314 Ch 313. Sleep Apnea and Sleep-Disordered Breathing

Sleep-disordered breathing (SDB) 三大族群：(1) obstructive sleep apnea (OSA) — 最常見，airway collapse；(2) central sleep apnea (CSA) — neurologic / HF (Cheyne-Stokes)；(3) sleep-related hypoventilation — OHS、CCHS、neuromuscular；OSA epidemiology：1 in 4 adults globally；risk factors：obesity、anatomy (large neck, retrognathia)、男性、age、smoking、alcohol、family hx；OSA consequences：HTN、AF、HF、stroke、MI、insulin resistance、dementia、accidents；diagnosis：polysomnography (PSG, gold standard) + home sleep apnea test (HSAT) for uncomplicated；AHI ≥ 5 (with symptoms) or ≥ 15 = diagnostic；severity by AHI 5-15 mild, 15-30 moderate, > 30 severe；treatment = CPAP (gold standard)、weight loss、mandibular advancement device、hypoglossal nerve stimulation (Inspire)、positional therapy、surgery；CSA / Cheyne-Stokes in HFrEF：CPAP + ASV (caution SERVE-HF — ↑ mortality)；2023-2024 GLP-1 + tirzepatide for OSA + obesity (SURMOUNT-OSA 2024) game-changer — tirzepatide reduces AHI 50%+；Inspire HGNS 2014 FDA approved for moderate-severe OSA, expanding indications。