阻塞性睡眠呼吸暂停综合征主要病因
OSAHS的直接发病机制是上气道的狭窄和阻塞,但OSAHS的发病并非简单的气道阻塞,还有呼吸中枢神经调节因素障碍。引起上气道狭窄和阻塞的原因很多,包括鼻中隔弯曲、息肉、鼻甲肥大、扁桃体肥大、扁桃体增生、软腭过长、腭弓低平、下颌弓狭窄、下 阻塞性睡眠呼吸暂停综合征
颌后缩畸形、小颌畸形、颞下颌关节强直,尤其是两侧关节强直继发的小颌畸形,舌体肥大、巨舌症,舌骨后移等。此外,肥胖、上气道组织黏液性水肿,以及口咽或下咽部肿瘤等也均可导致OSAHS。其病理解剖部位可在整个上气道,但以口咽部最为多见。应用多导睡眠图仪检查(polysomnograph,PSG)发现,OSAHS患者睡眠中颏舌肌肌电活动下降,睡眠时咽肌活动突然消失,造成气道上部狭窄,甚至突然闭塞。由于呼吸暂停,使肺泡血气交换障碍,造成低氧血症和高碳酸血症,由此诱发一系列全身症状,严重者血氧饱和度常在50%以下,动脉氧分压仅在3.73kPa(28mmHg)以下,这些可导致患者在睡眠中猝死。关于OSAHS的真正病因和发病机制,还待进一步研究。
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