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了解阻塞性睡眠呼吸暂停  

2015-11-29 11:01:59|  分类: 疾病与治疗 |  标签: |举报 |字号 订阅

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Obstructive sleep apnea is the most common form of apnea. Here's information to help you understand how obstructive sleep apnea can affect your life and what can be done about it.

What Is Sleep Apnea?

Apnea literally means "cessation of breath." If you have sleep apnea, your breath can become very shallow or you may even stop breathing while you are asleep. This state of not breathing can occur up to hundreds of times a night in some people.

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) -- also called obstructive sleep apnea syndrome -- occurs when there are repeated episodes of complete or partial blockage of the upper airway during sleep. During an obstructive sleep apnea episode, the diaphragm and chest muscles work harder to open the obstructed airway and pull air into the lungs. Breathing usually resumes with a loud gasp, snort, or body jerk. These episodes can interfere with sound sleep. They can also reduce the flow of oxygen to vital organs and cause irregular heart rhythms.


What Are the Symptoms of Obstructive Sleep Apnea?

Who Gets Obstructive Sleep Apnea?

According to the National Heart, Lung, and Blood Institute, more than 12 million people in the U.S. have sleep apnea. Of the total, more than half are overweight. Those figures also estimate that one in 25 middle-aged men and one in 50 middle-aged women have sleep apnea. If you are related to someone with sleep apnea, you are more likely to develop sleep apnea yourself.

Sleep apnea is more common in men than in women. It is also more likely to develop in African-Americans, Hispanics, and Pacific Islanders than in Caucasians. The likelihood of developing the condition increases with age. For women, the condition is more likely after menopause.

Sleep apnea is more common among people with thick or large necks. The condition is also more common among people who have smaller airways in their noses, throats, or mouths. The small airway could be related to the actual size and shape of the airway, or to obstructions or other medical conditions that are causing obstructions.

Babies and small children may have sleep apnea that is caused by swollen tonsils. Adults may also have enlarged tonsils causing obstruction. More commonly, their obstruction is caused by too much tissue at the back of the throat -- the uvula and soft palate -- that hangs down and blocks the windpipe. A larger than average tongue can also block the airway in many people as well as a deviated septum in the nose.

What Are the Risk Factors for Obstructive Sleep Apnea?

In addition to being overweight and getting older, other risk factors for obstructive sleep apnea include:

  • Smoking
  • High blood pressure
  • Having risk factors for heart failure or stroke

How Is Obstructive Sleep Apnea Diagnosed?

To diagnose obstructive sleep apnea, your doctor will perform a physical exam and take a medical and sleep history. The doctor may also ask people who live with you about your sleeping habits.

You might also be asked to take a sleep test called a polysomnogram, or PSG. Sleep testing is performed in a sleep lab and is supervised by a trained technologist. The test will measure various body functions, including:

  • Air flow
  • Blood oxygen levels
  • Breathing patterns
  • Electrical activity of the brain
  • Eye movements
  • Heart rate
  • Muscle activity

After the study is completed, the technologist will tally the number of times your breathing was impaired during sleep and grade the severity of sleep apnea. In some cases, a multiple sleep latency test is performed on the day after the overnight test. This measures how quickly you fall asleep. In this test, patients are given several opportunities to fall asleep during the course of a day when they normally would be awake.


How Is Obstructive Sleep Apnea Treated?

The treatment for obstructive sleep apnea will depend on the factors causing the obstruction. There are several possible treatments for obstructive sleep apnea. They range from a change in behavior to facial surgery. The aim of treatment is to open the airway and restore normal breathing during sleep and to alleviate the bothersome symptoms, such as daytime fatigue and snoring. Treatment may also help lower blood pressure and decrease risks for stroke, diabetes, and heart disease.

Conservative treatments -- In mild cases of sleep apnea, conservative therapy may be all that is needed. These treatments include the following:

  • Overweight individuals can benefit from losing weight. Even a 10% weight loss can reduce the number of sleep apnea events for most patients.
  • Individuals with sleep apnea should avoid the use of alcohol and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods.
  • In some patients who have mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using pillows and other devices that help them sleep in a side position may be helpful.
  • People with sinus problems or nasal congestion, who are more likely to experience sleep apnea, can try nasal sprays to reduce snoring and improve airflow for more comfortable nighttime breathing.
  • Avoiding sleep deprivation is important for all patients with sleep disorders.

Mechanical therapy -- Continuous positive airway pressure (CPAP) is the preferred initial treatment for people with mild to moderate obstructive sleep apnea. With CPAP, patients wear a mask over their nose and/or mouth. An air blower forces constant and continuous air through the nose and/or mouth. The air pressure is adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep. Other types of positive airway pressure devices are also available, including the BPAP, which has two levels of air flow that vary with breathing in and out.

Mandibular advancement devices -- For patients with mild sleep apnea, dental appliances or oral mandibular advancement devices that prevent the tongue from blocking the throat and/or advance the lower jaw forward can be made. These devices help keep the airway open during sleep. A qualified dental personnel who is trained in oral health, TMJ, and dental occlusion should help determine which type of oral device is best for you.

Surgery -- Surgical procedures may help people with sleep apnea. There are many types of surgical procedures, often performed on an outpatient basis. Surgery is reserved for people who have excessive or malformed tissue that is obstructing airflow through the nose or throat. For example, a person with a deviated nasal septum, markedly enlarged tonsils, or small lower jaw and a large tongue that causes the throat to be abnormally narrow might benefit from surgery. These procedures are typically performed after sleep apnea has failed to respond to conservative measures and a trial of CPAP. Types of surgery include:

  • Upper airway stimulator -- This device, called Inspire, consists of a small pulse generator placed under the skin in the upper chest. A wire leading to the lung detects the person's natural breathing pattern. Another wire, leading up to the neck, delivers mild stimulation to nerves that control airway muscles, keeping them open. A doctor can program the device from an external remote. Also, those who have Inspire use a remote to turn it on before bed and turn off upon waking in the morning.
  • Somnoplasty -- a minimally invasive procedure that uses radiofrequency energy to tighten the soft palate at the back of the throat.
  • UPPP, or UP3, which stands for uvulopalatopharyngoplasty -- a procedure that removes soft tissue in the back of the throat and palate, increasing the width of the airway at the throat opening.
  • Mandibular/maxillary advancement surgery -- surgically moving the jaw bone and face bones forward to make more room in the back of the throat -- an intricate procedure that is reserved for patients with severe sleep apnea and head-face abnormalities.
  • Nasal surgery-- correction of nasal obstructions, such as a deviated septum.

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