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1 1, % 20% 50% 29% 1

2 4% 2%

3 OSAS (obstructive sleep apnea syndrome, OSAS) (REM) (postural tone) 1 (OSAS). 3 OSAS 20% 40 60%

4 (AHI) (OSAS) 5 OSAS 5% 2 OSAS 4% 2% OSAS OSAS ( 1) 6,7 8,9 10 (CAD) OSAS 12 CAD OSAS 4

5 Table 1 (OSAS) 11 (AV) 13 OSAS OSAS OSAS 17 OSAS OSAS (RTA) 16% (RTA) 20% 50% 29% 20 5

6 OSAS OSAS OSAS OSAS OSAS OSAS Epworth 10 55% 52% 18% OSAS 10% (ACOEM) OSAS

7 OSAS OSAS (PSG) PSG OSAS (BMI) 24 Friedman M Mallampati (MMP) BMI OSA 25 MMP 4 - I (1 ) II (2 ) III (3 ) IV (4 ) ( 1) 5 0 (0 ) I (1 ) II (2 ) III (3 ) 3/4 IV (4 ( 2) 5 0 (0 ) BMI < 20 kg/m 2 I (1 ) BMI kg/m 2 II (2 ) BMI kg/m 2 III (3 ) BMI kg/m 2 IV (4 ) BMI > 40 kg/m 2 BMI + MMP OSA 7

(4 ( 2) 5 0 (0 ) BMI < 20 kg/m 2 I (1 ) BMI 20-25 kg/m 2 II (2 ) BMI 25-30

8 Fig. 1 Illustration of modified Mallampati grades: Mallampati I (A), Mallampati II (B), Mallampati 111 (C), and Mallampati IV (D). BMI + MMP OSA OSA 20 (RDI) 90% OSA OSA (RDI 45) 74% OSA RDI < 20 67% Fig. 2 Illustration of tonsil grades A. Grade 0 tonsils B. Grade I tonsils C. Grade II tonsils D. Grade III tonsils E. Grade IV tonsils 8

BMI + MMP + 4 4 OSA OSA 20 (RDI) 90% OSA OSA (RDI 45) 74% OSA RDI < 20 67% Fig.

9 (PSG) PSG OSAS OSAS (1) (SDB) (2) (3) SDB (4) OSA (5) SDB 27 SDB Epworth (ESS) 8 ( ) 0 = 1 = 2 = 3 = 8 ESS 9

10 ESS ESS SaO2 29 ESS 28 ESS (SDB) SDB SDB OSA OSA (RDI = 15~30) (RDI > 30) OSAS OSA OSAS SDB OSAS 3% (ODI) 3% ODI =5 AHI 5 10

11 80% 95% 3% ODI =15 AHI 20 85% 100% 30 OSAS OSAS 90% OSAS OSAS ( 2) 11 OSAS Table 2 OSAS 11 (CPAP) (autocpap) (bilevel PAP) 11

12 31 OSA (sleep architecture) (REM) (nasal CPAP) OSAS (functional residual capacity) 12

13 CPAP autocpap (bilevel PAP) CPAP OSAS 5 32 OSAS CPAP 33 OSAS OSAS OSAS CPAP (UPPP) UPPP 50% 31% UPPP OSA 34 UPPP % OSAS 13

14 OSAS OSAS References 1. Caples SM, Kara T, Somers VK. Cardiopulmonary consequences of obstructive sleep apnea. Semi Respir And Crit Care Med 2005;26: Young T, Peppard P, Gottlieb D. Epidemiology of obstructive sleep apnea. a population health perspective. Am J Respir Crit Care Med 2002;165; American Sleep Disorders Association. Primary Snoring. In: The International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual. Rochester, MN: American Sleep Disorders Association; 1997: Bloom J, Kaltenborn W, Quan S. Risk factors in a general population for snoring: importance of cigarette smoking and obesity. Chest 1988;93: Hoffstein V, Chaban R, Cole P, Rubinstin I. Snoring and upper airway properties. Chest 1988;94: Nieto F, Young T, Lind B et al. Association of sleep disordered breathing, sleep apnea and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283: Peppard P, Young T, Palta M et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342: Levie P, Herer P, Hoffstein V. Obstructive sleep apnea syndrome as a risk factor for hypertension: population study. BMJ 2000;320: Bixler E, Vgontzas A, Lin H et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med 2000;160: Davies C, Crosby J, Mulins R et al. Case-control study of 24 hour 14

In: The International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual. Rochester, MN: American Sleep Disorders Association; 1997:195-197 4. Bloom J, Kaltenborn W, Quan S.

