许多阻塞性睡眠呼吸暂停(Obstructive Sleep Apnea, OSA)患者都会出现日间过度嗜睡(Excessive daytime sleepiness, EDS),这种症状会对其日常活动、行为能力、认知、情绪和其他方面的健康造成一系列负面影响。虽然OSA的初级治疗,如持续气道正压通气(CPAP)治疗可以减少EDS的发生,但仍有相当一部分OSA患者在接受了临床治疗后仍继续经历EDS。目前OSA患者EDS的发生机制尚未完全明了,文献报道与以下因素有关:睡眠片断化、夜间低氧血症、细胞因子(IL-6和TNF-α)、肥胖、代谢异常(如糖尿病、胰岛素抵抗)、老龄化、抑郁及高碳酸血症等。本文就OSA患者EDS相关流行病学特征、评估方法、危险因素等内容作一综述。
Many patients with Obstructive Sleep Apnea (OSA) experience excessive daytime sleepiness (EDS), which can have a range of negative effects on their daily activities, behavioral ability, cognition, mood, and other aspects of health. Although primary treatment for OSA, such as continuous positive airway pressure (CPAP) therapy, can reduce the occurrence of EDS, a significant number of OSA pa-tients continue to experience EDS after receiving clinical treatment. At present, the mechanism of EDS in OSA patients is not yet fully understood, and it is reported in the literature that it is related to the following factors: sleep fragmentation, nocturnal hypoxemia, cytokines (IL-6 and TNF-α), obe-sity, metabolic abnormalities (such as diabetes, insulin resistance), aging, depression and hyper-capnia. This article reviews the epidemiological characteristics, assessment methods, and related risk factors associated with EDS in OSA patients.
Many patients with Obstructive Sleep Apnea (OSA) experience excessive daytime sleepiness (EDS), which can have a range of negative effects on their daily activities, behavioral ability, cognition, mood, and other aspects of health. Although primary treatment for OSA, such as continuous positive airway pressure (CPAP) therapy, can reduce the occurrence of EDS, a significant number of OSA patients continue to experience EDS after receiving clinical treatment. At present, the mechanism of EDS in OSA patients is not yet fully understood, and it is reported in the literature that it is related to the following factors: sleep fragmentation, nocturnal hypoxemia, cytokines (IL-6 and TNF-α), obesity, metabolic abnormalities (such as diabetes, insulin resistance), aging, depression and hypercapnia. This article reviews the epidemiological characteristics, assessment methods, and related risk factors associated with EDS in OSA patients.
孙雨浩,李 钦. 阻塞性睡眠呼吸暂停患者日间过度嗜睡相关研究进展Research Progress on Excessive Daytime Sleepiness in Patients with Obstructive Sleep Apnea[J]. 临床医学进展, 2022, 12(09): 8726-8732. https://doi.org/10.12677/ACM.2022.1291259
参考文献References李明娴, 王莹, 华树成, 等. 长春市20岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学现况调查[J]. 中华结核和呼吸杂志, 2005, 28(12): 833-835.Ye, L., Pien, G.W., Ratcliffe, S.J., et al. (2014) The Different Clinical Faces of Obstructive Sleep Apnoea: A Cluster Analysis. European Respiratory Journal, 44, 1600-1607. <br>https://doi.org/10.1183/09031936.00032314Kapur, V.K., Auckley, D.H., Chowdhuri, S., et al. (2017) Clini-cal Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medi-cine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13, 479-504. <br>https://doi.org/10.5664/jcsm.6506Benjafield, A.V., Ayas, N.T., Eastwood, P.R., et al. (2019) Estimation of the Global Prevalence and Burden of Obstructive Sleep Apnoea: A Literature-Based Analysis. The Lancet Respiratory Medicine, s7, 687-698.
<br>https://doi.org/10.1016/S2213-2600(19)30198-5Sateia, M.J. (2014) International Classification of Sleep Dis-orders-Third Edition: Highlights and Modifications. Chest, 146, 1387-1394. <br>https://doi.org/10.1378/chest.14-0970Pagel, J.F. (2009) Excessive Daytime Sleepiness. American Family Physician, 79, 391-396.Dongol, E.M. and Williams, A.J. (2016) Residual Excessive Sleepiness in Patients with Obstructive Sleep Apnea on Treatment with Continuous Positive Airway Pressure. Current Opinion in Pulmonary Med-icine, 22, 589-594.
