睡眠醫(yī)學(xué)的進展演講內(nèi)容大綱介紹睡眠呼吸問題睡眠呼吸問題與疾病的關(guān)係兒童睡眠呼吸問題猝睡癥肢動癥失眠癥的行為治療討論白天嗜睡的主要原因睡眠的質(zhì)或量不夠如睡眠時間不足或間斷性的睡眠(睡眠呼吸中止癥或身心癥)中樞神經(jīng)病変生理時鐘與環(huán)境的互動失調(diào)藥物的影響正常睡眠的階段非快速動眼期(Non-REM)睡眠--較規(guī)則的呼吸,較理性化的夢境,stage1,2,3,4.(stage3+4=slowwavesleep,SWS)快速動眼期(REM)睡眠--較不規(guī)則的呼吸,較情緒化的夢境,呼吸驅(qū)動力較弱,較易缺氧一個典型夜晚的睡眠是以70-90分鐘的非快速動眼期睡眠開始,然後進入約十分鐘的快速動眼期睡眠,如此重複循環(huán)整個夜晚阻塞性睡眠呼吸中止睡眠呼吸中止癥之

上呼吸道特徵鼻腔阻塞扁桃腺(tonsil),咽扁桃腺(nasaladenoid)肥大咽顎帆區(qū)(velopharyngealspace)淺而狹窄舌頭肥大(Macroglossia)下顎狹小,後縮(Micro,retro-gnatia)上呼吸道感覺神經(jīng)異常Signsandsymptomssuggestiveofsleepapnea

Atuletal.Lancet2002;360:237-45SnoringWitnessedapneas,gasping,orbothObesity(especiallyneckcircumference)HypertensionExcessivedaytimesleepinessFamilyhistoryNocturiaNon-restorativesleepAreFar-EastAsianMorePronetohaveSleepApnea?亞洲人與美洲人睡眠呼吸中止癥候群病人的比較亞洲的睡眠呼吸中止癥候群的病人較瘦,沒有像美洲的病人那麼胖亞洲人先天上顱骨底面積較美洲人小,所以亞洲人上呼吸道會比美洲人更小,更容易有睡眠呼吸問題行為治療維持理想體重側(cè)睡避免睡前鎮(zhèn)靜藥物避免睡眠不足避免睡前喝酒床頭搖高(肥胖特別是肚子大的人）感冒及過敏一定要治好睡前避免吃太多戒菸MedicalTreatmentofOSASRespiratoryCenterStimulants(?)MedroxyprogesteroneAcetateAcetazolamideClomipramineHydrochlorideTheophyllineNeuroactiveDrugs(?)ProtriptylineStrychnineModafinilOxygentherapy(avoidCO2retention)IntranasalsteroidorradiofrequencyTongueRetainingDevice(Oralappliant)(onlymildOSA,needfollowupsleepstudy)NasalCPAP-goldstandardoftreatment)SurgicalTreatmentofOSASTracheostomy-100%successratebut….Removaloftheunderlyingobstruction---enlargedtonsils,adenoid,thyroid.etcTonsillo-adenoidectomyPalatopharyngoplasty(PPP)Uvulopalatopharyngoplasty(UPPP)Laser-assistedUvulopalatoplasty(LAUP)GenioglossaladvancementRadiofrequencypalatoplastyandtonguebaseablationMandibularOsteostomy&HyoidBoneAdvancement(PhaseII)RadiofrequencyUsageinOSASChildOSAS猝睡癥(Narcolepsy)TheNarcolepsy“Tetrad”Excessivedaytimesleepiness(sleepattack)Cataplexy(suddenlossofmuscletone)Hypnogogichallucination(vividdream-likeimagesjustbeforesleeponset)Sleepparalysis(muscleparalysisonmorningawakening)Disruptednocturnalsleep?PeriodicLegMovementRestlessLegSyndromeRLSEpidemiology10-15%oftheresponders(in2019subjects)SimilarprevalenceamongmaleandfemaleThemeanageofonsetwasfoundtobetween27.2and41.0yearsTwolargesurveyfoundthat38.3and45%ofRLSpatients,respectively,experiencedtheirfirstsymptomsbeforetheageof20PeriodicLegsMovementsDefinitionOriginallycalled“nocturnalmyoclonus”,PLMSisbestdescribedasrhythmicalextensionsofthebigtoeanddorsiflexionsoftheanklewithoccasionalflexionsofthekneeandhip,eachmovementlastingapproximately0.5to5.0secwithafrequencyofaboutoneevery20to40secTheprevalenceofPLMSiscorrelatewithage,rarelydiagnosedin<30yearsp’t,5%30-50years,29%>50years,44%>65years.APLMSindex(numberofthePLMSperhourofsleep)>5fortheentirenightofsleepisconsideredpathological.SecondaryRLSduetoUnderlyingConditionsIron-deficiencyanemiaUremia(20-40%ofdialysispatients)Pregnancy(upto27%)Fibromyalgiaandrheumatoidarthritis(30%)Diabetes&parkinson’sdiseaseNeurologicallesionsbothspinalcordandperipheralnervelesionsDrug-induced(includewithdrawal)tricyclics,SSRI’s,lithium,dopamineblockers(e.g.,neuroleptics),xanthines,beta-blockers,caffeine,alcohol,andhistamineblockersInsomniaDefinedInsomniaischaracterizedbyanyofthefollowing:DifficultyfallingasleepDifficultystayingasleepEarlymorningawakeningFeelingunrefreshedinthemorningInsomniaEpidemiologyApproximately35%adultspopulationisafflictedwithinsomniaduringthecourseofayear.9-12%ofthepopulationoccuronaregularbasis(chronicinsomnia)BoththeincidenceandthecomplaintofinsomniaincreaseacrossthelifecyclesComplicationsofInsomniaInsomniaisafrequentsymptomofpsychiatricdisordersandisoftenariskfactorforfuturepsychiatricillness-Depression-Anxiety-Alcoholabuse-DrugabuseDiagnosingInsomniaCompletesleephistoryMedicalandpsychiatricassessment--substanceuseAlcohol,caffeine,andconcomitantmedicationPrescriptionand/orOTCmedicationDrugsSleepdiaryPolysomnographyNon-pharmacologicalInsomniaTreatment/CognitiveBehavioralTherapy(CBT)OutcomeReducesleeplatencyDecreasefrequencyanddurationofarousalIncreasesleepqualityDecreasesleep-relatedanxietyImprovedaytimefunctionandmoodProcedureofCBTComprehensiveevaluationOvernightsleepstudyIndividualofgroupformatWeeklysession(6-8weeks)DailysleeplogsMultiplecomponentapproachConcomitantdrugs