2 睡眠呼吸障碍的筛检
睡眠呼吸暂停综合征是可以预防和治疗的疾病, 睡眠呼吸障碍的早期发现和早期明确诊断最重要。因此, 在人群中筛选出有睡眠呼吸障碍者, 对其实施多导睡眠图检查以便及时发现睡眠呼吸暂停综合征患者达到治疗的目的。对轻度睡眠呼吸暂停综合征患者应进行健康保健指导, 指导改善能够使睡眠呼吸障碍的危险性增加的因素如肥胖、大量饮酒、吸烟等。
目前国际上广泛应用的睡眠呼吸障碍的筛检方法是采用白天嗜睡的问卷嗜睡量表( ESS) 调查, 但是只采用问卷调查不太理想。其理由是, 首先, 在睡眠呼吸障碍的患者中, 由于慢性睡眠不足对嗜睡的感觉变得迟钝; 其次, 人们怕在今后的工作中对自己有不利因素, 而对嗜睡的问卷产生抵触现象。睡眠呼吸障碍的筛检采用问卷和多导睡眠图相结合的方法是最理想的方法。日本筛检实验报道, 简易式血氧饱和度测定仪筛检3%ODI≥15 与多导睡眠图筛检AHI≥20 的敏感度是85%, 特异度是100%〔20〕,因此, 采用简易式血氧饱和度测定仪筛检睡眠呼吸障碍可能是目前比较简便经济且安全可靠的流行病学研究方法。
心脑血管疾病是人类的主要死亡原因之一, 从睡眠呼吸障碍疾病的较高患病率和该病所导致心脑血管疾病发生的危险性可见, 在超负荷工作人群、职业人群、特别是倒班工作人群中, 开展睡眠呼吸障碍的筛检是很重要的。
3 睡眠呼吸障碍的研究展望
目前, 我国在睡眠呼吸障碍领域的流行病学研究较少, 特别是在健康管理, 防止事故等方面几乎处于空白状态, 采用国外的研究结果不一定完全符合我国居民的实际情况。另外, 睡眠呼吸障碍的流行病学追踪研究非常少见, 有待进一步开展。有关睡眠呼吸障碍与心脑血管疾病发病的关系, 除了通过引起高血压而发生关联以外, 是否还通过其他机制产生联系尚待探讨。
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