<br>https://doi.org/10.1097/MCP.0000000000000324Gasa, M., Tamisier, R., Launois, S.H., et al. (2013) Resid-ual Sleepiness in Sleep Apnea Patients Treated by Continuous Positive Airway Pressure. Journal of Sleep Research, 22, 389-397. <br>https://doi.org/10.1111/jsr.12039Garbarino, S., Guglielmi, O., Sanna, A., et al. (2016) Risk of Oc-cupational Accidents in Workers with Obstructive Sleep Apnea: Systematic Review and Meta-Analysis. Sleep, 39, 1211-1218. <br>https://doi.org/10.5665/sleep.5834Lee, S.A., Han, S.H. and Ryu, H.U. (2015) Anxiety and Its Relationship to Quality of Life Independent of Depression in Patients with Obstructive Sleep Apnea. Journal of Psycho-somatic Research, 79, 32-36.
<br>https://doi.org/10.1016/j.jpsychores.2015.01.012Zhou, J., Camacho, M., Tang, X., et al. (2016) A Review of Neurocognitive Function and Obstructive Sleep Apnea with or without Daytime Sleepiness. Sleep Medicine, 23, 99-108. <br>https://doi.org/10.1016/j.sleep.2016.02.008Punjabi, N.M. (2008) The Epidemiology of Adult Obstructive Sleep Apnea. Proceedings of the American Thoracic Society, 5, 136-143.Kalucy, M.J., Grunstein, R., Lambert, T., et al. (2013) Obstructive Sleep Apnoea and Schizophrenia—A Research Agenda. Sleep Medicine Reviews, 17, 357-365. <br>https://doi.org/10.1016/j.smrv.2012.10.003Macey, P.M., Kumar, R., Woo, M.A., et al. (2008) Brain Struc-tural Changes in Obstructive Sleep Apnea. Sleep, 31, 967-977.中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组. 阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(2): 95-96.Weaver, T.E., Maislin, G., Dinges, D.F., et al. (2007) Relationship be-tween Hours of CPAP Use and Achieving Normal Levels of Sleepiness and Daily Functioning. Sleep, 30, 711-719. <br>https://doi.org/10.1093/sleep/30.6.711Budhiraja, R., Kushida, C.A., Nichols, D.A., et al. (2017) Predictors of Sleepiness in Obstructive Sleep Apnoea at Baseline and after 6 Months of Continuous Positive Airway Pressure Therapy. European Respiratory Journal, 50, Article ID: 1700348. <br>https://doi.org/10.1183/13993003.00348-2017Koutsourelakis, I., Perraki, E., Economou, N.T., et al. (2009) Predictors of Residual Sleepiness in Adequately Treated Obstructive Sleep Apnoea Patients. European Respiratory Journal, 34, 687-693.
<br>https://doi.org/10.1183/09031936.00124708阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版) [C]//第四届东北地区呼吸疾病学术会议暨吉林省第十一届呼吸病学年会论文集. 2012: 67-70.Littner, M.R., Kushida, C., Wise, M., et al. (2005) Practice Parameters for Clinical Use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test. Sleep, 28, 113-121. <br>https://doi.org/10.1093/sleep/28.1.113Doghramji, K., Mitler, M.M., Sangal, R.B., et al. (1997) A Normative Study of the Maintenance of Wakefulness Test (MWT). Electro-encephalography and Clinical Neurophysiology, 103, 554-562.
<br>https://doi.org/10.1016/S0013-4694(97)00010-2Bennett, L.S., Stradling, J.R. and Davies, R.J. (1997) A Be-havioural Test to Assess Daytime Sleepiness in Obstructive Sleep Apnoea. Journal of Sleep Research, 6, 142-145. <br>https://doi.org/10.1046/j.1365-2869.1997.00039.xJohns, M.W. (1991) A New Method for Measuring Day-time Sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540-545. <br>https://doi.org/10.1093/sleep/14.6.540Johns, M. and Hocking, B. (1997) Daytime Sleepiness and Sleep Hab-its of Australian Workers. Sleep, 20, 844-847.
