體位(側(cè)臥)療法的醫(yī)學(xué)理論基礎(chǔ)闡述

1、體位/側(cè)臥療法的醫(yī)學(xué)理論基礎(chǔ)闡述體位干預(yù)療法，也即是側(cè)臥療法，用于OSA（阻塞性睡眠呼吸暫停綜合征）的醫(yī)學(xué)研究已相當(dāng)充分，在改善打鼾、呼吸暫停、低通氣方面的療效獲得肯定，并由于其無創(chuàng)、依從性好的特點，被認(rèn)為是治療的新方向。下文將引用三篇睡眠領(lǐng)域最權(quán)威雜志的綜述進(jìn)行簡述。1.Joosten,S.A.,etal.,Supinepositionrelatedobstructivesleepapneainadults:pathogenesisandtreatment.SleepMedRev,2014.18(1):p.7-17.sleeplieREVIEWSsleeplieREVIEWSArtichs&

2、IssuesvViewforFree*ForAuthorsvJournalInfovSubscribeMorePeriodicalsvAllContentSearchcmSearchAllContentSupinepositionrelatedobstructivesleepapneainadults:Pathogenesisandtreatment,Practicepoints,ResearchagendaSimonAJciosten回回OUrisccilLPhili).日三qE.GauS.HamltcnReceived:No/emberSl2012:Receivednrevisedform

3、:Januarv21.203:AcreDied:Januarv21.2013:FubishedOnline:kay24,2013sleepmedicinereviews雜志影響因子8.513原文鏈接：Supinepositionrelatedobstructivesleepapneainadultspathogenesisandtreatment.pdf主要觀點：避免仰臥睡姿有效。目前臨床治療指南上，此類體位相關(guān)OSA（阻塞性睡眠呼吸暫停綜合征）的治療被極大地忽視了。OSA（阻塞性睡眠呼吸暫停綜合征）患者中，50-60%為體位因素相關(guān)，25-30%為體位因素直接導(dǎo)致。亞洲人群比白種人中患病率更

4、高，67-75%的患者為體位因素相關(guān)。研究發(fā)現(xiàn)患者24小時血壓下降了，心血管表現(xiàn)提高了。以下各研究，都使用體位干預(yù)的治療方法，令患者睡眠時的避免仰臥，從而改善了45-63.4%的睡眠呼吸暫停低通氣指數(shù)，顯著改善了疾病癥狀。I.BignoldJJ,MercerJD,AnticNA,McEvoyRD,CatchesidePG:Accuratepositionmonitoringandimprovedsupine-dependentobstructivesleepapneawithanewpositionrecordingandsupineavoidancedevice.JCLINSLEEPMED2

5、011;7:376-383.2.PermutI,Diaz-AbadM,ChatilaW,CrocettiJ,GaughanJP,DAlonzoGE,KrachmanSL:ComparisonofpositionaltherapytoCPAPinpatientswithpositionalobstructivesleepapnea.JCLINSLEEPMED2010;6:238-243.3.OksenbergAS:Positionaltherapyforsleepapnea:Apromisingbehavioraltherapeuticoptionstillwaitingforqualified

6、studies.SLEEPMEDREV2014;18:3-5.4.SkinnerMA,KingshottRN,FilsellS,TaylorDR:EfficacyofthetennisballtechniqueversusnCPAPinthemanagementofposition-dependentobstructivesleepapnoeasyndrome.RESPIROLOGY2008;13:708-715.Themech-aiiKnu-ofsupinerelatedOSA七anbecvercomebytheuseofcontinueuspositiveairwayp-ressule.T

7、herereconHictirgdorttieutilitydForaIappliances,whLietheeffectiveressof鵬藝值htII口帛享andn3ul-expiratcryresistsfker-emsinsunclear.Avoidanceofthesupine-pc5tureisefficciDLiE.butlongtermcompliancedataandwellpowerednrdomizedcontrolledtrialsarelacking.Thetreatmentofsijpinerelated05Aremainslatelyoredinmajorclin

8、icalguideline-s.TheprevalenceofspOSAisvariablyreportedasbetweenSOand.60密ofpatientswhopresentrosleepclinicsforovernightpaly-somnograptiyr,e20whereaaappinxim前el#25BO密ctfth已samepopulationmaybeclassifiedaslurvingsiOSA-2721TheprewalencofspOSAin(lieAsianp-opuhrionishigherdianforCaucashiisatbetween57and75無

9、產(chǎn)TherearenoreportsofdieprevalenceofeittierconditionindiegeneralpopulationThetennis-balltechniqueisoftenreportedbycliniciansasarelativelysimpleandcost-effectivemethodofsupinesleepavoidance.Inthisstrategyatennisballisheldoverthepatienfsbackeitherwithasling,apocketsewnintoat-shirtorclothbeltTherational

