1、睡眠呼吸暫停低通氣睡眠監測睡眠呼吸暫停低通氣睡眠監測Introduction“Damn That Boy” Said the old men, “Hes gone to sleep again”.“Very Extraordinary boy”, said Mr. Pickwick. Does he always sleep in this way?Introduction“Damn That Boy” SaIntroduction“Sleep” said the old gentleman, “hes always asleep”. “Goes on errands fast asleep

2、and snores as he waits at table”In 1837 Charles Dickens, in one of his novels describes some of the features of the disease that I am going to present. Introduction“Sleep” said the oIntroductionObstructive sleep apnea syndrome(OSAS) is by far the single most common disorder seen at sleep centers and

3、 is responsible for more mortality and morbidity than any other sleep disorder.IntroductionObstructive sleep IntroductionAlthough OSAS was identified more than 3 decades ago, the majority of physicians have had no formal training in recognizing or treating the conditionIntroductionAlthough OSAS was

4、IntroductionFurthermore, new information concerning the diagnosis and treatment of obstructed breathing during sleep is emerging faster than older concepts can be disseminated. The result is that most patients with treatable sleep-related breathing disorders currently remain undiagnosedIntroductionF

5、urthermore, new iDefinitionsOSA is describe as repetitive episodes of complete or partial upper airway obstruction during sleep. As a result affected persons have unrestful sleep and excessive daytime sleepiness.DefinitionsOSA is describe as DefinitionsOften presents other features, such as loud sno

6、ring, morning headaches, and dry mouth on awakening.During obstructive apnea, respiratory efforts persist, but airflow is absent at the nose and mouth while on central apnea both airflow and respiratory efforts are absent. DefinitionsOften presents otheOTHER DEFINITIONS OF OBSTRUCTIVE SLEEP APNEAAHI

7、 10 (46)AHI 15 (12)AHI 5 + symptoms (49)AI 2 (23)AI 20 (25)AHI = Apnea-plus-hypopnea index; AI= apnea indexOTHER DEFINITIONS OF OBSTRUCTEpidemiologyThe prevalence of OSA in the United States is 2% to 4% in middle-aged adults which is similar in magnitude to the prevalence of major diseases such as A

8、sthma and Diabetes.EpidemiologyThe prevalence of EpidemiologyEpidemiologyPathophysiologyEpidemiologyOSA is describe as repetitive episodes of complete or partial upper airway obstruction during sleep.Pathophysiology-SleepinessAnatomic compromises of the upper airway is worse during sleep and those e

9、vents are more prominent during REM sleep because of the hypotonia and atonia that involve most skelethal muscles, including the respiratory accessories muscles.Pathophysiology-SleepinessCephalometry has demonstrated a variety of craniofacial and upper airway soft tissue anatomy that may predispose

10、patients to obstruction during sleep, and affect the severity of OSA.the relaxed position.-SleepinessDoes he always sleep in this way?The most significant complaints of patients with OSA are:DefinitionsIn 1837 Charles Dickens, in one of his novels describes some of the features of the disease that I

11、 am going to present.OTHER DEFINITIONS OF OBSTRUCTIVE SLEEP APNEAEpidemiologyEpidemiologyPreliminary studies suggest an association between untreated OSAS and an increased risk for cardiovascular disease including HTN and CAD.PathophysiologyEpidemiologyPreEpidemiologyA history of heavy snoring is re

12、ported in more than 70% of adult patients with OSA.Symptoms related to apnea are more frequent in family members of affected patients than in age, sex, and socioeconomically matched control familiesEpidemiologyA history of heavyPathophysiologyObstructive Apneas are periods of cessation of breathing

13、despite a continued effort to breath, and this is a result of narrowing of the respiratory passage which may occur at one or more sites in the upper airway: (oropharynx, velopharynx, or hypopharynx).PathophysiologyObstructive ApnFIGURE 1B. Abnormal airway during sleep. Multiple sites of obstruction

14、often occur in patients with obstructive sleep apnea. An elongated and enlarged soft palate impinges on the posterior airway at the level of the nasopharynx and oral pharynx. In addition, a retruding jaw pushes an enlarged tongue posteriorly to impinge on the hypopharyngeal space.FIGURE 1B. Abnormal

15、 airway dur-SleepinessIntroductionAlthough OSAS was identified more than 3 decades ago, the majority of physicians have had no formal training in recognizing or treating the conditionAlthough OSAS was identified more than 3 decades ago, the majority of physicians have had no formal training in recog

16、nizing or treating the conditionPreliminary studies suggest an association between untreated OSAS and an increased risk for cardiovascular disease including HTN and CAD.EpidemiologyThe prevalence of OSA in the United States is 2% to 4% in middle-aged adults which is similar in magnitude to the preva

17、lence of major diseases such as Asthma and Diabetes.Anatomy of obstructive sleep apnoea.AHI 15 (12)Anatomic compromises of the upper airway is worse during sleep and those events are more prominent during REM sleep because of the hypotonia and atonia that involve most skelethal muscles, including th

18、e respiratory accessories muscles.-SleepinessPathophysiologyFigure 1. Anatomy of obstructive sleep apnoea. Coronal section of the head and neck showing the segment over which sleep related narrowing can occur (arrows). -SleepinessFigure 1. Anatomy oPathophysiologyAnatomic compromises of the upper ai

19、rway is worse during sleep and those events are more prominent during REM sleep because of the hypotonia and atonia that involve most skelethal muscles, including the respiratory accessories muscles.PathophysiologyAnatomic comproPathophysiologyIt is also clear that airflow obstruction in patients wi

20、th OSAS there is an increase in the pharyngeal critical pressurePathophysiologyIt is also cleaPathophysiologyCephalometry has demonstrated a variety of craniofacial and upper airway soft tissue anatomy that may predispose patients to obstruction during sleep, and affect the severity of OSA.Pathophys

21、iologyCephalometry haFIGURE 6. A 24-year-old woman with facial abnormalities that contribute to obstructive sleep apnea. (Left) The receding lower jaw provides inadequate support for the lower lip, resulting in lip curling and a deep mental-labial fold (curved arrow). (Right) Shortness of the lower

22、one third of the face (arrows) contributes to inadequacy of the airway.睡眠呼吸暫停低通氣睡眠監測課件PathophysiologyMany patients with OSA have been shown to have a small posterior airway space , an enlarged tongue and soft palate ,an inferiorly placed hyoid bone, or a combination of these.PathophysiologyMany pati

23、ents wPathophysiologyFIGURE 4. Enlarged uvula resting on the base of the tongue (large arrow), along with hypertrophied tonsils (small arrows). The posterior pharyngeal erythema may be secondary to repeated trauma from snoring or gastroesophageal refluxPathophysiologyPathophysiologyFIGURE 5. Elongated soft palate (arrows). In this patient, an increased anteroposterior dimension caused the soft palate to rest on the base of the tongue in the relaxed position.PathophysiologyFIGURE 5. ElongPathophysiology