追加：第 3 节第 27 条，打鼾憋气、白天犯困的去查睡眠呼吸暂停，中重度的戴呼吸机

2026-10-14。主任务按「对照各节主要风险补条目」派来的候选。

查重

  • 全书 grep「呼吸暂停|打鼾|CPAP|呼吸机」：第 2 节第 37 条（午睡）备注只说「打呼噜和睡觉憋气要查睡眠呼吸暂停」，第 2 节第 3 条（睡够 7 小时）备注把它列为睡得长的原因之一，第 3 节第 26 条（长期失眠）备注说规范要求先排除它。三处都是顺带一句，没有「怎么查、查出来怎么治、治了有什么用」，不算重复。
  • 第 3 节第 26 条备注原来写「怎么查见第 2 节第 37 条」，可那条并没写怎么查，改成指向本条。
  • 第 1 节第 9 条（困了就停车歇）管的是开车当下，本条管犯困的病因，两边互相指路。

四问

  1. 会碰上：2019 年估算中国 30 到 69 岁约 1.76 亿人有这个病。
  2. 普遍不知道：多数人把打鼾当睡得香，不知道能查、能治。
  3. 动作是新的：去做睡眠监测、戴呼吸机，全书没有。
  4. 有原始来源：美国睡眠医学会指南和系统综述、NEJM 随机试验、JAMA 荟萃。

1. Kapur 2017，AASM 诊断指南

  • https://doi.org/10.5664/jcsm.6506，全文 https://pmc.ncbi.nlm.nih.gov/articles/PMC5337595/（2026-10-14 带代理取到）
  • 「An increased risk of moderate to severe OSA is indicated by the presence of excessive daytime sleepiness and at least two of the following three criteria: habitual loud snoring, witnessed apnea or gasping or choking, or diagnosed hypertension.」
  • 「excessive daytime sleepiness occurring on most days」
  • 「We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG)」
  • 「We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients ...」（条目里「把仪器借回家戴着睡」的依据）
  • 诊断标准：「ICSD-3 defines OSA as a PSG-determined obstructive respiratory disturbance index (RDI) ≥ 5 events/h associated with the typical symptoms of OSA ... or an obstructive RDI ≥ 15 events/h (even in the absence of symptoms).」

2. Patil 2019，AASM 系统综述

  • https://doi.org/10.5664/jcsm.7638，全文 PMC6374080
  • 困倦：「A meta-analysis of 38 RCTs ... demonstrated a clinically significant reduction in self-reported sleepiness of −2.4 points in the ESS score (95% CI: −2.8 to −1.9 points) in participants on PAP compared to controls」
  • 不困的人：「A sub-analysis of the 5 studies ... recruiting only non-sleepy participants with OSA demonstrated an ESS reduction of −1.0 points (95% CI: −0.7 to −1.4 points) that the TF judged to not be clinically significant.」
  • 车祸：「Meta-analyses of the 10 non-randomized studies ... comparing participants with OSA before and after CPAP treatment demonstrated a mean crash rate risk ratio of 0.3 (95% CI: 0.2 to 0.4)」；「The quality of evidence for MVC ranged from low to moderate.」
  • ESS 满分 24 分是量表的通用设定，原文没写，条目只作解释用。

3. Tregear 2010，Sleep

  • https://doi.org/10.1093/sleep/33.10.1373，Europe PMC 摘要
  • 「A meta-analysis of 9 observational studies examining crash risk of drivers with OSA pre- vs. post-CPAP found a significant risk reduction following treatment (risk ratio = 0.278, 95% CI: 0.22 to 0.35; P < 0.001).」
  • 「daytime sleepiness improves significantly following a single night of treatment, and simulated driving performance improves significantly within 2 to 7 days of CPAP treatment.」

4. Tregear 2009，J Clin Sleep Med

  • PMID 20465027，PMC2792976
  • 「The mean crash-rate ratio associated with OSA is likely to fall within the range of 1.21 to 4.89.」

5. McEvoy 2016，SAVE，NEJM 375(10):919-931

  • https://doi.org/10.1056/NEJMoa1606599，摘要
  • 「randomly assigned 2717 eligible adults between 45 and 75 years of age who had moderate-to-severe obstructive sleep apnea and coronary or cerebrovascular disease」
  • 「Most of the participants were men who had moderate-to-severe obstructive sleep apnea and minimal sleepiness.」
  • 「the mean duration of adherence to CPAP therapy was 3.3 hours per night」
  • 「After a mean follow-up of 3.7 years, a primary end-point event had occurred in 229 participants in the CPAP group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P=0.34).」
  • 「CPAP significantly reduced snoring and daytime sleepiness and improved health-related quality of life and mood.」

6. Yu 2017，JAMA 318(2):156-166

  • https://doi.org/10.1001/jama.2017.7967，摘要
  • 「10 trials (9 CPAP; 1 ASV) of patients with sleep apnea (N = 7266」
  • 「all-cause death (RR, 1.13 [95% CI, 0.99 to 1.29]; P = .08」
  • 「meta-regressions identified no associations of PAP with outcomes for different levels of apnea severity, follow-up duration, or adherence to PAP (all P values > .13).」（备注「按戴的时长分开算也没看出差别」的依据）

7. Benjafield 2019，Lancet Respir Med 7(8):687-698

  • https://doi.org/10.1016/S2213-2600(19)30198-5，全文 PMC7007763
  • 附表中国一行：「China 744 511 252 175 704 655 (23·6%) 65 516 990 (8·8%)」，分别是 30 到 69 岁人口、AHI ≥5 人数、AHI ≥15 人数。条目写成约 1.76 亿、约 6552 万。
  • 「The estimated number of individuals with obstructive sleep apnoea was highest in China」
  • 中国的输入数据是 Table 2 里一项研究：「China 38 3648 2005 ≥20 50% Chicago 1999」。
  • 「Funding ResMed.」

8. USPSTF 2022，JAMA 328(19):1945-1950

  • https://doi.org/10.1001/jama.2022.20304
  • 「The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population. (I statement).」对象是「Asymptomatic adults (18 years or older) and adults with unrecognized symptoms of OSA.」

等级与量级

  • 证据等级 A：困倦改善来自 38 项随机试验。标「争议」：心血管和总死亡率在随机试验和荟萃里都没看出差别；车祸数字只来自前后对比。
  • 收益「中」是判断：口径是时间（精力），困倦分数降 2.4 分有临床意义，但没有研究量出每天多出几小时清醒时间，不够「每天小时级」。车祸少约七成属于死亡率口径，不跨口径换算。
  • 成本：没查到睡眠监测和呼吸机的官方价格，成本栏只写「一笔不小的钱」，没写数字；钱=多按呼吸机是一次性大件定。
  • 没加人群标签：7 个值里没有对应的。