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Obstructive sleep apnea (obstructive type) (폐쇄수면무호흡)

The Root of Ambulatory Care (외래 진료 지침서) 전체 목록 보기
KEYWORDS: ..The respiratory disturbance variation i. Apnea : the cessation of airflow at the nose and mouth for 10 seconds or longer ii. Hypopnea : a reduction in airflow at the nose and mouth Fig 1. Abnormal airway during sleep. Multiple sites of obstruction often occur in patients with obstructive sleep apnea. An elongated and enlarged soft palate impinges on the posterior airway at the level of the nasopharynx and oral pharynx. In additon, a retruding jaw pushes an enlarged tongue posteriorly to impinge on the hypopharyngeal space. 1. Snoring 2. Excessive daytime sleepiness Noctural i. Snoring ii. Abnormal motor activity : flail out, throw and may sit up or get out of bed. iii. Nocturia (even enuresis) Obstructive sleep apnea (obstructive type) Key symptoms Small or retruding jaw Tongue Epiglottis Soft palate Uvula iv. GERD symptoms : negative intrapleural pressures developed during obstructed breaths Diurnal i. Excessive daytime sleepiness ii. Cognitive impairement : correlates best with noctural hypoxemia iii. Morning headache, nausea : resulting from nocturnal hypercapnia ▶ Many patients are not aware of their heavy snoring and nocturnal arousals, therefore it is helpful to question the bedroom partner of a patient with chronic sleepiness and fatigue. ..여성인 경우 snoring, excessive daytime sleepiness를 호소하는 남성에 비해 morning headache, depression, fatigue를 더 호소하는 경향이 있다. ▶ The snoring and apneic episodes may be worse after the patient drinks alcohol or takes sleeping pills, because these sedatives decrease pharyngeal muscle tone and can exacerbate obstructive sleep apnea. 1. Polysomnography : 총 검사 시간은 6시간으로 만일 최소 검사 시간인 2시간 검사결과 가 OSA진단기준에 부합된다면, 통상적으로 CPAP titration-a split night study를 시행하 게 된다. ▶ 6시간의 야간 수면 중에 1시간 동안 5회 이상의 폐쇄성 무호흡이나 저호흡이 발생하면 진단한다. A suggested self-administered screening questionnaire may be helpful at primary care office. 363 The Root of ambulatory care Key tests Obstructive sleep apnea (obstructive type) If you snore excessively and have any of the additional problems listed below, you may have sleep apnea. Please consider discussing a sleep evaluation with your doctor. 1. Do you snore loudly? Yes/No 2. Does your bedroom partner complain about your snoring? Yes/No 3. Does your snoring wake you up at night? Yes/No 4. Do you or your bedroom partner notice that you make gasping and choking noises during sleep? Yes/No 5. Do you have a dry mouth, sore throat or headache in the morning? Yes/No 6. Do you often fall asleep during the daytime when you want to stay awake? Yes/No 7. Are you often tired during the day? Yes/No 8. Do you have high blood pressure? Yes/No Fig 2. A suggested self-administered questionnaire for use in the diagnosis of obstructive sleep apnea. Fig 3. Prevalence of obstructive sleep apnea (OSA) in patients with cardiovascular and cerebrovascular disease. ..Depression, mood changes, poor memory, irritability, impaired concentration, nocturnal panic attacks also associated with sleep apnea. OSA 50% Hypertension 25% Congestive Cardiac Failure 30% Acute Coronary Syndromes 60% Stroke 365 The Root of ambulatory care 1. Abstaining from the use of alcohol and sedatives 2. Avoiding the supine position 3. Weight loss : A modest (10~20%) weight loss has also been shown to reduce the Respiratory Disturbance Index (RDI) by as much as 50% in some individuals. 4. CPAP (Continuous positive airway pressure) : In general, heavier patients with thicker necks require higher pressure settings. 5. Surgery (Uvulopalatopharyngoplasty, Laser-assisted uvulopalatoplasty) : often effective in elimination snoring but not necessarily curative for obstructive sleep apnea, because areas of the airway other than the soft palate also collapse in most patients with this sleep disorder. 6. Tongue-retaining devices/bite guards CPAP complications i. Sneezing and rhinorrhea : reduced by steroid nasal sprays ii. Dry mucus membranes : reduced by humidification iii. Dermal irritation : reduced by changing the mask size or trying a different kind of mask ..현재까지 밝혀진 효과적인 약물요법은 없다. Key treatments 참고 문헌 Lyle D. Victor, M.D., M.B.A. : Treatment of Obstructive Sleep Apnea in Primary Care.A journal of the American Family Physicains 2004 ; 69(3) : 561-568, 572-574 Lee K. Brown : Sleep Apnea, in Saunders Manual of Medical Practice, 2nd ed,Robert E. Rakel(ed). Philadelphia, Saunders, 2000, P 270-272 최환석 : 수면 무호흡, in 가정의학 임상편. 서울, 계측문화사, 2002, P 844-849 Charles A. Polnitsky, M.D. : Obstructive Sleep Apnea, in Conn's Current Therapy 2004, Robert E.Rakel(ed), Edward T. Bope(ed). hiladelphia, Saunders, 2004, P 239-243 Lyle D. Victor, M.D. : Obstructive Sleep Apnea. A journal of the American Family Physicains 1999 ; 60(8) : 2279-2286