10、eisthatwheneverpatientsrollontotheirbackthediscomfortoflyingonthetennis-ballforcesthemtorollontotheirside.Oksenbergetal?08recruited12spOSApatientswhohad!refusedcontinuouspositiveairwaypressure(CPAP)therapyandappliedaclothbeltwhichheldatennisbaIIinthemiddleofChesubjects,backandrepeatedthepolysomnogra

11、mwiththedeviceinsitu.Timespentsupinereducedfrom79%ondhediagnosticnightto12.3%onChetreatmentnightleadingtoareductioninoverallAHIfrom46.5events/hto17.5events/h.Interestingly.theaverageof79XsupinesleepinChediagnosticstudyismuchhigherthaninmostotherreportedstudies17-180-2124andmayhaveledtoanoverstatemen

12、tofthetreatmenteffect.Inanotherstudy.Skinneretal?09conducted!arandomizedcross-overtrialcomparingamodifiedtennis-balltechniquetoCPAPin20positionalOSApatients.Thepatientswerediagnosedwithmild-moderateOSAand!selectedonthebasisoftwiceasmanyeventsinthesupinesleepingpositionandanon-supineAHIof10events/h.A

13、lthoughtherewerenodifferencesinEpworthsleepinessscores(ESS)orFunctionalOutcomesofSleepQuestionnaire,CPAPwasmoreeffectiveatreducingtheAHI(fromameanof22.9events/hinbothgroupspriortotreatmentto4.9events/hversus12.0events/h).inthisstudy,dhemodifiedtechniquereduced!supinesleepingfrom34.4%to6.3%.Inadditio

14、nitoreducingtimespentsupine,thetennis-balltechnique”hasbeenshowncoreduce24-hbloodpressureinasnnallsampleofpatientswithspOSA.110ThuslongtermtreatnientofsupinerelatedOSAcouldimprovecardiovascularoutcomes,althoughfindingsneedtobereplicatedinalargersamplewithalongerfollow-upperiod.2.Lee,J.B.,etal.,Deter

15、miningoptimalsleeppositioninpatientswithpositionalsleep-disorderedbreathingusingresponsesurfaceanalysis.JSleepRes,2009.18(1):p.26-35.JournalOfSleepResearchDeterminingoptimalsleeppositioninpatientswithpcsitionalsleep-diEordenedbreathingusingresponsesurfaceanalysisJUNGBOKDeterminingoptimalsleeppositio

16、ninpatientswithpcsitionalsleep-diEordenedbreathingusingresponsesurfaceanalysisJUNGBOKLEE1,YOUNGHWANPaRK2,JUNGHWAHDNG2.3ELNGHOONLEE3.KIHWAN兒NW4正136圖泌.HYERYE3NM5andCHCiL訓(xùn)儲Articlefrstpudishedonline:24FEB2009DOI：10.1111/j.126E-2069.2OOS.OC7C3.：(居sueuunjaldf一.JournalofSle&pR&saarchVoltme18,lssu&1,pages26

17、-35.March2009journalofsleepresearch雜志影響因子原文鏈接：Determiningoptimalsleeppositioninpatientswithpositionalsleep-disorderedbreathingusingresponsesurfaceanalysis.pdf主要觀點：研究通過數(shù)據(jù)建模分析，發(fā)現(xiàn)側(cè)臥（至少30）是打鼾率和AHI（呼吸暫停低通氣指數(shù)）的主要影響因素。理想的睡姿可以減少80%的打鼾率。當(dāng)側(cè)臥至少30，背部墊高2cm時，AHI（呼吸暫停低通氣指數(shù)）可以降低80%。SIAhierdpetition(LP|duringileepis

18、effectiveinreducingsleepdisrudersyniptonzsinTrilclc)rnicxienilesleepapnenptlienIi.However,theeiieclofheadandhrmlderpDilLireinLPonreducingsleepdisc，Rk$hawnotbeenreprled.InIhigstudy,electivesleepingpositionsandacombmilionofsleeppositiondelemiinLiidswereevahicitedwilkrespectIollieirability3reciiceironn

19、gandapnea.ThepositionsevahicitedinchicedIlie(oil口wing:cer/icLlvertebrciesupport竄ilhheadtilting(CVS-HT),scapulasupport(S&XandLP.AcenirLiltompDiiledesignwasLippliecforresponsesurfaceanalysis(RSA).SixleenpatientswithmildormoderatepositionalsleepEipneiiyndsnoringArhouiiand/o2。tthieipecliely.Todelemiinea

