1、阻塞性睡眠呼吸暂停综合征阻塞性睡眠呼吸暂停综合征ObstructiveSleep Apnea Hypopnea SyndromeThe Frist Hospital Attached to Guangzhou Medical UniversityENT DepartmentJia Wang Have you met this sleep condition before.flvDefinition and Classification Sleep Apnea Hypopnea Sleep hypoxemia AHIClassification central sleep apnea syndr
2、ome,CSAS obstructive sleep apnea syndrome,OSAS mixed sleep apnea syndrome,MSASBreathing waveChest movementAbdomen movementObstructive Sleep Apnea Hypopnea Syndrome（OSAHS）Air stops flowing through the nose and mouth,but thoracic and abdominal breathing efforts are uninterrupted.It is the most common
3、type in the clinical.Central Sleep Apnea Syndrome(CSAS)Both oral breathing and thoracic-abdominal breathing efforts are simultaneously interrupted The pure CSAS is few,no more than 10%；Mixed Sleep Apnea Syndrome(MSAS)Usually，a brief period of central apnea is followed by a longer period of obstructi
4、ve apnea Sleep apnea is a condition in which breathing stops for more than 10 seconds during sleep.DefinitionDefinitionEpidemiology of OSAHS In USA,there is more than 4%In Shanghai,there is more than 3.6%,about 50 million patients Among these,Men is four times that of womenRisk Factors Obesity（BMI 2
5、5）75.9%Neck Circumference 63.2%（male41cm，female38cm）Male 78.5%Age（3555）66.4%EtiologyFactors and conditions that promote sonring and apneaWhats the causes.flvexpirationinspirationPathophysiologyOnset of sleep Muscle tone(oral floor,tongue,pharynx,auxiliary respiratory muscles)Pharyngea cross-section
6、Pharyngeal compliance Negative pressure(oropharynx,trachea,thorax)Airway resistance Apnea pO2 pCO2 pH Return to sleepCentral arousalResumption of breathing Bradycardia,arrhythmia Pulmonary vasoconstriction Loss of deep sleep,fragmented sleep Erythropoiesis Systemic vasoconstriction Sudden cardiac de
7、ath Pulmonary hypertension Systemic arterial hypertension Daytime fatigue,drowsiness,intellectual deteriorationPolycythemia?Pathophysiology of OSAHS The upper airway keep opening Fall asleep Compensatory restoration Compensatory reduce Arousal microarousal The tendency for the Thoracic negative uppe
8、r airway to collapse pressure increases Apnea Hypopnea pO2 pCO2 Sleep CyclelNREM(non rapid eye movement sleep)(slow wave sleep):Stage1_Drowsiness Stage2_Light sleep Stage3_Deep sleep Stage4_Slow-wave deep sleeplREM(rapid eye movement sleep)NomalOSAHSSLEEPPATTERNGRAPH Signs in the patients history th
9、at are suggestive of(obstructive)sleep apnea Loud,irregular snoring Periods of apnea during sleep(witnessed)Unusual daytime sleepiness or fatigue Restless sleep Intellectual deterioration(poor concentration and impaired memory)Personality changes Loss of libido,impotence Nycturia,enuresis Symptom Ob
10、esityShort fat neckLarge tonsilsFacial abnormality ExaminationAdenotonsillar hypertrophyGlossoptosisMandibular retrusionThe patients with OSAHS will have a troublesome life.Daytime fatigueDrowsinessDisturbing the bed companion.Traffic AccidentsDiagnosis of OSAHS Clinical diagnosis:PSG Polysomonograp
11、hy,PSG:The golden stander for OSAHS.electroencephalogram,EEG（二导脑电图）、（二导脑电图）、electrooculogram,EOG（二导眼电图（二导眼电图)、include electromyogram，EMG（下颌颏肌电图）、（下颌颏肌电图）、electrocardiogram,ECG（心电图（心电图)、Airflow of the nose and mouse Thoracic and abdominal movement saturation of blood oxygen body position Determining
12、the site of airway obstruction in OSAHS Flexible transnasal endoscopy Airway pressure measurementsOSAHS 睡眠时上气道反复发生坍塌、阻塞引起的睡眠时呼吸暂停和通气不足，伴有打鼾、睡眠结构紊乱，频繁发生血氧饱和度下降、白天嗜睡等症状。睡眠中呼吸暂停/低通气反复发作超过30次以上，或睡眠呼吸暂停/低通气指数（index of apnea/hypopnea,AHI；呼吸暂停/低通气次数 睡眠时间）5（次/小时）。OSAHS的诊断标准的诊断标准index mild moderate severeAHI
13、 515 1530 30SaO2 8590 6585 65lThe Severity Level of OSAHSWhy to treat the OSAHS存活率的统计存活率的统计929293939494959596969797989899991001000 01 12 23 34 45 56 67 78 89 91010年年不嗜睡和不打鼾者不嗜睡和不打鼾者嗜睡的打鼾者嗜睡的打鼾者Survival rateNormal personOSAHSYearsTreatments for OSAHS1.Behaviour Management Body weight reduction Sleep
14、on the side Good sleep hygieneAvoid alcohol and sedative Stop smokingGeneral treatment General treatment measuresmeasures2In patients with severe grades of OSAHS or an unsuccessful trial with surgical tratment.CPAP/BiPAPCPAP/BiPAPThe principleof CPAP T h e u n s t a b l e portions of the airway can
15、be“p n e u m a t i c a l l y splinted”by means o f t r a n s n a s a l continuous positive pressure ventilation;this keeps the tissues f r o m c o l l a p s i n g during sleep and obstructinglSurgical treatment requires very careful patient selection,because many patients will derive little or no benefit from the operation.Surgical Management UvulopalatopharyngoplastySurgical Management UvulopalatopharyngoplastySurgical ManagementTongue Base ProceduresMandibular ProceduresSurgical ManagementMaxillary-Mandibular AdvancementLingual SuspensionThanks for your attention
