摘要
阻塞性睡眠呼吸中止症(obstructive sleep apnea, OSA)是睡眠呼吸障礙(Sleepdisordered breathing)中最常見且重要的一種疾病，長遠的併發症為各種心血管及代謝性疾病，進而提高病患的死亡率。很多研究均顯示年齡是阻塞性睡眠呼吸中止症重要的影響因子，老年病患的阻塞性睡眠呼吸中止症可視為一個特殊的族群，其表現和年輕及中年族群略有不同。本文從此疾病在老年病患的盛行率、病程進展、臨床表現、死亡率及治療等面向探討老年和中年病患的阻塞性睡眠呼吸中止症的差異。老年的阻塞性睡眠呼吸中止症盛行率應是多於年輕世代的族群，但其臨床表徵較不典型，可能導致篩檢及診斷上的困難。阻塞性睡眠呼吸中止症在老年人增加的原因是解剖構造及生理隨著老化的改變，增加喉頭塌陷的程度導致。然而，雖然阻塞性睡眠呼吸中止症會增加中年族群的死亡率，但此現象在老年族群未被觀察到。目前仍認為應該對於有症狀且影響生活功能的老年人提供正壓輔助呼吸器治療，不應以年紀為不給予治療的理由。總結而言，阻塞性睡眠呼吸中止症雖在老年族群有高盛行率，但所造成的臨床症狀、併發症及死亡率，其臨床重要性似乎比年輕族群來的輕微。然而，此領域仍有許多未解且值得探討的地方，尚待進一步研究。
並列摘要
Obstructive sleep apnea (OSA), a major and the most common type of sleep disordered breathing, is an independent risk factor for hypertension, metabolic disease and cardiovascular events and is associated with increased mortality. Aging plays an important role in the pathogenesis of OSA as its presentations and outcomes in the elderly are different from those in the middle aged population. The elderly should therefore be treated as a specific subgroup in OSA. The paper accordingly focuses on examining the noticeable disparities in prevalence, disease progression, clinical presentation, mortality and treatment between middle-aged and elderly OSA. The prevalence of OSA in the elderly appears to be higher than that of the younger population. Also to be noted is that the screening and diagnosis of OSA in the elderly are more difficult due to its atypical presentation. The increased pharyngeal airway collapsibility associated with old age renders the elderly more vulnerable to obstructive sleep apnea. While moderate-to-severe sleep apnea is observed to increase the risk of all-cause mortality in the middle-aged population, the OSA-mortality association emerges to be nonsignificant in elderly patients. Continuous positive airway pressure (CPAP) treatment should be offered to older patients with symptomatic OSA syndrome. In conclusion, in spite of its high prevalence, OSA leads to less profound effects in the elderly in terms of clinical symptoms, morbidity and mortality when compared to OSA in the middle-aged population.
延伸閱讀
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