314.2 🩺 國考版

314.2.1 高頻考點

314.2.1.1 AHI Classification

  • < 5: normal
  • 5-14: mild
  • 15-29: moderate
  • ≥ 30: severe

314.2.1.2 Diagnostic Criteria

  • AHI ≥ 15 OR
  • AHI ≥ 5 + symptoms or comorbidities

314.2.1.3 STOP-BANG

  • Snoring + Tired + Observed apnea + BP elevated + BMI > 35 + Age > 50 + Neck > 40 cm + Gender male
  • ≥ 3 = high risk

314.2.1.4 Treatments

  • Lifestyle: weight loss, alcohol avoidance, positional
  • CPAP: gold standard
  • BiPAP: for OHS, comfort, complex
  • MAD (mandibular advancement device): mild-moderate
  • HGNS (Inspire): moderate-severe + CPAP-intolerant + BMI < 32
  • Surgical: UPPP (limited), MMA (effective select), tracheostomy (rarely), bariatric (obese)
  • Pharmacotherapy: tirzepatide (SURMOUNT-OSA 2024 NEW)

314.2.1.5 CSA Types

  • Primary (idiopathic)
  • Cheyne-Stokes (HFrEF, brainstem)
  • High altitude
  • Opioid-induced
  • Treatment-emergent

314.2.1.6 HFrEF + Cheyne-Stokes

  • SERVE-HF 2015: ASV ↑ mortality — DON’T use
  • CPAP modest benefit
  • Optimize HF therapy

314.2.1.7 Key Trials

  • STAR (2014): Inspire HGNS for OSA — FDA approved
  • SERVE-HF (2015): ASV ↑ mortality in HFrEF + CSR
  • SAVE (2016): CPAP in OSA + CVD — neutral
  • SURMOUNT-OSA (2024): tirzepatide for OSA + obesity — game-changer

314.2.1.8 Pediatric OSA

  • Adenotonsillar hypertrophy primary cause
  • Adenotonsillectomy first-line
  • CPAP if persistent

314.2.2 易混淆比范

Type Mechanism Treatment
OSA Airway collapse CPAP, MAD, HGNS, surgery
CSA (idiopathic) Loss of central drive Acetazolamide, O2, CPAP
Cheyne-Stokes (HFrEF) Periodic breathing Optimize HF; NO ASV
Opioid-induced CSA Drug effect Wean opioid
OHS Hypoventilation + obesity CPAP/BiPAP + weight loss
CCHS PHOX2B mutation Lifelong ventilation

314.2.2.1 Treatment Adherence Metrics

  • Goal: ≥ 4 hr/night, ≥ 5 nights/week (Medicare standard)
  • Tracked by CPAP device data
  • 50% suboptimal
  • Mask fit, education, follow-up improve adherence