阻塞性睡眠呼吸暂停的正压通气设备替代方案：一项表型指导的综述

文献信息

中文摘要

引言： 持续气道正压通气（PAP）是阻塞性睡眠呼吸暂停（OSA）的参考治疗；然而，依从性有限使许多患者治疗不充分，从而迫切需要与个体疾病机制相匹配的有效替代方案。
涵盖领域： 本综述探讨了成人中PAP的主要替代方案——定制口腔矫治器、上气道及依从性导向手术、舌下神经刺激、体位治疗、肌功能与呼吸肌训练、日间神经肌肉刺激、神经肌肉药物治疗以及体重导向的肠促胰岛素治疗。对于每种方案，我们总结了适应证、证据和局限性，并将药物诱导睡眠内镜、床旁功能测试和生理内型分析整合到候选者选择中。检索了PubMed/MEDLINE和Cochrane Library，时间范围为2005年1月至2026年7月，使用“obstructive sleep apnea”、“CPAP alternative”、“phenotype”、“endotype”、“drug-induced sleep endoscopy”以及每种模式名称的组合；优先纳入关键随机试验、当前临床实践指南和来自高影响力期刊的机制研究，并补充手工检索参考文献列表。
专家意见： OSA诊疗正从一刀切模式转向表型指导的精准管理。首个获批的药物治疗、舌下神经刺激的成熟与推广，以及内型靶向药物治疗，将使基于机制的选择和合理联合治疗成为治疗无法使用PAP患者的临床医生的核心任务。

英文摘要

INTRODUCTION: Continuous positive airway pressure (PAP) is the reference treatment for obstructive sleep apnea (OSA); however, limited adherence leaves many patients inadequately treated, creating a pressing need for effective alternatives matched to individual disease mechanisms.
AREAS COVERED: This review examines the principal alternatives to PAP - custom oral appliances, upper airway and adherence-directed surgery, hypoglossal nerve stimulation, positional therapy, myofunctional and respiratory muscle training, daytime neuromuscular stimulation, neuromuscular pharmacotherapy, and weight-directed incretin therapy in adults. For each, we summarize indications, evidence, and limitations, and integrate drug-induced sleep endoscopy, bedside functional testing, and physiological endotyping into candidate selection. PubMed/MEDLINE and the Cochrane Library were searched from January 2005 through July 2026 using combinations of 'obstructive sleep apnea,' 'CPAP alternative,' 'phenotype,' 'endotype,' 'drug-induced sleep endoscopy,' and each modality's name; pivotal randomized trials, current clinical practice guidelines, and mechanistic studies from high-impact journals were prioritized, supplemented by hand-searching reference lists.
EXPERT OPINION: OSA care is shifting from a one-size-fits-all model toward phenotype-guided precision management. The first approved drug therapy, the maturation and broadening of hypoglossal nerve stimulation, and endotype-targeted pharmacotherapy will make mechanism-based selection and rational combination therapy the central task for clinicians treating patients unable to use PAP.