то сумдяоло апмоиым стом упмо ыс пяобкгла дглосиас уцеиас йаи уцеиaс KAI асжакеиас тгс еяцасиас

Transcription

1 то сумдяоло апмоиым стом упмо ыс пяобкгла дглосиас уцеиас йаи уцеиaс KAI асжакеиас тгс еяцасиас ои епиптысеис тоу стом амхяыпимо ояцамисло йаи сто йоимымийо сумоко лесы тгс еяцасиас ецвеияидио диацмысгс циа то иатяийо пяосыпийо тым упгяесиым пяытобахлиас жяомтидас уцеиас (еидийоус иатяоус еяцасиас йаи еидийоус иатяоус цемийгс иатяийгс) е мщма еккгмийч етаияеъа иатяийчр ТГР еяцасъар ЙАИ пеяибэккомтор ахчма ащцоустор 2009

2 () () 4 Charles Dickens 'Pickwick Papers' (1830) Joe ( James Budden Dickens ) Dickens Joe 1877 Dr William Broadbent 12 Caton Morrison (International Classification of Sleep Disorders ICSD2) 1 A B / / 5 ( RERAs) / 15 ( RERAs) / 10 ( / ) ( 1) ( 2) 5 6

3 ( 3) 3 1 (American Academy of Sleep Medicine AASM) 1 30% 10 4% (Apnea Hypopnea Index ) 2 ( ) 7 8

4 (arousals) () () 3% 7% 2% 5% 2 20% 3 10% (screening) % 10 () > 30 kg/m 2 (waisthip ratio) ( 1) libido / / 9 10

5 ( ) ( ) 12 ) 13 ) ) 14 ( ) / Pack 176% 58% 47% % 10% ( )

6 ( ) ( ) ( ) ( ) Chernobyl Challenger ' ( ) (golden standard) (screening) 14

7 ( score ) () () () ( ) Epworth 45 Johns (1991) 0 ( ) 3 ( ) () ; 0 = 1 = 2 = 3 = 1 () 2 3 () ( ) 4 5 () 6 () 7 () 8 () 4 Epworth 16

8 Karolinska Sleepiness Scale (KSS) Stanford Sleepiness Scale (SSS) Berlin Questionnaire score / (continuous positive airway pressurecpap) ( ) ( ) 5 17 / 18

9 1 International Classification of Sleep Disorders ICSD2 (American Academy of Sleep Medicine The international classification of sleep disorders diagnostic & coding manual (2nd ed) Westchester IL American Academy of Sleep Medicine Punjabi NM The epidemiology of adult obstructive sleep apnea Proc Am Thorac Soc ;5(2) Young T Peppard P Gottlieb D Epidemiology of obstructive sleep apnea A population health perspective Am J Respir Crit Care Med 2002; Young T Blustein J Finn L et al Sleepdisordered breathing and motor vehicle accidents in a populationbased sample of employed adults Sleep 1997; Bixler EO Vgontzas AN Ten Have T Tyson K Kales A Effects of age in sleep apnea in men Prevalence and severity Am J Respir Crit Care Med 1998;157(1) Young T Finn L Austin D Peterson A Menopausal status and sleepdisordered breathing in the Wisconsin Sleep Cohort Study Am J Respir Crit Care Med 2003;167(9) Vgontzas AN Legro RS Bixler EO et al Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness role of insulin resistance J Clin Endocrin Metab 2001; Schwartz AR Patil SP Laggan AM et al Obesity and obstructive sleep apnea pathogenic mechanisms and therapeutic approaches Proc Am Thor Soc 2008; Crummy F Piper AJ Naughton MT Obesity and the lung obesity and sleepdisordered breathing Thorax 2008; 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; Bottini P Tantucci C Sleep apnea syndrome in endocrine diseases Respiration 2003; Peppard PE Young t Palta M et al Prospective study of the associationbetween sleepdisordered breathing and hypertension N Eng J Med 2000; McNicholas WT Bonsignore MR Sleep apnoea as an independent risk factor for cardiovascular disease current evidence basic mechanisms and research priorities Management committee of EU COST ACTION B26 Eur Respir J 2007; Steiropoulos P Tsara V Nena E et al Effect of continuous positive airway pressure treatment on serum cardiovascular risk factors in patients with obstructive sleep apnea hypopnea syndrome Chest 2007;132(3) Kanagala R Murali NS Friedman PA et al Obstructive sleep apnea and the recurrence of atrial fibrillation Circulation 2003;107(20) Yaggi H Mohsenin V Obstructive sleep apnoea and stroke Lancet Neurol 2004;

