MixedSleepApneaSyndrome MSAS Usually abriefperiodofcentralapneaisfollowedbyalongerperiodofobstructiveapnea Sleepapneaisaconditioninwhichbreathingstopsformorethan10secondsduringsleep Definition Hypopneaisaconditioninwhicha50 reductioninthoracic abdominalmovementlastingfor10s associatedwithdecreasesSaO2 3 Sleephypoxemiaisaconditioninwhichcausingperiodsofapneaorhypopnea thebloodoxygenlevelswilllessthan90 AHIisanindexusedtoassesstheseverityofsleepapneabasedonthetotalnumberofcompletecessations apnea andpartialobstructions hypopnea ofbreathingoccurringperhourofsleep AHI apnea h hypopnea hAHI 5 WhatisOSAHS Sleepapnea hypopneaoccurs30ormoretimesduringa7 hourperiodofnocturnalsleep ortheAHI 5 Definition EpidemiologyofOSAHS InUSA thereismorethan4 InShanghai thereismorethan3 6 about50millionpatientsAmongthese Menisfourtimesthatofwomen RiskFactors Obesity BMI 25 75 9 NeckCircumference63 2 male 41cm female 38cm Male78 5 Age 35 55 66 4 Etiology Factorsandconditionsthatpromotesonringandapnea What sthecauses flv NormalBreathing ObstructedBreathing expiration inspiration Pathophysiology Onsetofsleep Muscletone oralfloor tongue pharynx auxiliaryrespiratorymuscles Pharyngeacross section Pharyngealcompliance Negativepressure oropharynx trachea thorax Airwayresistance Apnea pO2 pCO2 pH Returntosleep Centralarousal Resumptionofbreathing Bradycardia arrhythmia Pulmonaryvasoconstriction Lossofdeepsleep fragmentedsleep Erythropoiesis Systemicvasoconstriction Suddencardiacdeath Pulmonaryhypertension Systemicarterialhypertension Daytimefatigue drowsiness intellectualdeterioration Polycythemia PathophysiologyofOSAHS Theupperairwaykeepopening FallasleepCompensatoryrestoration CompensatoryreduceArousal microarousal ThetendencyfortheThoracicnegativeupperairwaytocollapsepressureincreases Apnea Hypopnea pO2 pCO2 SleepCycle NREM nonrapideyemovementsleep slowwavesleep Stage1 DrowsinessStage2 LightsleepStage3 DeepsleepStage4 Slow wavedeepsleepREM rapideyemovementsleep Nomal OSAHS SLEEPPATTERNGRAPH Signsinthepatient shistorythataresuggestiveof obstructive sleepapnea Loud irregularsnoring Periodsofapneaduringsleep witnessed Unusualdaytimesleepinessorfatigue Restlesssleep Intellectualdeterioration poorconcentrationandimpairedmemory Personalitychanges Lossoflibido impotence Nycturia enuresis Symptom ObesityShortfatneckLargetonsilsFacialabnormality Examination Adenotonsillarhypertrophy Glossoptosis Mandibularretrusion ThepatientswithOSAHSwillhaveatroublesomelife DaytimefatigueDrowsiness ThepatientswithOSAHSwillhaveatroublesomelife Disturbingthebedcompanion ThepatientswithOSAHSwillhaveatroublesomelife TrafficAccidents DiagnosisofOSAHS Clinicaldiagnosis LoudSnoring95 8 ExcessiveDaytimeSleepiness86 7 RestlessandUnrefreshingsleep40 2 Morningheadache31 4 Chokingatnight21 5 Reducedlibido26 3 PSG Polysomonography PSG ThegoldenstanderforOSAHS electroencephalogram EEG 二導(dǎo)腦電圖 electrooculogram EOG 二導(dǎo)眼電圖 includeelectromyogram EMG 下頜頦肌電圖 electrocardiogram ECG 心電圖 AirflowofthenoseandmouseThoracicandabdominalmovementsaturationofbloodoxygenbodyposition DeterminingthesiteofairwayobstructioninOSAHS FlexibletransnasalendoscopyAirwaypressuremeasurements OSAHS 睡眠時上氣道反復(fù)發(fā)生坍塌 阻塞引起的睡眠時呼吸暫停和通氣不足 伴有打鼾 睡眠結(jié)構(gòu)紊亂 頻繁發(fā)生血氧飽和度下降 白天嗜睡等癥狀 睡眠中呼吸暫停 低通氣反復(fù)發(fā)作超過30次以上 或睡眠呼吸暫停 低通氣指數(shù) indexofapnea hypopnea AHI 呼吸暫停 低通氣次數(shù) 睡眠時間 5 次 小時 OSAHS的診斷標(biāo)準(zhǔn) indexmildmoderatesevereAHI5 1515 30 30SaO285 9065 85 65 TheSeverityLevelofOSAHS WhytotreattheOSAHS Survivalrate Normalperson OSAHS Years TreatmentsforOSAHS 1 BehaviourManagementBodyweightreductionSleeponthesideGoodsleephygieneAvoidalcoholandsedativeStopsmoking Generaltreatmentmeasures 2 InpatientswithseveregradesofOSAHSoranunsuccessfultrialwithsurgicaltratment CPAP BiPAP TheprincipleofCPAP Theunstableportionsoftheairwaycanbe pneumaticallysplinted bymeansoftransnasalcontinuouspositivepressureventilation thiskeepsthetissuesfromcollapsingduringsleepandobstructing OralAppliances SurgicalTratment Surgicaltreatmentrequiresverycarefulpatientselection becausemanypatientswillderivelittleornobenefitfromtheoper