睡眠呼吸暫停低通氣綜合征( SAHS) 是一種常見病癥,臨床上以阻塞性睡眠呼吸暫停低通氣綜合征( OSAHS) 最為常見[1] 。1993 年一項基于社區人群的研究中, Young 等[2] 發現年齡介于30 ～60 歲的人群中, 以睡眠呼吸暫停低通氣指數( AHI) ≥5 次/h 定義的OSAHS在女性的患病率為9% ,在男性為24% , 2% 的女性和4% 的男性同時存在嗜睡癥狀。越來越多的證據表明睡眠呼吸暫停可導致許多并發癥, 包括行為和軀體兩方面。行為并發癥包括日間嗜睡、注意力下降和神經心理異常, 而軀體并發癥主要包括心腦血管疾病, 尤其是高血壓[3, 4] 。OSAHS 是全身多個臟器功能損害的獨立危險因素, 其中心血管并發癥是主要死因[5] 。如何評價OSAHS 病情嚴重程度, 對患者的診斷、治療及預后判斷具有非常重要的意義。目前AHI 仍然是診斷OSAHS 的金標準,但其與靶器官損害的相關性存在諸多爭議。
Citation： LIU Ying,WANG Guangfa. Is AHI the Gold Standard for Assessing the Severity of OSAHS?——The Relevance of AHI and the Main Target Organs Damage due to OSAHS. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(5): 417-420. doi: Copy
Copyright ? the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
| 1. | 中華醫學會呼吸病學分會睡眠呼吸疾病學組. 阻塞性睡眠呼吸暫停低通氣綜合征診治指南( 草案) . 中華內科雜志, 2003, 42:594-597. |
| 2. | Young T, Palta M, Dempsey J, et al. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med,1993, 328: 1230-1235. |
| 3. | Krieger J, McNicholas WT, Levy P, et al. Public health and medicolegal implications of sleep apnoea. Eur Respir J, 2002 , 20 :1594-1609. |
| 4. | Palom ki H, Partinen M, Juvela S, et al. Snoring as a risk factor for sleep-related brain infarction. Stroke, 1989, 20: 1311-1315. |
| 5. | Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest, 1988 ,94: 1200-1204. |
| 6. | Guilleminault C. Obstructive sleep apnea. The clinical syndrome and historical perspective.Med Clin North Am, 1985, 69: 1187-1203. |
| 7. | American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep,1999, 22: 662-689. |
| 8. | Hosselet JJ, Ayappa I, Norman RG, et al. Classification of Sleepdisordered Breathing. Am J Respir Crit Care Med, 2001, 163: 398-405. |
| 9. | Ancoli-Israel S, Klauber MR, Kripke DF, et al. Sleep apnea in female patients in a nursing home. Increased risk of mortality.Chest, 1989, 96: 1054-1058. |
| 10. | Bliwise DL, Bliwise NG, Partinen M, et al. Sleep apnea and mortality in an aged cohort. Am J Public Health, 1988, 78: 544-547. |
| 11. | Grant I, Heaton RK, McSweeny AJ, et al. Neuropsychologic findings in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med, 1982, 142: 1470-1476. |
| 12. | Sériès F, Marc I, Cormier Y, et al. Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Intern Med, 1993, 119: 449-453. |
| 13. | Lévy P, Pépin JL, Deschaux-Blanc C, et al. Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest, 1996, 109: 395-399. |
| 14. | Olson LG, Ambrogetti A, Gyulay SG. Prediction of sleep disordered breathing by unattended overnight oximetry. J Sleep Res, 1999, 8 :51-55. |
| 15. | Chiner E, Signes-costa J, Arrieiro JM, et al. Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax, 1999, 54: 968 -971. |
| 16. | Williams AJ, Stein M. Screening for obstructive sleep apnea using pulse oximetry. West JMed, 1992, 157: 175-176. |
| 17. | Kumano-go T, Mikami A, Suganuma N, et al. Three components of obstructive sleep apnea/ hypopnea syndrome. Psychiatry Clin Neurosci, 2003, 57: 197-203. |
| 18. | Sajkov D, Cowie RJ, Thornton AT, et al. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med, 1994, 149: 416-22. |
| 19. | Carlson JT, Hedner JA, Ejnell H, et al. High prevalence of hypertension in sleep apnea patients independent of obesity. Am J Respir Crit Care Med, 1994 , 150: 72 -77 . |
| 20. | 楊琳, 何僅瀛, 羅華, 等. 睡眠呼吸暫停與睡前、醒后血壓變化關系的初步研究. 中國呼吸與危重監護雜志, 2008, 7: 110-115. |
| 21. | 王菡僑, 何僅瀛. 阻塞性睡眠呼吸暫停綜合征與高血壓. 中國呼吸與危重監護雜志, 2008, 7: 313-317. |
| 22. | 孫凱, 韓瑞娟, 趙瑞平. 阻塞性睡眠呼吸暫停低通氣綜合征對心血管系統的影響. 中國呼吸與危重監護雜志, 2008, 7: 398-400. |
| 23. | Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study. JAMA, 2000, 283: 1829-1836. |
| 24. | Lavie P, Yoffe N, Berger I, et al. The relationship between the severity of sleep apnea syndrome and 24-h blood pressure values in patients with obstructive sleep apnea. Chest, 1993, 103: 717-721. |
| 25. | Berman EJ, DiBenedetto RJ, Causey DE, et al. Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. Chest, 1991, 100: 347-350. |
