Innovative treatments for adults with obstructive sleep apnea.
Innovative treatments for adults with obstructive sleep apnea.
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DOI：
10.2147/nss.s46818
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发表时间：
2014
影响因子：
3.4
通讯作者：
Carley DW
中科院分区：
文献类型：
--
作者：
Weaver TE;Calik MW;Farabi SS;Fink AM;Galang-Boquiren MT;Kapella MC;Prasad B;Carley DW
阻塞性睡眠呼吸暂停(OSA)影响五分之一的成年男性，并与严重的共病、认知障碍、白天过度嗜睡和生活质量下降有关。25年来，主要的治疗方法是持续正压，它引入了一根空气柱，作为上呼吸道的气动夹板，防止了这种综合征的生理学定义--呼吸道塌陷。然而，患者耐受性和不可接受的治疗依从性的问题促使了对其他潜在治疗方法的探索。随着对阻塞性睡眠呼吸暂停相关生理机制的进一步了解，在过去的5年中出现了新的干预措施。本文的目的是描述治疗阻塞性睡眠呼吸暂停及相关的复杂睡眠呼吸暂停的新方法。治疗复杂睡眠呼吸暂停的新方法包括自适应伺服呼吸机。有越来越多的文献表明，行为干预对改善持续气道正压治疗的依从性的作用已被证明相当有效。新的非手术治疗包括口腔加压装置、改进的下颌推进装置、鼻呼气正压和更新的体位治疗方法。最近在外科干预方面的创新包括激光辅助悬雍垂腭成形术、射频消融、腭部植入物和电刺激上呼吸道肌肉。目前还没有药物被批准用于治疗OSA，但潜在的药物疗法主要集中在增加呼吸机动力、改变觉醒阈值、改变环路增益(量化呼吸控制系统稳定性的无量纲值)，或者通过影响表面张力来防止呼吸道塌陷。一种新兴的方法是应用大麻类药物来增加上呼吸道张力。
Obstructive sleep apnea (OSA) affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical stimulation of the upper airway muscles. No drugs have been approved to treat OSA, but potential drug therapies have centered on increasing ventilatory drive, altering the arousal threshold, modifying loop gain (a dimensionless value quantifying the stability of the ventilatory control system), or preventing airway collapse by affecting the surface tension. An emerging approach is the application of cannabinoids to increase upper airway tone.