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Obstrüktif Uyku Apne Sendromu: Patofizyoloji, Tanı ve Tedavi

Yıl 2011, Cilt: 20 Sayı: 2, 118 - 129, 01.06.2011

Öz

Obstrüktif uyku apne sendromu (OUAS), dünya çapında milyonlarca insanı etkileyen, ciddi komorbiditelere yol açan, hastaların yaşam kalitelerini düşüren tehlikeli bir hastalıktır. Birçok hasta uzun yıllar teşhiş edilmeden veya hastalığı fark etmeden yaşamaktadır. Hastalık, sürekli pozitif hava yolu basıncı uygulaması (CPAP) ile etkin biçimde tedavi edilebilirken, bir kısım hasta çeşitli sebeplerden dolayı bu tedaviyi reddetmektedir. Bu makale, OUAS fizyopatolojisi, cerrahi ve cerrahi olmayan tedavi yöntemleri üzerine değinecektir.

Kaynakça

  • Meyer JB, Knudson RC. The sleep apnea syndrome. Part I: diagnosis. J Prosthet Dent 1989; 62: 675-679.
  • Shahar E, Whitney CW, Redline S et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001 Jan;163(1):19-25. 3. Reichmuth KJ, Austin D, Skatrud JB et al. Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med. 2005 Dec 15;172(12):1590-5. Epub 2005 Sep 28.
  • Lombardi C, Rocchi R, Montagna P et al.Obstructive sleep apnea syndrome: a cause of acute delirium. J Clin Sleep Med. 2009 Dec 15;5(6):569-70.
  • Luboshitzky R, Aviv A, Hefetz A et al. Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab. 2002 Jul;87(7):3394-8. 6. Kajaste S, Brander PE, Telakivi T et al. A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med. 2004 Mar;5(2):125-31 7. Smith IE, Quinnell TG. Pharmacotherapies for obstructive sleep apnoea: where are we now? Drugs. 2004;64(13):1385-99.
  • Block AJ, Wynne JW, Boysen PG et al. Menopause, medroxyprogesterone and breathing during sleep. Am J Med 1981; 70: 506-10.
  • Whyte K, Gould G, AMie A et al. Role of protriptyline and acetazolamide in the sleep apnoea/hypopnea syndrome. Sleep 1988; 11:463-72.
  • Smith PL, Haponik EF, Allen RP et al. The effects of protriptyline in sleep-disordered breathing. Am Rev Respir Dis 1983;127:8-13.
  • Sunderram J, Parisi RA, Strobel RJ. Serotonergic stimulation of the genioglossus and the response to nasal continuous positive airway pressure. Am J Respir Crit Care Med 2000; 162:925-9.
  • Hanzel DA, Proia NG, Hudgel DW. Response of obstructive sleep apnea to fluoxetine and protriptyline. Chest 1991; 100:416-21.
  • Kraiczi H, Hedner J, Dahlof P et al. Effect of serotonin uptake inhibition on breathing during sleep and daytime symptoms in obstructive sleep apnea. Sleep 1999; 22: 61-7.
  • Ip MS, Tse HF, Lam B et al. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med. 2004 Feb 1;169(3):348-53
  • Pack AI, Gislason T. Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis. 2009 Mar-Apr;51(5):434-51.
  • Harsch IA, Schahin SP, Brückner K et al. The effect of continuous positive airway pressure treatment on insulin sensitivity in patients with obstructive sleep apnoea syndrome and type 2 diabetes. Respiration. 2004 May-Jun;71(3):252-9.
  • L. Ozturk, Z. Pelin, D. Kaynak ve ark. Obstrüktif uyku apne sendromunda nazal CPAP tedavisine uyuma, görsel ağırlıklı eğitimin katkısı. Cerrahpaşa Tıp Dergisi. Cilt (Sayı): 32 (4)
  • D'Ambrosio C, Bowman T. Quality of life in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure--a prospective study. Chest. 1999 Jan;115(1):123- 9.
  • Sher AE, Thorpy MJ, Shprintzen RJ et al. Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty. Laryngoscope. 1985 Dec;95(12):1483-7.
  • Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996 Feb;19(2):156-77.
  • Kezirian EJ, Weaver EM, Yueh B et al. Incidence of serious complications after uvulopalatopharyngoplasty. Laryngoscope. 2004 Mar;114(3):450-3.
  • Back GW, Nadig S, Uppal S et al. Why do we have a uvula?: literature review and a new theory. Clin Otolaryngol Allied Sci. 2004 Dec;29(6):689-93.
  • Finkelstein Y, Meshorer A, Talmi YP et al. The riddle of the uvula. Otolaryngol Head Neck Surg. 1992 Sep; 107(3):444-50.
  • Kwon M, Jang YJ, Lee BJ et al. The Effect of Uvula-Preserving Palatopharyngoplasty in Obstructive Sleep Apnea on Globus Sense and Positional Dependency. Clinical and Experimental Otorhinolaryngology Vol. 3, No. 3: 141-146, Sep 2010
  • Madani M. Palatal Implants for treatment of habitual snoring; techniques, indications and limitations. Atlas Oral Maxillofac Surg Clin North Am 2007; 15 : 155-61.
  • Madani M. Laser Assisted Uvulopalatopharyngoplasty (LAUPPP) for the treatment of snoring and mild to moderate obstructive sleep apnea. Atlas Oral Maxillofac Surg ClinNorth Am 2007; 15 : 129-37.
  • Polites N, Joniau, Wabnitz D. Postoperative pain following coblation tonsillectomy: randomized clinical trial. ANZ J Surg 2006; 76 : 226-9.
  • Windfuhr JP, Deck JC, Remmert S. Hemorrhage following coblation tonsillectomy. Ann Otol Rhinol Laryngol 2005; 114 : 749-56.
  • Powell NB. Contemporary surgery for obstructive sleep apnea syndrome. Clin Exp Otorhinolaryngol. 2009 Sep;2(3):107-14.
  • Schmidt-Nowara W, Lowe A, Wiegand L et al. Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea: A Review. Sleep 1995,18:501-10
  • Johal A, Battagel JM. Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances. Br Dent J 2001;190:532-6
  • Kyung HS, Park YC, Pae EK. Obstructive sleep apnea patients with the oral appliance experince pharyngeal size and shape changes in three dimensions. Angle Orthod 2005;75(1):15-22.
  • Lazard DS, Blumen M, Lévy P et al. The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome. J Clin Sleep Med. 2009 Oct 15;5(5):431-8.
  • D. Nalbantgil, M.O. Öztoprak, V. Uyar. Obstrüktif Uyku Apnesi Sendromu ve Tedavi Yaklaşımları. Yeditepe Üniversitesi Diş Hekimliği Fakültesi Dergisi. Cilt 2 S 4. 2010
  • Clark GT, Arand D, Chung E et al. Effect of anterior mandibular positioning on obstructive sleep apnea. Am Rev Respir Dis. 1993 Mar;147(3):624-9

