(Young et al., 1993) AHI 15 AHI >5. (Peppard et al., 2013) - 10% 17%

Transcription

1 InSpiro

2 ICSD American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd edition. Darien IL American Academy of Sleep Medicine 2014

3 Pickwick American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd edition. Darien IL American Academy of Sleep Medicine 2014

4 Pickwick American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd edition. Darien IL American Academy of Sleep Medicine 2014

5 Young et al % AHI 15 AHI >5. 9% AHI >5 4% / / / 2% Peppard et al % % 3% 9% Young T Palta M Dempsey J et al. The occurrence of sleepdisordered breathing among middleaged adults. N Engl J Med Peppard P Young T Barnet J et al. Increased Prevalence of SleepDisordered Breathing in Adults. Am J Epidemiol

6 0.37% 10% 15% BMI 50 / 2 50% 3. 80% 90% Piper A Obesity hypoventilation syndrome the big and the breathless. Sleep Med Rev Nowbar S Burkart K Gonzales R et al. Obesityhypoventilation in hospitalized patients prevalence effects and outcome. Am J Med

7 >50% 3. >50% nondipper / / Baguet J BaroneRochette G Tamisier R et al. Mechanisms of cardiac disfunction in obstructive sleep apnoea. Nat Rev Cardiol Budhiraja R Budhiraja P Quan S. Sleepdisordered breathing and cardiovascular disorders. Respir Care Sajkov D McEvoy R Obstructive sleep apnea and pulmonary hypertension. Prog Cardiovasc Dis Bakker JP Sharma B Malhotra A Obstructive sleep apnea the elephant in the cardiovascular room. Chest

8 20 40% CPAP Sajkov D McEvoy R Obstructive sleep apnea and pulmonary hypertension. Prog Cardiovasc Dis Baguet J BaroneRochette G Tamisier R et al. Mechanisms of cardiac disfunction in obstructive sleep apnoea. Nat Rev Cardiol

9 50% / 20% Mokhlesi B Obesity hypoventilation syndrome a stateoftheart review. Respir Care Kauppert C Dvorak I Kollert F et al. Pulmonary hypertension in obesityhypoventilation syndrome. Respir Med

10 A 1 A. C ь B. B 5 2 [RERAs] C. 15 [RERAs] American Academy of Sleep Medicine. International Classification of Sleep Disorders. Third Edition. AASM USA 2014

11 AC. PaCO2 >45 mmhg endtidal B. >30 / 2 >95 C. Pickwick American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd edition. Darien IL American Academy of Sleep Medicine 2014

12 3. 4. Pcrit Ц. genioglossus 86% Randerath W Sleeprelated breathing disorders pathophysiology. In Bassetti C Dogas Z Peigneux P et al. European Sleep Medicine Textbook. ESRS 2014 D

13 Norman et al. Berger et al. 3.! Piper A Obesity hypoventilation syndrome the big and the breathless. Sleep Med Rev Berger K Goldring R Rapoport D Obesity hypoventilation syndrome. Semin Respir Crit Care Med Norman R Goldring R Clain J et al. Transition from acute to chronic hypercapnia in patients with periodic breathing predictions from a computer model. J Appl Physiol

14 BMI ESS 3. ESS Epworth Sleepiness Scale BMI bodymass index CO2! Mallampati score Piper A Obesity hypoventilation syndrome the big and the breathless. Sleep Med Rev Berger K Goldring R Rapoport D Obesity hypoventilation syndrome. Semin Respir Crit Care Med Andreas S Obstructive sleep apnoea clinical aspects. In Simonds A de Backer W ERS handbook of respiratory sleep medicine. ERS 2012 UK Friedman M Ibrahim H Bass L Clinical staging for sleepdisordered breathing. Otolaryngol. Head Neck Surg

15 и и г афия я. г афия я. иг афи я я.. Berry R Budhiraja R Gottlieb D et al. Rules of scoring respiratory events in sleep update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events Deliberations of the Sleep Apnoea Definitions Task Force of the American Academy of Sleep Medicine. J. Clin. Sleep Med Collop N Anderson W Boehlecke B et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnoea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J. Clin. Sleep Med

16 3. 4. PaCO2 >45 mmhg 5. 6.! Er Hct Berger K Goldring R Rapoport D Obesity hypoventilation syndrome. Semin Respir Crit Care Med Mokhlesi B Kryger M Grunstein R Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd edition. Darien IL American Academy of Sleep Medicine 2014

17 ESS section cesarea 90 / II

18 56 38 / Cor BMI 57.5 / 92 / 2 RR 80/50 mmhg 60%! BiPAP S/T 24/8 mmhg 55 43% % 1/ 96.77%

19 10% 10% 32% AHI 26% Pevernagie D Sastry M Vanderveken O Sleeprealted breathing disorders treatment of respiratory sleep disorders. In Bassetti C Dogas Z Peigneux P et al. European Sleep Medicine Textbook. ESRS 2014 D Peppard P Young T Palta M et al.longitudinal study of moderate weight change and sleepdisordered breathing. JAMA Piper A Obesity hypoventilation syndrome the big and the breathless. Sleep Med Rev

20 theophylline acetazolamide Pevernagie D Sastry M Vanderveken O Sleeprealted breathing disorders treatment of respiratory sleep disorders. In Bassetti C Dogas Z Peigneux P et al. European Sleep Medicine Textbook. ESRS 2014 D Peppard P Young T Palta M et al.longitudinal study of moderate weight change and sleepdisordered breathing. JAMA Piper Obesityhypoventilation hypoventilation syndrome theand bigthe and the breathless. Sleep Med Rev Piper AAObesity syndrome thebig breathless. Sleep Med Rev

21 CPAP BiPAP 3. VAPS. S T S/T Pickwick VolumeAssured Pressure Support Pickwick 4. Piper A Obesity hypoventilation syndrome the big and the breathless. Sleep Med Rev Simonds A Positive airway pressure treatment. In In Simonds A de Backer W ERS handbook of respiratory sleep medicine. ERS 2012 UK

22 Mandibular Advancement Devices MAD Tongueretaining devices 3. HGNS System Aura6000 system Inspire II Upper Airway Stimulation device 3. Randerath W Verbraecken J Andreas S et al. NonCPAP therapies in obstructive sleep apnoea. Eur Respir J Simonds A Positive airway pressure treatment. In In Simonds A de Backer W ERS handbook of respiratory sleep medicine. ERS 2012 UK Eastwood P Barnes M Walsh J et al. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep Certal V Zaghi S Riaz M et al. Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea A systematic review and metaanalysis. Laryngoscope

23 / website inspirobg.com

24 !