美国阻塞性睡眠呼吸暂停诊疗生态系统：临床路径与耳鼻咽喉科不断演变的作用

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）是一种常见的异质性疾病，通过多学科路径进行管理，该路径连接识别、生理测试、治疗选择、专科转诊、保险覆盖和纵向再评估。本叙述性综述面向国际临床读者，提供美国成人OSA诊疗生态系统的临床导向、系统层面概述，并特别强调耳鼻咽喉科不断演变的作用。我们描述了睡眠医师、耳鼻咽喉科医师、牙科医师和 allied health professionals 的组织结构和互补功能。我们还概述了多导睡眠监测和家庭睡眠呼吸暂停检测的作用，以及主要治疗路径，包括气道正压、口腔矫治器治疗、体重管理、上气道手术和神经刺激。耳鼻咽喉科通过整合解剖评估、睡眠状态气道表型分析、干预选择和治疗后再评估，在生理诊断和气道特异性治疗之间提供重要接口。神经刺激、药物体重管理、可穿戴和家庭监测、气流分析以及人工智能的最新进展正在扩大可及且基于表型的诊疗机会。重要挑战包括诊断不足、治疗脱落、转诊衔接碎片化、覆盖范围差异以及对呼吸暂停低通气指数的依赖。尽管国际间医疗保健结构不同，多学科协调、个体化治疗选择和纵向再评估为发展以患者为中心的OSA项目提供了广泛适用的原则。

英文摘要

Obstructive sleep apnea (OSA) is a common, heterogeneous disorder managed through a multidisciplinary pathway that connects recognition, physiologic testing, treatment selection, specialty referral, insurance coverage, and longitudinal reassessment. This narrative review provides a clinically oriented, system-level overview of the adult OSA care ecosystem in the United States for an international clinical audience, with particular emphasis on the evolving role of otolaryngology. We describe the organization and complementary functions of sleep physicians, otolaryngologists, dentists, and allied health professionals. We also outline the roles of polysomnography and home sleep apnea testing, along with major therapeutic pathways including positive airway pressure, oral appliance therapy, weight management, upper-airway surgery, and neurostimulation. Otolaryngology provides an important interface between physiologic diagnosis and airway-specific treatment by integrating anatomic evaluation, sleep-state airway phenotyping, intervention selection, and post-treatment reassessment. Recent advances in neurostimulation, pharmacologic weight management, wearable and home-based monitoring, airflow analysis, and artificial intelligence are expanding opportunities for accessible and phenotype-informed care. Important challenges include underdiagnosis, treatment attrition, fragmented transitions, variable coverage, and reliance on the apnea-hypopnea index. Although health-care structures differ internationally, multidisciplinary coordination, individualized treatment selection, and longitudinal reassessment provide broadly applicable principles for developing patient-centered OSA programs.