Obstructive Sleep Apnea Syndrome: Pathophysıology, Diagnosis and Treatment

Yıl 2011, Cilt: 20 Sayı: 2, 118 - 129, 01.06.2011

Öz

Obstructive sleep apnea syndrome (OSAS), is a dangerous disease that effect millions of people around the world. OSAS leads to serious comorbidities as well as it reduces the quality of life for patients. Many people do not recognize the disease or live undiagnosed for several years. OSAS can be treated effectively with continious positive airway pressure (CPAP) while others do not tolerate this treatment modality for various reasons. In this article, the pathophysiology, surgical and non surgical treatment modalities for OSAS were discussed.

Kaynakça

  • Meyer JB, Knudson RC. The sleep apnea syndrome. Part I: diagnosis. J Prosthet Dent 1989; 62: 675-679.
  • Shahar E, Whitney CW, Redline S et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001 Jan;163(1):19-25. 3. Reichmuth KJ, Austin D, Skatrud JB et al. Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med. 2005 Dec 15;172(12):1590-5. Epub 2005 Sep 28.
  • Lombardi C, Rocchi R, Montagna P et al.Obstructive sleep apnea syndrome: a cause of acute delirium. J Clin Sleep Med. 2009 Dec 15;5(6):569-70.
  • Luboshitzky R, Aviv A, Hefetz A et al. Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab. 2002 Jul;87(7):3394-8. 6. Kajaste S, Brander PE, Telakivi T et al. A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med. 2004 Mar;5(2):125-31 7. Smith IE, Quinnell TG. Pharmacotherapies for obstructive sleep apnoea: where are we now? Drugs. 2004;64(13):1385-99.
  • Block AJ, Wynne JW, Boysen PG et al. Menopause, medroxyprogesterone and breathing during sleep. Am J Med 1981; 70: 506-10.
  • Whyte K, Gould G, AMie A et al. Role of protriptyline and acetazolamide in the sleep apnoea/hypopnea syndrome. Sleep 1988; 11:463-72.
  • Smith PL, Haponik EF, Allen RP et al. The effects of protriptyline in sleep-disordered breathing. Am Rev Respir Dis 1983;127:8-13.
  • Sunderram J, Parisi RA, Strobel RJ. Serotonergic stimulation of the genioglossus and the response to nasal continuous positive airway pressure. Am J Respir Crit Care Med 2000; 162:925-9.
  • Hanzel DA, Proia NG, Hudgel DW. Response of obstructive sleep apnea to fluoxetine and protriptyline. Chest 1991; 100:416-21.
  • Kraiczi H, Hedner J, Dahlof P et al. Effect of serotonin uptake inhibition on breathing during sleep and daytime symptoms in obstructive sleep apnea. Sleep 1999; 22: 61-7.
  • Ip MS, Tse HF, Lam B et al. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med. 2004 Feb 1;169(3):348-53
  • Pack AI, Gislason T. Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis. 2009 Mar-Apr;51(5):434-51.
  • Harsch IA, Schahin SP, Brückner K et al. The effect of continuous positive airway pressure treatment on insulin sensitivity in patients with obstructive sleep apnoea syndrome and type 2 diabetes. Respiration. 2004 May-Jun;71(3):252-9.
  • L. Ozturk, Z. Pelin, D. Kaynak ve ark. Obstrüktif uyku apne sendromunda nazal CPAP tedavisine uyuma, görsel ağırlıklı eğitimin katkısı. Cerrahpaşa Tıp Dergisi. Cilt (Sayı): 32 (4)