| 26. | Chami HA, Devereux RB, Gottdiener JS, et al. Left ventricular morphology and systolic function in sleep-disordered bBreathing. The sleep heart health study.Circulation, 2008, 117: 2567-2569. |
| 27. | Alonso-Fernández A, García-Río F, Racionero MA, et al. Cardiac rhythm disturbances and ST-segment depression episodes in patients with obstructive seep apnea-hypopnea syndrome and its mechanisms. Chest, 2005, 127: 15-22. |
| 28. | Narkiewicz K, Montano N, Cogliati C, et al. Altered cardiovascular variability in obstructive sleep apnea. Circulation, 1998, 98: 1071 -1077. |
| 29. | Bonsignore MR, Parati G, Insalaco G, et al. Continuous positive airway pressure treatment improves baroreflex control of heart rRate during sleep in severe obstructive sleep apnea syndrome. Am J Respir Crit Care Med, 2002, 166: 279-286. |
| 30. | Fischer AQ, Chaudhary BA, Taormina MA, et al. Intracranial hemodynamics in sleep apnea. Chest, 1992, 102: 1402-1406. |
| 31. | Palomaki H. Snoring and the risk of ischemic brain infarction. Stroke. , 1991, 22: 1021-1025. |
| 32. | Rola R, Jarosz H, Wierzbicka A, et al. Sleep disordered breathing and recurrence of cerebrovascular events, case-fatality, and functional outcome in patients with ischemic stroke or transient ischemic attack. J Physiol Pharmacol, 2008, 59 Suppl 6: 615-621. |
| 33. | 王廣發, 何冰, 遲春花, 等. 阻塞性睡眠呼吸暫停綜合征的睡眠結構改變. 中華結核和呼吸雜志, 1998, 21: 477-479. |
| 34. | Siddiqui F, Walters AS, Goldstein D, et al. Half of patients with obstructive sleep apnea have a higher NREM AHI than REM AHI.Sleep Med, 2006, 7: 281-285. |
| 35. | Muraki M, Kitaguchi S, Ichihashi H, et al. Apnoea-hypopnoea index during rapid eye movement and non-rapid eye movement sleep in obstructive sleep apnoea. J Int Med Res, 2008, 36: 906 -913. |
| 36. | Smurra MV, Dury M, Aubert G, et al. Sleep fragmentation:comparison of two definitions of short arousals during sleep in OSAS patients. Eur Respir J, 2001, 17: 723-727. |
| 37. | Jordan AS, McEvoy RD, Edwards JK, et al. The influence of gender and upper airway resistance on the ventilatory response to arousal in obstructive sleep apnoea in humans. J Physiol, 2004, 558: 993 -1004. |
| 38. | Watanabe T, Kumano-Go T, Suganuma N, et al. The relationship between esophageal pressure and apnea hypopnea index in obstructive sleep apnea-hypopnea syndrome. Sleep Res Online,2000, 3: 169-172. |
| 39. | Sforza E, Addati G, Cirignotta F, et al. Natural evolution of sleep apnoea syndrome: a five year longitudinal study. Eur Respir J, 1994 ,7: 1765-1770. |
| 40. | Kass JE, Akers SM, Bartter TC, et al. Rapid-eye-movement-specific sleep-disordered breathing: a possible cause of excessive daytime sleepiness. Am J Respir Crit Care Med, 1996, 154: 167-169. |
| 41. | Young T, Blustein J, Finn L, et al. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep, 1997, 20: 608-613. |
| 42. | Cheshire K, Engleman H, Deary I, et al. Factors impairing daytime performance in patients with sleep apnea /hypopnea syndrome. Arch Intern Med, 1992, 152: 538-541. |
| 43. | Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 1991, 14: 540-545. |
| 44. | Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest, 1993, 103: 30-36. |
| 45. | Kripke DF, Ancoli-Israel S, Klauber MR, et al. Prevalence of sleepdisordered breathing in ages 40-64 years : A population-based survey. Sleep, 1997, 20: 65-76. |
| 46. | Weaver EM, Kapur V, Yueh B. Polysomnography vs Self-reported Measures in Patients With Sleep Apnea. Arch Otolaryngol Head Neck Surg, 2004, 130: 453-458. |
| 47. | Bixler EO, Vgontzas AN, Ten Have T, et al. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med, 1998, 157: 144-148. |
| 48. | 王立曼, 周光耀, 李春華, 等. 阻塞性睡眠呼吸暫停低通氣綜合征危險因素探討. 華西醫學, 2009, 24: 46-49. |
- 1. 中華醫學會呼吸病學分會睡眠呼吸疾病學組. 阻塞性睡眠呼吸暫停低通氣綜合征診治指南( 草案) . 中華內科雜志, 2003, 42:594-597.
