osahsppt课件.ppt

阻塞性睡眠呼吸暂停综合征阻塞性睡眠呼吸暂停综合征ObstructiveSleepApneaHypopneaSyndromeThe Frist Hospital Attached to Guangzhou Medical UniversityENT DepartmentJia WangHave you met this sleep condition before.flvDefinition and ClassificationSleep ApneaHypopneaSleep hypoxemiaAHIClassification central sleep apnea syndrome,CSASobstructive sleep apnea syndrome,OSASmixed sleep apnea syndrome,MSASBreathingwaveChestmovementAbdomenmovementObstructiveSleepApneaHypopneaSyndrome（OSAHS）Air stops flowing through the nose and mouth,but thoracic and abdominal breathing efforts are uninterrupted.It is the most common type in the clinical.CentralSleepApneaSyndrome(CSAS)Bothoralbreathingandthoracic-abdominalbreathingeffortsaresimultaneouslyinterrupted ThepureCSASisfew,nomorethan10%；MixedSleepApneaSyndrome(MSAS)Usually，abriefperiodofcentralapneaisfollowedbyalongerperiodofobstructiveapnea Sleep apnea is a condition in which breathing stops for more than 10 seconds during sleep.Definition Hypopnea Hypopnea is a condition in which a 50%is a condition in which a 50%reduction in thoracic-abdominal movement reduction in thoracic-abdominal movement lasting for 10 s,associated with decreases lasting for 10 s,associated with decreases SaO2SaO2 3%.3%.Sleep hypoxemiaSleep hypoxemia is a condition in which is a condition in which causing periods of apnea or hypopnea,the causing periods of apnea or hypopnea,the blood oxygen levels will less than 90%.blood oxygen levels will less than 90%.AHI AHI is an index used to assess the severity of is an index used to assess the severity of sleep apnea based on the total number of sleep apnea based on the total number of complete cessations(apnea)and partial complete cessations(apnea)and partial obstructions(hypopnea)of breathing occurring obstructions(hypopnea)of breathing occurring per hour of sleep.per hour of sleep.AHI=apnea/h+hypopnea/hAHI=apnea/h+hypopnea/hAHIAHI 5 5。What is OSAHS?What is OSAHS?Sleep apnea/hypopnea occurs 30 or more times during Sleep apnea/hypopnea occurs 30 or more times during a 7-hour period of nocturnal sleep,or the AHI=5.a 7-hour period of nocturnal sleep,or the AHI=5.DefinitionEpidemiologyofOSAHSInUSA,thereismorethan 4%InShanghai,thereismorethan3.6%,about50 million patients50 million patientsAmongthese,Men is four times that of Men is four times that of womenwomenRiskFactorsObesity（BMI25）75.9%NeckCircumference63.2%（male41cm，female38cm）Male78.5%Age（3555）66.4%EtiologyFactorsandconditionsthatpromotesonringandapneaWhats the causes.flvNormalBreathingNormalBreathingObstructedBreathingObstructedBreathingexpirationinspirationPathophysiologyOnsetofsleep Muscletone(oralfloor,tongue,pharynx,auxiliaryrespiratorymuscles)Pharyngeacross-sectionPharyngealcomplianceNegativepressure(oropharynx,trachea,thorax)Airwayresistance Apnea pO2 pCO2pHReturntosleepCentralarousalResumptionofbreathing Bradycardia,arrhythmia Pulmonaryvasoconstriction Lossofdeepsleep,fragmentedsleep ErythropoiesisSystemicvasoconstriction Suddencardiacdeath Pulmonaryhypertension Systemicarterialhypertension Daytimefatigue,drowsiness,intellectualdeteriorationPolycythemia?Pathophysiology of OSAHSTheupperairwaykeepopening Fallasleep Compensatory restorationCompensatory restoration Compensatory reduce Arousal Compensatory reduce Arousal microarousal ThetendencyfortheThoracic negative Thoracic negative upperairwaytocollapsepressure increasespressure increases ApneaHypopneapO2 pCO2 SleepCyclelNREM(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)NomalOSAHSSLEEPPATTERNGRAPHSignsinthepatientshistorythataresuggestiveof(obstructive)sleepapnea 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 SymptomObesityShortfatneckLargetonsilsFacialabnormalityExaminationAdenotonsillarhypertrophyGlossoptosisMandibularretrusionThe patients with OSAHS will have a troublesome life.DaytimefatigueDrowsinessThe patients with OSAHS will have a troublesome life.Disturbingthebedcompanion.The patients with OSAHS will have a troublesome life.TrafficAccidentsDiagnosisofOSAHSClinicaldiagnosis:l l LoudSnoringLoudSnoring95.8%95.8%ExcessiveExcessiveDaytimeSleepinessDaytimeSleepiness86.7%86.7%RestlessandUnrefreshingsleep40.2%RestlessandUnrefreshingsleep40.2%MorningheadacheMorningheadache31.4%31.4%ChokingatnightChokingatnight21.5%21.5%ReducedlibidoReducedlibido26.3%26.3%PSGPolysomonography,PSG:ThegoldenstanderforOSAHS.electroencephalogram,EEG（二导脑电图）、（二导脑电图）、electrooculogram,EOG （二导眼电图（二导眼电图)、includeelectromyogram，EMG（下颌颏肌电图）、（下颌颏肌电图）、electrocardiogram,ECG （心电图（心电图)、Airflowofthenoseandmouse Thoracic and abdominal movementsaturationofbloodoxygenbodypositionDeterminingthesiteofairwayobstructioninOSAHSFlexibletransnasalendoscopyAirwaypressuremeasurementsOSAHS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indexmildmoderatesevereAHI515153030SaO28590658565lTheSeverityLevelofOSAHSWhytotreattheOSAHSSurvival rateNormal personOSAHSYearsTreatmentsforOSAHS1.BehaviourManagementBodyweightreductionSleeponthesideGoodsleephygieneAvoidalcoholandsedativeStopsmokingGeneral treatment General treatment measuresmeasures2InpatientswithseveregradesofOSAHSoranunsuccessfultrialwithsurgicaltratment.CPAP/BiPAPCPAP/BiPAPTheprincipleofCPAPTheunstableportionsoftheairwaycanbe“pneumaticallysplinted”by means oftransnasalcontinuouspositivepressureventilation;this keepsthetissuesfromcollapsing during sleepandobstructingOralAppliancesSurgicalTratmentlSurgicaltreatmentrequiresverycarefulpatientselection,because many patients will derive little or no benefitfromtheoperation.Surgical ManagementUvulopalatopharyngoplastySurgical ManagementUvulopalatopharyngoplastySurgical ManagementTongue Base ProceduresMandibular ProceduresSurgical ManagementMaxillary-Mandibular AdvancementLingual SuspensionThanks for your attention