睡眠呼吸暂停低通气睡眠监测

睡眠呼吸暂停低通气睡眠监测第1页，课件共27页，创作于2023年2月Introduction“DamnThatBoy”Saidtheoldmen,“He’sgonetosleepagain”.“VeryExtraordinaryboy”,saidMr.Pickwick.Doeshealwayssleepinthisway?第2页，课件共27页，创作于2023年2月Introduction“Sleep”saidtheoldgentleman,“he’salwaysasleep”.“Goesonerrandsfastasleepandsnoresashewaitsattable”In1837CharlesDickens,inoneofhisnovelsdescribessomeofthefeaturesofthediseasethatIamgoingtopresent.第3页，课件共27页，创作于2023年2月IntroductionObstructivesleepapneasyndrome(OSAS)isbyfarthesinglemostcommondisorderseenatsleepcentersandisresponsibleformoremortalityandmorbiditythananyothersleepdisorder.第4页，课件共27页，创作于2023年2月IntroductionAlthoughOSASwasidentifiedmorethan3decadesago,themajorityofphysicianshavehadnoformaltraininginrecognizingortreatingthecondition第5页，课件共27页，创作于2023年2月IntroductionFurthermore,newinformationconcerningthediagnosisandtreatmentofobstructedbreathingduringsleepisemergingfasterthanolderconceptscanbedisseminated.Theresultisthatmostpatientswithtreatablesleep-relatedbreathingdisorderscurrentlyremainundiagnosed第6页，课件共27页，创作于2023年2月DefinitionsOSAisdescribeasrepetitiveepisodesofcompleteorpartialupperairwayobstructionduringsleep.Asaresultaffectedpersonshaveunrestfulsleepandexcessivedaytimesleepiness.第7页，课件共27页，创作于2023年2月DefinitionsOftenpresentsotherfeatures,suchasloudsnoring,morningheadaches,anddrymouthonawakening.Duringobstructiveapnea,respiratoryeffortspersist,butairflowisabsentatthenoseandmouthwhileoncentralapneabothairflowandrespiratoryeffortsareabsent.第8页，课件共27页，创作于2023年2月OTHERDEFINITIONSOF

OBSTRUCTIVESLEEPAPNEAAHI>10(46)AHI>15(12)AHI>5+symptoms(49)AI>2(23)AI>20(25) AHI=Apnea-plus-hypopneaindex;AI=apneaindex第9页，课件共27页，创作于2023年2月EpidemiologyTheprevalenceofOSAintheUnitedStatesis2%to4%inmiddle-agedadultswhichissimilarinmagnitudetotheprevalenceofmajordiseasessuchasAsthmaandDiabetes.第10页，课件共27页，创作于2023年2月Epidemiology第11页，课件共27页，创作于2023年2月EpidemiologyPreliminarystudiessuggestanassociationbetweenuntreatedOSASandanincreasedriskforcardiovasculardiseaseincludingHTNandCAD.第12页，课件共27页，创作于2023年2月EpidemiologyAhistoryofheavysnoringisreportedinmorethan70%ofadultpatientswithOSA.Symptomsrelatedtoapneaaremorefrequentinfamilymembersofaffectedpatientsthaninage,sex,andsocioeconomicallymatchedcontrolfamilies第13页，课件共27页，创作于2023年2月PathophysiologyObstructiveApneasareperiodsofcessationofbreathingdespiteacontinuedefforttobreath,andthisisaresultofnarrowingoftherespiratorypassagewhichmayoccuratoneormoresitesintheupperairway:(oropharynx,velopharynx,orhypopharynx).第14页，课件共27页，创作于2023年2月FIGURE1B.Abnormalairwayduringsleep.Multiplesitesofobstructionoftenoccurinpatientswithobstructivesleepapnea.Anelongatedandenlargedsoftpalateimpingesontheposteriorairwayatthelevelofthenasopharynxandoralpharynx.Inaddition,aretrudingjawpushesanenlargedtongueposteriorlytoimpingeonthehypopharyngealspace.第15页，课件共27页，创作于2023年2月Figure1.Anatomyofobstructivesleepapnoea.

Coronalsectionoftheheadandneckshowingthesegmentoverwhichsleeprelatednarrowingcanoccur(arrows).

第16页，课件共27页，创作于2023年2月PathophysiologyAnatomiccompromisesoftheupperairwayisworseduringsleepandthoseeventsaremoreprominentduringREMsleepbecauseofthehypotoniaandatoniathatinvolvemostskelethalmuscles,includingtherespiratoryaccessoriesmuscles.第17页，课件共27页，创作于2023年2月PathophysiologyItisalsoclearthatairflowobstructioninpatientswithOSASthereisanincreaseinthepharyngealcriticalpressure第18页，课件共27页，创作于2023年2月PathophysiologyCephalometryhasdemonstratedavarietyofcraniofacialandupperairwaysofttissueanatomythatmaypredisposepatientstoobstructionduringsleep,andaffecttheseverityofOSA.第19页，课件共27页，创作于2023年2月FIGURE6.A24-year-oldwomanwithfacialabnormalitiesthatcontributetoobstructivesleepapnea.(Left)Therecedinglowerjawprovidesinadequatesupportforthelowerlip,resultinginlipcurlingandadeepmental-labialfold(curvedarrow).(Right)Shortnessoftheloweronethirdoftheface(arrows)contributestoinadequacyoftheairway.第20页，课件共27页，创作于2023年2月PathophysiologyManypatientswithOSAhavebeenshowntohaveasmallposteriorairwayspace,anenlargedtongueandsoftpalate,aninferiorlyplacedhyoidbone,oracombinationofthese.第21页，课件共27页，创作于2023年2月PathophysiologyFIGURE4.Enlargeduvularestingonthebaseofthetongue(largearrow),alongwithhypertrophiedtonsils(smallarrows).Theposteriorpharyngealerythemamaybesecondarytorepeatedtraumafromsnoringorgastroesophagealreflux第22页，课件共27页，创作于2023年2月PathophysiologyFIGURE5.Elongatedsoftpalate(arrows).Inthispatient,anincreasedanteroposteriordimensioncausedthesoftpalatetorestonthebaseofthetongueintherelaxedposition.第23页，课件共27页，创作于2023年2月PathophysiologyAnimportantcauseofupperairwaynarrowingisthedepositionofadiposetissueinthesofttissuesorroundingthepharynx.DysfunctionoftheupperairwaymusclesisanotherfactorthatcontributetothedevelopmentofOSA.第24页，课件共27页，创作于2023年2月PathophysiologyFIGURE3.Anobeseyoungwomanwiththeshort,thicknecktypicallyseeninpatientswithobstructivesleepapnea.第25页，课件共27页，创作于2023年2月ClinicalManifestationThemostsignificantcomplaintsof