- 2. Young T, Palta M, Dempsey J, et al. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med,1993, 328: 1230-1235.
- 3. Krieger J, McNicholas WT, Levy P, et al. Public health and medicolegal implications of sleep apnoea. Eur Respir J, 2002 , 20 :1594-1609.
- 4. Palom ki H, Partinen M, Juvela S, et al. Snoring as a risk factor for sleep-related brain infarction. Stroke, 1989, 20: 1311-1315.
- 5. Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest, 1988 ,94: 1200-1204.
- 6. Guilleminault C. Obstructive sleep apnea. The clinical syndrome and historical perspective.Med Clin North Am, 1985, 69: 1187-1203.
- 7. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep,1999, 22: 662-689.
- 8. Hosselet JJ, Ayappa I, Norman RG, et al. Classification of Sleepdisordered Breathing. Am J Respir Crit Care Med, 2001, 163: 398-405.
- 9. Ancoli-Israel S, Klauber MR, Kripke DF, et al. Sleep apnea in female patients in a nursing home. Increased risk of mortality.Chest, 1989, 96: 1054-1058.
- 10. Bliwise DL, Bliwise NG, Partinen M, et al. Sleep apnea and mortality in an aged cohort. Am J Public Health, 1988, 78: 544-547.
- 11. Grant I, Heaton RK, McSweeny AJ, et al. Neuropsychologic findings in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med, 1982, 142: 1470-1476.
- 12. Sériès F, Marc I, Cormier Y, et al. Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Intern Med, 1993, 119: 449-453.
- 13. Lévy P, Pépin JL, Deschaux-Blanc C, et al. Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest, 1996, 109: 395-399.
- 14. Olson LG, Ambrogetti A, Gyulay SG. Prediction of sleep disordered breathing by unattended overnight oximetry. J Sleep Res, 1999, 8 :51-55.
- 15. Chiner E, Signes-costa J, Arrieiro JM, et al. Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax, 1999, 54: 968 -971.
- 16. Williams AJ, Stein M. Screening for obstructive sleep apnea using pulse oximetry. West JMed, 1992, 157: 175-176.
- 17. Kumano-go T, Mikami A, Suganuma N, et al. Three components of obstructive sleep apnea/ hypopnea syndrome. Psychiatry Clin Neurosci, 2003, 57: 197-203.
- 18. Sajkov D, Cowie RJ, Thornton AT, et al. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med, 1994, 149: 416-22.
- 19. Carlson JT, Hedner JA, Ejnell H, et al. High prevalence of hypertension in sleep apnea patients independent of obesity. Am J Respir Crit Care Med, 1994 , 150: 72 -77 .
- 20. 楊琳, 何僅瀛, 羅華, 等. 睡眠呼吸暫停與睡前、醒后血壓變化關系的初步研究. 中國呼吸與危重監護雜志, 2008, 7: 110-115.
- 21. 王菡僑, 何僅瀛. 阻塞性睡眠呼吸暫停綜合征與高血壓. 中國呼吸與危重監護雜志, 2008, 7: 313-317.
- 22. 孫凱, 韓瑞娟, 趙瑞平. 阻塞性睡眠呼吸暫停低通氣綜合征對心血管系統的影響. 中國呼吸與危重監護雜志, 2008, 7: 398-400.
- 23. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study. JAMA, 2000, 283: 1829-1836.
- 24. Lavie P, Yoffe N, Berger I, et al. The relationship between the severity of sleep apnea syndrome and 24-h blood pressure values in patients with obstructive sleep apnea. Chest, 1993, 103: 717-721.
