Is AHI the Gold Standard for Assessing the Severity of OSAHS?——The Relevance of AHI and the Main Target Organs Damage due to OSAHS_Chinese Journal of Respiratory and Critical Care Medicine

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LIU Ying , WANG Guangfa

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阻塞性睡眠呼吸暂停低通气综合征; 睡眠呼吸暂停低通气指数

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睡眠呼吸暂停低通气综合征( SAHS) 是一种常见病症,临床上以阻塞性睡眠呼吸暂停低通气综合征( OSAHS) 最为常见[1] 。1993 年一项基于社区人群的研究中, Young 等[2] 发现年龄介于30 ～60 岁的人群中, 以睡眠呼吸暂停低通气指数( AHI) ≥5 次/h 定义的OSAHS在女性的患病率为9% ,在男性为24% , 2% 的女性和4% 的男性同时存在嗜睡症状。越来越多的证据表明睡眠呼吸暂停可导致许多并发症, 包括行为和躯体两方面。行为并发症包括日间嗜睡、注意力下降和神经心理异常, 而躯体并发症主要包括心脑血管疾病, 尤其是高血压[3, 4] 。OSAHS 是全身多个脏器功能损害的独立危险因素, 其中心血管并发症是主要死因[5] 。如何评价OSAHS 病情严重程度, 对患者的诊断、治疗及预后判断具有非常重要的意义。目前AHI 仍然是诊断OSAHS 的金标准,但其与靶器官损害的相关性存在诸多争议。

Citation： LIU Ying,WANG Guangfa. Is AHI the Gold Standard for Assessing the Severity of OSAHS?——The Relevance of AHI and the Main Target Organs Damage due to OSAHS. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(5): 417-420. doi: Copy

