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成人阻塞性睡眠呼吸暂停的临床表现和诊断

Author
Lewis R Kline, MD
Section Editor
Nancy Collop, MD
Deputy Editor
Geraldine Finlay, MD
Translators
周海霞, 主治医师

引言

阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)是一种因睡眠过程中上气道反复塌陷引起的、以阻塞性呼吸暂停和低通气为特征的疾病。对于存在诸如白天睡眠过多、打鼾和睡眠中窒息或倒吸气(gasping)等症状的患者，特别是同时存在诸如肥胖、男性和高龄等危险因素时，应考虑该诊断。因为历来需要进行昂贵和费时的检查来识别OSA，所以筛选出OSA可能性最大的患者以行进一步诊断性评估对医生来说是个挑战。

本文将总结OSA的临床表现、临床特征、诊断方法和鉴别诊断，而OSA的流行病学、危险因素、发病机制、自然病程和处理将单独介绍。 (参见“成人阻塞性睡眠呼吸暂停概述”和“成人阻塞性睡眠呼吸暂停的治疗”)

临床特征

临床表现 — 大多数OSA患者首次就医是因为其诉日间嗜睡，或同床伴侣诉其在睡眠中大声打鼾、倒吸气、哼鼻或呼吸中断等现象。这些症状可能是患者就诊的主诉，也可能是患者因其他主诉就诊医生评估时发现的，或是在保健筛查中发现的，又或是在术前筛查中报告的。不管是如何发现这类主诉的，对于所有诉日间嗜睡或睡眠中打鼾、倒吸气、哼鼻或呼吸中断的患者，都应询问和检查有无OSA的其他特征。这一信息对于决定哪些患者需要诊断性检查非常重要。

体征和症状 — 日间嗜睡(不同于疲乏)是OSA的常见特征。嗜睡是指无法在睡眠-觉醒周期的觉醒部分保持完全觉醒或警觉状态，而疲乏是患者本人或其照料者主观感知到患者体力或精力匮乏而干扰到日常活动和期望的活动[1]。通常不明确患者所诉的“日间嗜睡”是代表真正的嗜睡还是疲乏。此时可通过一系列针对性提问结合Epworth嗜睡评分来量化评估患者的嗜睡和/或疲乏感(表 1和表 2) [2,3]。 (参见“白天睡眠过多患者的概述”，关于‘病史’一节)

因为日间嗜睡起病隐匿且呈慢性化，故可能被忽视或其临床意义可能被低估。患者可能不会将症状描述为“嗜睡”，而是使用其他词汇，如“疲乏”、“疲倦”和“精神不振”[4]。通过仔细询问患者常可发现其在无聊、被动或单调的环境中容易昏昏欲睡或陷入睡眠。例如，患者可能承认总会在阅读、看电视甚至开车时睡着。此外，患者还可能诉尴尬的或不合时宜的睡着经历(如在宗教仪式上或开车时)。需回顾患者在工作场所之外的行为，因为工作活动可能会掩盖日间嗜睡。还应询问患者有无可能掩盖嗜睡的行为，如摄入咖啡因。

              

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-27.
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