10 17 Punjabi NM Shahar E Redline S et al Sleepdisordered breathing glucose intolerance and insulin resistance the Sleep Heart Health Study Am J Epidemiol 2004; Steiropoulos P Papanas N Nena E et al Markers of glycemic control and insulin resistance in nondiabetic patients with obstructive sleep apnea hypopnea syndrome Does adherence to CPAP treatment improve glycemic control? Sleep Med 2009 Feb 20 [epub ahead of print] 19 Findley L Suratt P Serious motor vehicle crashes the cost of untreated apnea Thorax 2001; George C Smiley A Sleep apnea and automobile crashes Sleep 1999; Ulfberg J Carter N talback M et al Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea Chest 1996;110(3) Roehrs T Merrion M Pedrosi B et al Neuropsychological function in obstructive sleep apnea syndrome (OSAS) compared to chronic obstructive pulmonary disease (COPD) Sleep 1995;18(5) Engleman HM Kingshott RN Martin SE et al Cognitive function in sleep apnea hypopnea syndrome Sleep 2000;23(sup 4)S Arai H furuta H Kosaka K et al Changes in work performances in obstructive sleep apnea patients after dental appliance therapy Psychiatry Clin Neurosci 1998;52(2) Young T Blustein J Finn L et al Sleepdisordered breathing and motor vehicle accidents in a populationbased sample of employed adults Sleep 1997; Findley LJ Unverzagt ME Suratt PM Automobile accidents involving patients with obstructive sleep apnea Am Rev Respirn Dis 1988; Howard ME Desai AV Grunstein RR et al Sleepiness Sleepdisordered breathing and accident risk factors in commercial vehicle drivers Am J Respi Crit Care Med 2004; TeranSantos J JimenezGomez A CorderoGuerava J The association between sleep apnea and the risk of traffic accidents Cooperative Group BurgosSantander N Eng J Med 1999; Howard ME Desai AV Grunstein RR et al Sleepiness Sleepdisordered breathing and accident risk factors in commercial vehicle drivers Am J Respi Crit Care Med 2004; Moreno CR Carvalho FA Lorenzi C et al High risk for obstructive sleep apnea in truck drivers estimated by the Berlin questionnaire prevalence and associated factors Chronobiol Int 2004; Hartenbaum N Collop N Rosen IM et al Sleep apnea and commercial motor vehicle operators Statement frm the joint task force of the American College of Chest Physicians American College of Occupational and Environmental Medicine and the National Sleep Foundation J Occup Environ Med 2006;48(9 Suppl)S George CF Sleep 5 driving and automobile crashes in patients with obstructive sleep apnea/hypopnea syndrome Thorax 2004; Philip P Sleepiness of occupational drivers Ind Health 2005; Reuveni H Tarasiuk A Wainstock T et al Awareness level of obstructive sleep apnea syndrome during routine unstructured interviews of a standardized patient by primary care physicians Sleep 2004; Pack AI Dinges D Maislin G A study of prevalence of sleep apnea among commercial truck drivers Federal Motor Carrier Safety Administration Publication No DOTRT02030 Washington DC;2002 Tech brief available at wwwfmcsadotgov/factsresearch/researchtechnology/tech/sleepapnea TechBriefpdf 36 Bearpark J Elliott L Grunstein R et al Snoring and sleep apnea A population study in Australian men Am J Respir Care Med 1995; Stoohs RA Bingham LA Itoi A et alsleep and sleepdisordered breathing in commercial longhaul truck drivers Chest 1995; Barbe F Sunyer J De la Pena A et al Effect of continuous positive airway pressure on the risk of road accidents in sleep apnea patients Respiration 2007; George CFP Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP Thorax 2001; US Congress Office of Technology Assessment Gearing up for safety Motor carrier safety in a competitive environment Publication OTASET382 Washington DC US Government Printing Office Lindberg E Carter N Gislason T et al Role of snoring and daytime sleepiness in occupational accidents Am J Respir Crit Care Med 2001; Young T Finn L Peppard PE et al Sleep disordered breathing and mortality eighteen year follow u of the Wisconsin sleep cohort Sleep 2008;31(8) Sivertsen B Overland S Glozier N et al The effect of OSAS on sick leave and work disability Eur Respir J 2008; Mitler MM Dawson A McNally E Sleep disorders and coronary disease In Zipes DP Rowlands DJ (eds) Progress in Cardiology vol 4/2 Philadelphia 1991pp Johns W A new method for measuring daytime sleepiness the Epworth Sleepiness Scale Sleep 1991; Tsara V Serasli E Amfilochiou A Constantinidis TC Christaki P Greek version of the Epworth Sleepiness Scale Sleep Breath 2004;8(2)915 22

11 1 50% 49% / (56%) ' ( ) ( ) 2 ( ) libido / / 23 24

12 Mallampati 4 V V ' 0 ( ) 4 ( ) 2 Epworth (Epworth Sleepiness Scale) 11 () ; 0 = 1 = 2 = 3 = 1 () 2 3 () ( ) 4 5 () 6 () 7 () 8 () Tsara V Serasli E Amfilochiou A Constantinidis TC and Christaki P Greek version of the Epworth Sleepiness Scale Sleep and Breathing 2004;8(2)