1.	中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南( 草案) . 中华内科杂志, 2003, 42:594-597.
2.	Young T, Palta M, Dempsey J, et al. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med,1993, 328: 1230-1235.
3.	Krieger J, McNicholas WT, Levy P, et al. Public health and medicolegal implications of sleep apnoea. Eur Respir J, 2002 , 20 :1594-1609.
4.	Palom　ki H, Partinen M, Juvela S, et al. Snoring as a risk factor for sleep-related brain infarction. Stroke, 1989, 20: 1311-1315.
5.	Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest, 1988 ,94: 1200-1204.
6.	Guilleminault C. Obstructive sleep apnea. The clinical syndrome and historical perspective.Med Clin North Am, 1985, 69: 1187-1203.
7.	American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep,1999, 22: 662-689.
8.	Hosselet JJ, Ayappa I, Norman RG, et al. Classification of Sleepdisordered Breathing. Am J Respir Crit Care Med, 2001, 163: 398-405.
9.	Ancoli-Israel S, Klauber MR, Kripke DF, et al. Sleep apnea in female patients in a nursing home. Increased risk of mortality.Chest, 1989, 96: 1054-1058.
10.	Bliwise DL, Bliwise NG, Partinen M, et al. Sleep apnea and mortality in an aged cohort. Am J Public Health, 1988, 78: 544-547.
11.	Grant I, Heaton RK, McSweeny AJ, et al. Neuropsychologic findings in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med, 1982, 142: 1470-1476.
12.	Sériès F, Marc I, Cormier Y, et al. Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Intern Med, 1993, 119: 449-453.
13.	Lévy P, Pépin JL, Deschaux-Blanc C, et al. Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest, 1996, 109: 395-399.
14.	Olson LG, Ambrogetti A, Gyulay SG. Prediction of sleep disordered breathing by unattended overnight oximetry. J Sleep Res, 1999, 8 :51-55.
15.	Chiner E, Signes-costa J, Arrieiro JM, et al. Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax, 1999, 54: 968 -971.
16.	Williams AJ, Stein M. Screening for obstructive sleep apnea using pulse oximetry. West JMed, 1992, 157: 175-176.
17.	Kumano-go T, Mikami A, Suganuma N, et al. Three components of obstructive sleep apnea/ hypopnea syndrome. Psychiatry Clin Neurosci, 2003, 57: 197-203.
18.	Sajkov D, Cowie RJ, Thornton AT, et al. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med, 1994, 149: 416-22.
19.	Carlson JT, Hedner JA, Ejnell H, et al. High prevalence of hypertension in sleep apnea patients independent of obesity. Am J Respir Crit Care Med, 1994 , 150: 72 -77 .
20.	杨琳, 何仅瀛, 罗华, 等. 睡眠呼吸暂停与睡前、醒后血压变化关系的初步研究. 中国呼吸与危重监护杂志, 2008, 7: 110-115.
21.	王菡侨, 何仅瀛. 阻塞性睡眠呼吸暂停综合征与高血压. 中国呼吸与危重监护杂志, 2008, 7: 313-317.
22.	孙凯, 韩瑞娟, 赵瑞平. 阻塞性睡眠呼吸暂停低通气综合征对心血管系统的影响. 中国呼吸与危重监护杂志, 2008, 7: 398-400.
23.	Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study. JAMA, 2000, 283: 1829-1836.
24.	Lavie P, Yoffe N, Berger I, et al. The relationship between the severity of sleep apnea syndrome and 24-h blood pressure values in patients with obstructive sleep apnea. Chest, 1993, 103: 717-721.
25.	Berman EJ, DiBenedetto RJ, Causey DE, et al. Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. Chest, 1991, 100: 347-350.
26.	Chami HA, Devereux RB, Gottdiener JS, et al. Left ventricular morphology and systolic function in sleep-disordered bBreathing. The sleep heart health study.Circulation, 2008, 117: 2567-2569.