  • D'Ambrosio C, Bowman T. Quality of life in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure--a prospective study. Chest. 1999 Jan;115(1):123- 9.
  • Sher AE, Thorpy MJ, Shprintzen RJ et al. Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty. Laryngoscope. 1985 Dec;95(12):1483-7.
  • Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996 Feb;19(2):156-77.
  • Kezirian EJ, Weaver EM, Yueh B et al. Incidence of serious complications after uvulopalatopharyngoplasty. Laryngoscope. 2004 Mar;114(3):450-3.
  • Back GW, Nadig S, Uppal S et al. Why do we have a uvula?: literature review and a new theory. Clin Otolaryngol Allied Sci. 2004 Dec;29(6):689-93.
  • Finkelstein Y, Meshorer A, Talmi YP et al. The riddle of the uvula. Otolaryngol Head Neck Surg. 1992 Sep; 107(3):444-50.
  • Kwon M, Jang YJ, Lee BJ et al. The Effect of Uvula-Preserving Palatopharyngoplasty in Obstructive Sleep Apnea on Globus Sense and Positional Dependency. Clinical and Experimental Otorhinolaryngology Vol. 3, No. 3: 141-146, Sep 2010
  • Madani M. Palatal Implants for treatment of habitual snoring; techniques, indications and limitations. Atlas Oral Maxillofac Surg Clin North Am 2007; 15 : 155-61.
  • Madani M. Laser Assisted Uvulopalatopharyngoplasty (LAUPPP) for the treatment of snoring and mild to moderate obstructive sleep apnea. Atlas Oral Maxillofac Surg ClinNorth Am 2007; 15 : 129-37.
  • Polites N, Joniau, Wabnitz D. Postoperative pain following coblation tonsillectomy: randomized clinical trial. ANZ J Surg 2006; 76 : 226-9.
  • Windfuhr JP, Deck JC, Remmert S. Hemorrhage following coblation tonsillectomy. Ann Otol Rhinol Laryngol 2005; 114 : 749-56.
  • Powell NB. Contemporary surgery for obstructive sleep apnea syndrome. Clin Exp Otorhinolaryngol. 2009 Sep;2(3):107-14.
  • Schmidt-Nowara W, Lowe A, Wiegand L et al. Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea: A Review. Sleep 1995,18:501-10
  • Johal A, Battagel JM. Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances. Br Dent J 2001;190:532-6
  • Kyung HS, Park YC, Pae EK. Obstructive sleep apnea patients with the oral appliance experince pharyngeal size and shape changes in three dimensions. Angle Orthod 2005;75(1):15-22.
  • Lazard DS, Blumen M, Lévy P et al. The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome. J Clin Sleep Med. 2009 Oct 15;5(5):431-8.
  • D. Nalbantgil, M.O. Öztoprak, V. Uyar. Obstrüktif Uyku Apnesi Sendromu ve Tedavi Yaklaşımları. Yeditepe Üniversitesi Diş Hekimliği Fakültesi Dergisi. Cilt 2 S 4. 2010
  • Clark GT, Arand D, Chung E et al. Effect of anterior mandibular positioning on obstructive sleep apnea. Am Rev Respir Dis. 1993 Mar;147(3):624-9
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Derleme
Yazarlar

Emrah Kara Bu kişi benim

Yayımlanma Tarihi 1 Haziran 2011
Yayımlandığı Sayı Yıl 2011 Cilt: 20 Sayı: 2

Kaynak Göster

AMA Kara E. Obstrüktif Uyku Apne Sendromu: Patofizyoloji, Tanı ve Tedavi. aktd. Haziran 2011;20(2):118-129.