15 ambulatory blood pressure in patients with obstructive sleep apnea and normal matched control subjects. Thorax 2000;55: Collop NA. Obstructive sleep apnea syndromes. Semi Respir And Crit Care Med 2005;26: Shahar E, Whitney C, 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;163: Guilleminault C, Connolly S, Winkle R. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983;52: Chaouat A, Weitzenblum E, Krieger J, et al. Pulmonary hemodynamics in the obstructive sleep apnea syndrome: results in 220 consecutive patients. Chest 1996;109: Bassetti C, Aldrich M, Cheryin R, et al. Sleep apnea in patients with transient ischemic attack and stroke; a prospective study of 59 patients. Neurology 1996;47: Punjabi N, Sorkin J, Katzel, et al. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002;165: George C, Smiley A. Sleep apnea and automobile crashes. Sleep 1999;22: Ulfberg J, Carter N, Talback M, et al. Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy smorers and patients with obstructive sleep apnea. Chest 1996;110: Ulfberg J, Carter N, Edling C. Sleep-disordered breathing and occupational accidents. Scand J Work Environ Health 2000;26: Horne J, Reyner LA. Sleep related vehicle accidents. BMJ 1995;310: Vennelle M, Engleman HM, Douglas NJ. Sleepiness and sleep-related accidents in commercial bus drivers. Sleep Breath 2010;14: Nakata A, Takahashi M, Ikeda T, et al. Perceived job stress and sleep-related breathing disturbance in Japanese male workers. Social Science and Medicine 2007;64: Durand G, Kales SN. Obstructive sleep apnea screening during commercial driver medical examinations: a survey of ACOEM members. J Occup Environ Med 2009;51:

Am J Respir Crit Care Med 2001;163:19-25 13. Guilleminault C, Connolly S, Winkle R. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome.

16 24. Katz I, Stradling J, Slutsky AS, et al. Do patients with obstructive sleep apnea have thick neck? Am Rev Respir Dis 1990;141: Friedman M, Tanyeri H, Rosa ML, et al. Clinical Predictors of Obstructive Sleep Apnea. The Laryngoscope 1999;109: Gurubhagavatula I, Maislin G, Nkwuo JE, et al. Occupational screening for obstructive sleep apnea in commercial drivers. Am J Respir Crit Care Med 2004;170: Tanigawa T, Horie S, Sakurai S, et al. Screening for sleep-disordered breathing at workplace. Industrial Health 2005;42: Chen NH, Johns MW, Li HY, et al. Validation of a Chinese version of the Epworth sleepiness scale. Qual Life Res 2002;11: Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14: Nakamata M, Kubota Y, Sakai K, et al. The limitation of screening test for patients with sleep apnea syndrome using pulse oximetry. J Jpn Soc Respir Care 2003;12: Browman C, Sampson M, Yolles S, et al. Obstructive sleep apnea and body weight. Chest 1984;85: Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N, et al. Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. Chest 2005;128: Mazza S, Pepin JL, Naegele B, et al. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J 2006;28: Shepard J, Olsen D. Uvulopalatopharyngoplasty for treament of OSA. Mayo Clin Proc 1990;65: Boot H, Wegen RV, Poublon RML, et al. Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. The Laryngoscope 2000;110:

Occupational screening for obstructive sleep apnea in commercial drivers. Am J Respir Crit Care Med 2004;170:371-376 27. Tanigawa T, Horie S, Sakurai S, et al.

196 睡眠呼吸中止患者體質險 5,7 ; 又因為睡眠時上呼吸道呼吸暫停, 身體無法獲得充分休息, 常於白天出現疲倦嗜睡等情形如果患者需要於日間操作機械或駕駛車輛, 甚至常

196 睡眠呼吸中止患者體質險 5,7 ; 又因為睡眠時上呼吸道呼吸暫停, 身體無法獲得充分休息, 常於白天出現疲倦嗜睡等情形如果患者需要於日間操作機械或駕駛車輛, 甚至常 J Chin Med 22(3,4): 195-204, 2011 195 1 1,2, * 3 4 5 1 2 3 4 5 100 07 07 100 10 31 阻塞型睡眠呼吸中止症候群 (Obstructive Sleep Apnea-Hypopnea Syndrome, OSA) 的患者, 睡眠時會因呼吸中止而缺氧, 近年來中醫治療