27.	Alonso-Fernández A, García-Río F, Racionero MA, et al. Cardiac rhythm disturbances and ST-segment depression episodes in patients with obstructive seep apnea-hypopnea syndrome and its mechanisms. Chest, 2005, 127: 15-22.
28.	Narkiewicz K, Montano N, Cogliati C, et al. Altered cardiovascular variability in obstructive sleep apnea. Circulation, 1998, 98: 1071 -1077.
29.	Bonsignore MR, Parati G, Insalaco G, et al. Continuous positive airway pressure treatment improves baroreflex control of heart rRate during sleep in severe obstructive sleep apnea syndrome. Am J Respir Crit Care Med, 2002, 166: 279-286.
30.	Fischer AQ, Chaudhary BA, Taormina MA, et al. Intracranial hemodynamics in sleep apnea. Chest, 1992, 102: 1402-1406.
31.	Palomaki H. Snoring and the risk of ischemic brain infarction. Stroke. , 1991, 22: 1021-1025.
32.	Rola R, Jarosz H, Wierzbicka A, et al. Sleep disordered breathing and recurrence of cerebrovascular events, case-fatality, and functional outcome in patients with ischemic stroke or transient ischemic attack. J Physiol Pharmacol, 2008, 59 Suppl 6: 615-621.
33.	王广发, 何冰, 迟春花, 等. 阻塞性睡眠呼吸暂停综合征的睡眠结构改变. 中华结核和呼吸杂志, 1998, 21: 477-479.
34.	Siddiqui F, Walters AS, Goldstein D, et al. Half of patients with obstructive sleep apnea have a higher NREM AHI than REM AHI.Sleep Med, 2006, 7: 281-285.
35.	Muraki M, Kitaguchi S, Ichihashi H, et al. Apnoea-hypopnoea index during rapid eye movement and non-rapid eye movement sleep in obstructive sleep apnoea. J Int Med Res, 2008, 36: 906 -913.
36.	Smurra MV, Dury M, Aubert G, et al. Sleep fragmentation:comparison of two definitions of short arousals during sleep in OSAS patients. Eur Respir J, 2001, 17: 723-727.
37.	Jordan AS, McEvoy RD, Edwards JK, et al. The influence of gender and upper airway resistance on the ventilatory response to arousal in obstructive sleep apnoea in humans. J Physiol, 2004, 558: 993 -1004.
38.	Watanabe T, Kumano-Go T, Suganuma N, et al. The relationship between esophageal pressure and apnea hypopnea index in obstructive sleep apnea-hypopnea syndrome. Sleep Res Online,2000, 3: 169-172.
39.	Sforza E, Addati G, Cirignotta F, et al. Natural evolution of sleep apnoea syndrome: a five year longitudinal study. Eur Respir J, 1994 ,7: 1765-1770.
40.	Kass JE, Akers SM, Bartter TC, et al. Rapid-eye-movement-specific sleep-disordered breathing: a possible cause of excessive daytime sleepiness. Am J Respir Crit Care Med, 1996, 154: 167-169.
41.	Young T, Blustein J, Finn L, et al. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep, 1997, 20: 608-613.
42.	Cheshire K, Engleman H, Deary I, et al. Factors impairing daytime performance in patients with sleep apnea /hypopnea syndrome. Arch Intern Med, 1992, 152: 538-541.
43.	Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 1991, 14: 540-545.
44.	Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest, 1993, 103: 30-36.
45.	Kripke DF, Ancoli-Israel S, Klauber MR, et al. Prevalence of sleepdisordered breathing in ages 40-64 years : A population-based survey. Sleep, 1997, 20: 65-76.
46.	Weaver EM, Kapur V, Yueh B. Polysomnography vs Self-reported Measures in Patients With Sleep Apnea. Arch Otolaryngol Head Neck Surg, 2004, 130: 453-458.
47.	Bixler EO, Vgontzas AN, Ten Have T, et al. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med, 1998, 157: 144-148.
48.	王立曼, 周光耀, 李春华, 等. 阻塞性睡眠呼吸暂停低通气综合征危险因素探讨. 华西医学, 2009, 24: 46-49.