<br>https://doi.org/10.1093/sleep/20.10.844Erman, M., Emsellem, H., Black, J., et al. (2017) Correlation between the Epworth Sleepiness Scale and the Maintenance of Wakefulness Test in Patients with Narcolepsy Participating in Two Clinical Trials of Sodium Oxybate. Sleep Medicine, 38, 92-95. <br>https://doi.org/10.1016/j.sleep.2017.07.015Akerstedt, T. and Gillberg, M. (1990) Subjective and Objective Sleepiness in the Active Individual. International Journal of Neuroscience, 52, 29-37. <br>https://doi.org/10.3109/00207459008994241Carskadon, M.A. and Dement, W.C. (1981) Cumulative Effects of Sleep Restriction on Daytime Sleepiness. Psychophysiology, 18, 107-113. <br>https://doi.org/10.1111/j.1469-8986.1981.tb02921.xBatool-Anwar, S., Kales, S.N., Patel, S.R., et al. (2014) Obstructive Sleep Apnea and Psychomotor Vigilance Task Performance. Nature and Science of Sleep, 6, 65-71. <br>https://doi.org/10.2147/NSS.S53721D'rozario, A.L., Field, C.J., Hoyos, C.M., et al. (2018) Impaired Neuro-behavioural Performance in Untreated Obstructive Sleep Apnea Patients Using a Novel Standardised Test Battery. Fron-tiers in Surgery, 5, Article No. 35.
<br>https://doi.org/10.3389/fsurg.2018.00035Jongen, S., Perrier, J., Vuurman, E.F., et al. (2015) Sensitivity and Validity of Psychometric Tests for Assessing Driving Impairment: Effects of Sleep Deprivation. PLOS ONE, 10, e0117045.
<br>https://doi.org/10.1371/journal.pone.0117045Epstein, L.J., Kristo, D., Strollo, P.J., Jr., Friedman, N., et al. (2009) Clinical Guideline for the Evaluation, Management and Long-Term Care of Obstructive Sleep Apnea in Adults. Journal of Clinical Sleep Medicine, 5, 263-276.
<br>https://doi.org/10.5664/jcsm.27497Strollo Jr., P.J. and Malhotra, A. (2016) Stimulating Therapy for Obstruc-tive Sleep Apnoea. Thorax, 71, 879-880.
<br>https://doi.org/10.1136/thoraxjnl-2016-209077Strollo Jr., P.J., Soose, R.J., Maurer, J.T., et al. (2014) Up-per-Airway Stimulation for Obstructive Sleep Apnea. New England Journal of Medicine, 370, 139-149. <br>https://doi.org/10.1056/NEJMoa1308659郑艳文, 邬海燕, 胡立红, 等. 肥胖对OSAHS患者日间嗜睡的影响[J]. 中外医学研究, 2020, 18(11): 6-8.王扬, 朱鲁平, 陈仁杰. 阻塞性睡眠呼吸暂停低通气综合征与肥胖相关的研究进展[J]. 中国中西医结合耳鼻咽喉科杂志, 2019, 27(2): 156-160.王珍, 屠春林. 阻塞性睡眠呼吸暂停低通气综合征患者日间嗜睡的影响因素[J]. 临床肺科杂志, 2021, 26(8): 1193-1197.Young, T., Finn, L. and Kim, H. (1997) Nasal Obstruction as a Risk Factor for Sleep-Disordered Breathing. The University of Wis-consin Sleep and Respiratory Research Group. Journal of Allergy and Clinical Immunology, 99, S757-S762. <br>https://doi.org/10.1016/S0091-6749(97)70124-6Lofaso, F., Coste, A., D’ortho, M.P., et al. (2000) Nasal Obstruction as a Risk Factor for Sleep Apnoea Syndrome. European Respiratory Journal, 16, 639-643. <br>https://doi.org/10.1034/j.1399-3003.2000.16d12.xVerse, T. and Pirsig, W. (2003) Impact of Impaired Nasal Breathing on Sleep-Disordered Breathing. Sleep and Breathing, 7, 63-76. <br>https://doi.org/10.1007/s11325-003-0063-2Chen, W. and Kushida, C.A. (2003) Nasal Obstruction in Sleep-Disordered Breathing. Otolaryngologic Clinics of North America, 36, 437-460. <br>https://doi.org/10.1016/S0030-6665(02)00175-5Virkkula, P., Hurmerinta, K., Löytönen, M., et al. (2003) Postural Cephalometric Analysis and Nasal Resistance in Sleep-Disordered Breathing. The Laryngoscope, 113, 1166-1174. <br>https://doi.org/10.1097/00005537-200307000-00012Koseoglu, S., Ozcan, K.M., Ikinciogullari, A., et al. (2015) Relationship between Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Obstructive Sleep Apnea Syndrome. Advances in Clinical and Experimental Medicine, 24, 623-627. <br>https://doi.org/10.17219/acem/58969