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Apneia obstrutiva do sono em adultos

最后审阅: 18 Jun 2025
最后更新: 11 Dec 2024

小结

定义

病史和体格检查

关键诊断因素

  • obesidade
  • sexo masculino
  • anomalias maxilomandibulares
  • sonolência diurna excessiva
  • episódios de apneia
  • episódios de arquejo
  • sono não restaurador
  • insônia
  • macroglossia
  • ronco crônico
完整详情

其他诊断因素

  • doença cardiovascular
  • ganho de peso
  • circunferência grande do pescoço
  • endocrinopatias
  • história de intubação difícil para anestesia geral; obstrução durante sedação
  • história familiar de AOS ou ronco
  • história de mucopolissacaridose
  • história de DRGE
  • história de síndrome de Down
  • história de extração dentária para liberar espaço
  • história de acidentes com veículo automotor
  • disfunção neurocognitiva
  • transtornos de humor
  • noctúria
  • disfunção erétil
  • cefaleias pela manhã
  • pirose/dispepsia
  • xerostomia
  • transpiração noturna
完整详情

危险因素

  • obesidade
  • sexo masculino
  • menopausadas (mulheres)
  • circunferência grande do pescoço
  • anomalias maxilomandibulares (por exemplo, estenose, retrognatia e palato arqueado alto)
  • aumento do volume dos tecidos moles (inclui amígdalas, adenoides e língua)
  • história familiar de AOS
  • ronco crônico
  • síndrome do ovário policístico (SOPC)
  • hipotireoidismo
  • Síndrome de Down
  • mucopolissacaridose
  • idade mais avançada
  • etnias negra, hispânica ou asiática
  • tabagismo
  • obstrução nasal
  • níveis dos hormônios sexuais
  • uso de bebidas alcoólicas
  • exposição ambiental à fumaça do tabaco
  • uso de opioides
完整详情

诊断性检查

首要检查

  • polissonografia (PSG) presencial
  • PSG não laboratorial não supervisionada
  • testes de sono domésticos multicanais portáteis
  • endoscopia de fibra óptica sem sedação
完整详情

新兴检查

  • RNM dinâmica
  • endoscopia com sono induzido por medicamentos (ESIM)
  • aprendizado de máquinas

治疗流程

急症处理

Índice de apneia-hipopneia (IAH) ou índice de eventos respiratórios (IER) ≥30 episódios/hora: nenhuma lesão anatômica distinta

IAH ou IER ≥5, mas <30 episódios/hora: nenhuma lesão anatômica distinta

índice de apneia-hipopneia (IAH) ou índice de eventos respiratórios ≥5 episódios/hora com lesões anatômicas distintas

持续性治疗

AOS persistente pós-operatória

撰稿人

作者

Ofer Jacobowitz, MD, PhD, FAASM

Co-director of Sleep

ENT and Allergy Associates

Associate Professor

Department of Otolaryngology

Northwell/Zucker School of Medicine, Hofstra University

New York

NY

利益声明

OJ is a scientific consultant for, and has received a consulting fee from Aerin Medical, LivaNova, Deerfield Catalyst, and Nyxoah. OJ has received research support from LivaNova for US Food and Drug Administration trial research. Aerin Medical has developed nasal valve treatment devices for nasal obstruction. Both LivaNova and Nyxoah have developed implantable neurostimulation systems for obstructive sleep apnoea. Zsquare has developed endoscopy systems. OJ is an author of a paper cited in this topic.

同行评议者

Carla Daltro, MD

Professor of Medicine

Bahiana School of Medicine and Public Health

Brazil

利益声明

CD has been reimbursed by Sanofi-Aventis, Novartis, Merck Sharp Dohme, and Eli Lilly as an investigator of clinical trials.

Krishna M. Sundar, MD

Adjunct Assistant Professor

University of Utah

Director

Pulmonary & Critical Care Research

IHC Urban South Intermountain Utah Valley Pulmonary Clinic

Provo

UT

利益声明

KMS declares that he has no competing interests.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

American Academy of Sleep Medicine. The AASM International classification of sleep disorders – third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].全文

Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Mar 15;13(3):479-504.全文  摘要

Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. Sleep. 2019 Feb 15;15(2):335-43.全文  摘要

Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021 Jul 20;144(3):e56-67.全文  摘要

Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015 Jul 15;11(7):773-827.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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