1. 中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南( 草案) . 中华内科杂志, 2003, 42:594-597.
2. Young T, Palta M, Dempsey J, et al. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med,1993, 328: 1230-1235.
3. Krieger J, McNicholas WT, Levy P, et al. Public health and medicolegal implications of sleep apnoea. Eur Respir J, 2002 , 20 :1594-1609.
4. Palom　ki H, Partinen M, Juvela S, et al. Snoring as a risk factor for sleep-related brain infarction. Stroke, 1989, 20: 1311-1315.
5. Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest, 1988 ,94: 1200-1204.
6. Guilleminault C. Obstructive sleep apnea. The clinical syndrome and historical perspective.Med Clin North Am, 1985, 69: 1187-1203.
7. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep,1999, 22: 662-689.
8. Hosselet JJ, Ayappa I, Norman RG, et al. Classification of Sleepdisordered Breathing. Am J Respir Crit Care Med, 2001, 163: 398-405.
9. Ancoli-Israel S, Klauber MR, Kripke DF, et al. Sleep apnea in female patients in a nursing home. Increased risk of mortality.Chest, 1989, 96: 1054-1058.
10. Bliwise DL, Bliwise NG, Partinen M, et al. Sleep apnea and mortality in an aged cohort. Am J Public Health, 1988, 78: 544-547.
11. Grant I, Heaton RK, McSweeny AJ, et al. Neuropsychologic findings in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med, 1982, 142: 1470-1476.
12. Sériès F, Marc I, Cormier Y, et al. Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Intern Med, 1993, 119: 449-453.
13. Lévy P, Pépin JL, Deschaux-Blanc C, et al. Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest, 1996, 109: 395-399.
14. Olson LG, Ambrogetti A, Gyulay SG. Prediction of sleep disordered breathing by unattended overnight oximetry. J Sleep Res, 1999, 8 :51-55.
15. Chiner E, Signes-costa J, Arrieiro JM, et al. Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax, 1999, 54: 968 -971.
16. Williams AJ, Stein M. Screening for obstructive sleep apnea using pulse oximetry. West JMed, 1992, 157: 175-176.
17. Kumano-go T, Mikami A, Suganuma N, et al. Three components of obstructive sleep apnea/ hypopnea syndrome. Psychiatry Clin Neurosci, 2003, 57: 197-203.
18. Sajkov D, Cowie RJ, Thornton AT, et al. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med, 1994, 149: 416-22.
19. Carlson JT, Hedner JA, Ejnell H, et al. High prevalence of hypertension in sleep apnea patients independent of obesity. Am J Respir Crit Care Med, 1994 , 150: 72 -77 .
20. 杨琳, 何仅瀛, 罗华, 等. 睡眠呼吸暂停与睡前、醒后血压变化关系的初步研究. 中国呼吸与危重监护杂志, 2008, 7: 110-115.
21. 王菡侨, 何仅瀛. 阻塞性睡眠呼吸暂停综合征与高血压. 中国呼吸与危重监护杂志, 2008, 7: 313-317.
22. 孙凯, 韩瑞娟, 赵瑞平. 阻塞性睡眠呼吸暂停低通气综合征对心血管系统的影响. 中国呼吸与危重监护杂志, 2008, 7: 398-400.
23. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study. JAMA, 2000, 283: 1829-1836.
24. Lavie P, Yoffe N, Berger I, et al. The relationship between the severity of sleep apnea syndrome and 24-h blood pressure values in patients with obstructive sleep apnea. Chest, 1993, 103: 717-721.
25. Berman EJ, DiBenedetto RJ, Causey DE, et al. Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. Chest, 1991, 100: 347-350.
26. Chami HA, Devereux RB, Gottdiener JS, et al. Left ventricular morphology and systolic function in sleep-disordered bBreathing. The sleep heart health study.Circulation, 2008, 117: 2567-2569.
27. Alonso-Fernández A, García-Río F, Racionero MA, et al. Cardiac rhythm disturbances and ST-segment depression episodes in patients with obstructive seep apnea-hypopnea syndrome and its mechanisms. Chest, 2005, 127: 15-22.
28. Narkiewicz K, Montano N, Cogliati C, et al. Altered cardiovascular variability in obstructive sleep apnea. Circulation, 1998, 98: 1071 -1077.
29. Bonsignore MR, Parati G, Insalaco G, et al. Continuous positive airway pressure treatment improves baroreflex control of heart rRate during sleep in severe obstructive sleep apnea syndrome. Am J Respir Crit Care Med, 2002, 166: 279-286.
30. Fischer AQ, Chaudhary BA, Taormina MA, et al. Intracranial hemodynamics in sleep apnea. Chest, 1992, 102: 1402-1406.
31. Palomaki H. Snoring and the risk of ischemic brain infarction. Stroke. , 1991, 22: 1021-1025.
32. Rola R, Jarosz H, Wierzbicka A, et al. Sleep disordered breathing and recurrence of cerebrovascular events, case-fatality, and functional outcome in patients with ischemic stroke or transient ischemic attack. J Physiol Pharmacol, 2008, 59 Suppl 6: 615-621.
33. 王广发, 何冰, 迟春花, 等. 阻塞性睡眠呼吸暂停综合征的睡眠结构改变. 中华结核和呼吸杂志, 1998, 21: 477-479.
34. Siddiqui F, Walters AS, Goldstein D, et al. Half of patients with obstructive sleep apnea have a higher NREM AHI than REM AHI.Sleep Med, 2006, 7: 281-285.
35. Muraki M, Kitaguchi S, Ichihashi H, et al. Apnoea-hypopnoea index during rapid eye movement and non-rapid eye movement sleep in obstructive sleep apnoea. J Int Med Res, 2008, 36: 906 -913.
36. Smurra MV, Dury M, Aubert G, et al. Sleep fragmentation:comparison of two definitions of short arousals during sleep in OSAS patients. Eur Respir J, 2001, 17: 723-727.
37. Jordan AS, McEvoy RD, Edwards JK, et al. The influence of gender and upper airway resistance on the ventilatory response to arousal in obstructive sleep apnoea in humans. J Physiol, 2004, 558: 993 -1004.
38. Watanabe T, Kumano-Go T, Suganuma N, et al. The relationship between esophageal pressure and apnea hypopnea index in obstructive sleep apnea-hypopnea syndrome. Sleep Res Online,2000, 3: 169-172.
39. Sforza E, Addati G, Cirignotta F, et al. Natural evolution of sleep apnoea syndrome: a five year longitudinal study. Eur Respir J, 1994 ,7: 1765-1770.
40. Kass JE, Akers SM, Bartter TC, et al. Rapid-eye-movement-specific sleep-disordered breathing: a possible cause of excessive daytime sleepiness. Am J Respir Crit Care Med, 1996, 154: 167-169.
41. Young T, Blustein J, Finn L, et al. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep, 1997, 20: 608-613.
42. Cheshire K, Engleman H, Deary I, et al. Factors impairing daytime performance in patients with sleep apnea /hypopnea syndrome. Arch Intern Med, 1992, 152: 538-541.
43. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 1991, 14: 540-545.
44. Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest, 1993, 103: 30-36.
45. Kripke DF, Ancoli-Israel S, Klauber MR, et al. Prevalence of sleepdisordered breathing in ages 40-64 years : A population-based survey. Sleep, 1997, 20: 65-76.
46. Weaver EM, Kapur V, Yueh B. Polysomnography vs Self-reported Measures in Patients With Sleep Apnea. Arch Otolaryngol Head Neck Surg, 2004, 130: 453-458.
47. Bixler EO, Vgontzas AN, Ten Have T, et al. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med, 1998, 157: 144-148.
48. 王立曼, 周光耀, 李春华, 等. 阻塞性睡眠呼吸暂停低通气综合征危险因素探讨. 华西医学, 2009, 24: 46-49.

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