- 25. Berman EJ, DiBenedetto RJ, Causey DE, et al. Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. Chest, 1991, 100: 347-350.
- 26. Chami HA, Devereux RB, Gottdiener JS, et al. Left ventricular morphology and systolic function in sleep-disordered bBreathing. The sleep heart health study.Circulation, 2008, 117: 2567-2569.
- 27. Alonso-Fernández A, García-Río F, Racionero MA, et al. Cardiac rhythm disturbances and ST-segment depression episodes in patients with obstructive seep apnea-hypopnea syndrome and its mechanisms. Chest, 2005, 127: 15-22.
- 28. Narkiewicz K, Montano N, Cogliati C, et al. Altered cardiovascular variability in obstructive sleep apnea. Circulation, 1998, 98: 1071 -1077.
- 29. Bonsignore MR, Parati G, Insalaco G, et al. Continuous positive airway pressure treatment improves baroreflex control of heart rRate during sleep in severe obstructive sleep apnea syndrome. Am J Respir Crit Care Med, 2002, 166: 279-286.
- 30. Fischer AQ, Chaudhary BA, Taormina MA, et al. Intracranial hemodynamics in sleep apnea. Chest, 1992, 102: 1402-1406.
- 31. Palomaki H. Snoring and the risk of ischemic brain infarction. Stroke. , 1991, 22: 1021-1025.
- 32. Rola R, Jarosz H, Wierzbicka A, et al. Sleep disordered breathing and recurrence of cerebrovascular events, case-fatality, and functional outcome in patients with ischemic stroke or transient ischemic attack. J Physiol Pharmacol, 2008, 59 Suppl 6: 615-621.
- 33. 王廣發, 何冰, 遲春花, 等. 阻塞性睡眠呼吸暫停綜合征的睡眠結構改變. 中華結核和呼吸雜志, 1998, 21: 477-479.
- 34. Siddiqui F, Walters AS, Goldstein D, et al. Half of patients with obstructive sleep apnea have a higher NREM AHI than REM AHI.Sleep Med, 2006, 7: 281-285.
- 35. Muraki M, Kitaguchi S, Ichihashi H, et al. Apnoea-hypopnoea index during rapid eye movement and non-rapid eye movement sleep in obstructive sleep apnoea. J Int Med Res, 2008, 36: 906 -913.
- 36. Smurra MV, Dury M, Aubert G, et al. Sleep fragmentation:comparison of two definitions of short arousals during sleep in OSAS patients. Eur Respir J, 2001, 17: 723-727.
- 37. Jordan AS, McEvoy RD, Edwards JK, et al. The influence of gender and upper airway resistance on the ventilatory response to arousal in obstructive sleep apnoea in humans. J Physiol, 2004, 558: 993 -1004.
- 38. Watanabe T, Kumano-Go T, Suganuma N, et al. The relationship between esophageal pressure and apnea hypopnea index in obstructive sleep apnea-hypopnea syndrome. Sleep Res Online,2000, 3: 169-172.
- 39. Sforza E, Addati G, Cirignotta F, et al. Natural evolution of sleep apnoea syndrome: a five year longitudinal study. Eur Respir J, 1994 ,7: 1765-1770.
- 40. Kass JE, Akers SM, Bartter TC, et al. Rapid-eye-movement-specific sleep-disordered breathing: a possible cause of excessive daytime sleepiness. Am J Respir Crit Care Med, 1996, 154: 167-169.
- 41. Young T, Blustein J, Finn L, et al. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep, 1997, 20: 608-613.
- 42. Cheshire K, Engleman H, Deary I, et al. Factors impairing daytime performance in patients with sleep apnea /hypopnea syndrome. Arch Intern Med, 1992, 152: 538-541.
- 43. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 1991, 14: 540-545.
- 44. Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest, 1993, 103: 30-36.
- 45. Kripke DF, Ancoli-Israel S, Klauber MR, et al. Prevalence of sleepdisordered breathing in ages 40-64 years : A population-based survey. Sleep, 1997, 20: 65-76.
- 46. Weaver EM, Kapur V, Yueh B. Polysomnography vs Self-reported Measures in Patients With Sleep Apnea. Arch Otolaryngol Head Neck Surg, 2004, 130: 453-458.
- 47. Bixler EO, Vgontzas AN, Ten Have T, et al. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med, 1998, 157: 144-148.
- 48. 王立曼, 周光耀, 李春華, 等. 阻塞性睡眠呼吸暫停低通氣綜合征危險因素探討. 華西醫學, 2009, 24: 46-49.