20、n田Rcint日式、戶itiu】.LW-HI】對一。Mlj.t1式卜廣亡ufihuLP.shuLild1hconturrerllvconsiceredinpLilianswilhposiliiKilsleepapneaorLmring.3.Ravesloot,M.J.,etal.,Theundervaluedpotentialofpositionaltherapyinposition-dependentsnoringandobstructivesleepapnea-areviewoftheliterature.SleepBreath,2013.17(1):p.39-49.RaviswSl=ef

21、andBreathingParzh2C13,Volume17,Issue1,op39-4SFirstorlie:24MErcn20-2SLEEPan蛆BreathmgOpenAccesE3.Ravesloot,M.J.,etal.,Theundervaluedpotentialofpositionaltherapyinposition-dependentsnoringandobstructivesleepapnea-areviewoftheliterature.SleepBreath,2013.17(1):p.39-49.RaviswSl=efandBreathingParzh2C13,Vol

22、ume17,Issue1,op39-4SFirstorlie:24MErcn20-2SLEEPan蛆BreathmgOpenAccesETheundervaluedpotentialofpositionaltherapyinposition-dependentsnoringandobstructivesleepapneaareviewoftheliteratureLookInsideArticeMetricsLURa、1居式11P*n反需nen皿】卜1rF工SleepandBreathing雜志影響因子2.482原文鏈接：Theundervaluedpotentialofpositionalt

23、herapyinposition-dependentsnoringand)structivesleepapneaireviewoftheliterature.pdfZ：主要觀點：OSA（阻塞性睡眠呼吸暫停綜合征）在人群中患病率為2-26%?；颊叩男难芗膊?、交通意外風(fēng)險升高。眾研究認(rèn)為打鼾在仰臥睡姿下加重了。側(cè)臥狀態(tài)下打鼾的平均時間由17.5%降至6.4%，平均聲強由101.6分貝降至98.3分貝。打鼾率從36.7%下降至15.7%。所有的研究都肯定了體位/側(cè)臥療法對于降低AHI（呼吸暫停低通氣指數(shù)）的效果。一種基于震動裝置形式的體位/側(cè)臥療法，使平均AHI（呼吸暫停低通氣指數(shù)）由27.7降至

24、12.8。有研究將基于背囊形式的體位/側(cè)臥療法與公認(rèn)最有效的正壓通氣治療進(jìn)行對比，肯定了兩者的療效，前者將平均AHI（呼吸暫停低通氣指數(shù)）由17.9降至9.5,后者降至3.4。有研究將基于胸帶形式的體位/側(cè)臥療法與公認(rèn)最有效的正壓通氣治療進(jìn)行對比，前者將平均AHI（呼吸暫停低通氣指數(shù)）由22.7降至12,后者由降至4.9,而且體位/側(cè)臥療法持續(xù)使用的依從性優(yōu)于正壓通氣治療。R，portrhakethatgnoring重aggrzrvrt&dbyagjpin巳sleeping0口sition25n3S).Nakaneetal.39describedtheeffectofpositionon叩or

25、i.ngin2Inon-apneic(AHI5).TheyconcludethatSnoringtimeaswellassnoringintensitywas.lowerinthelateralpositiojithaninthesupinepositioninthenon-apneicpatientswhilstintheapneicgroupneithersnoringtimenorintensityhadstatisticaldjfferences.Innon-apneic語mtsth已snoringtine*七與17.5%andS_4%andtheint已nsity1力18andg&一

26、3d日inthesai口in巳andnon-su口ineAtion導(dǎo).用g口ectiqel用Intheapneicgroup,thesn-oringtimewas16.9%and15.4%andtheintensityIC2.9andIQ33dBin(liesupineandnon-supinepositions,respectively.IdarattempttodecreasediswmfortandnmprovecorrvpliancyourgroupdevelopedanEwrtreatmentconcept:asmallneclc-w-omvibratingdevicewtuctip

27、reventspatientsfk)mapplying-asupinesleepingposition53.Whenwearingthe-device,adaptingas-upine-positiontriggersavibrationwhkhincreasesinintensityiintaanewpositionisadapted,withoutsignicantlyreducingtotalsleeptimeordisruptingsleep.ThirtypatientswithpositionalsleepapneawereincludedinpilotstudyNosideeffe

28、ctswerereported.丁tiemeanAHIdnjppedfk3m27一7上工4toSevenpatientsdevelopedanoverallAHIbelow5whenuxingthedevi-ceinONmodus.Althoughthuresultsareencouraging,severalitemsremaintobeaddress.edwiththisdevi-ce,andtkereisroom,fcriinpr-ovement.Thelong-termeffectrefnain5tobetudied.ThreepublicalicnsstudiedtheeffectofPTcomparedtoCPAPinarandamizedcrossoverstudysetup.Jakketal.48included13patientswhowere