<International Circulation>:One of the causes of secondary hypertension is sleep apnea. In the clinic， how can the physician improve their diagnosis rate of sleep apnea?
　　Prof. Viera: One strategy would be to formally test for it using clinical measures such as the Epworth Sleepiness Scale which is a brief questionnaire which asks patients how sleepy they are in certain situations during the day and it gives the clinician a clue that this patient may have excessive daytime sleepiness which implies that they may not be getting good quality sleep. That is the first strategy. The second is to not forget about it and if you remember to think about obstructive sleep apnea then in many settings a sleep study is not that far away or hard to get. That is the gold standard to make the diagnosis.

　　《国际循环》：继发性高血压的原因之一是睡眠呼吸暂停。在诊室里，医生如何促进睡眠呼吸暂停的诊断？
　　Viera教授：一个策略是通过采用Epworth睡眠量表来正规地测定患者是否有睡眠呼吸暂停，该量表是一个简短的问卷，询问患者在白天某些情况下的嗜睡程度，这提示临床医生，患者可能有白天过度嗜睡，意味着患者的睡眠质量可能不好。这是第一个策略。第二个策略是不要忘记睡眠呼吸暂停综合征，如果你记得考虑阻塞性睡眠呼吸暂停综合征，在很多情形下，观察睡眠就不那么遥远或难以实施了。这是做出诊断的金标准。

　　<International Circulation>:And what is the most effective control once it has been diagnosed?
　　Prof. Viera: Once obstructive sleep apnea has been identified， most patients can be managed with continuous positive airway pressure or CPAP， the device worn at night. That actually not only helps the patient get a better night’s sleep and not have the apneic episodes that disrupt sleep， but it also helps lower their blood pressure. In patients with resistant hypertension for instance， one of the common causes of making the blood pressure more difficult to control is undiagnosed and/or untreated sleep apnea. Some patients are resistant to wearing the device so compliance is an issue. So emphasizing that it is not only about good quality sleep but about preventing damage to their heart might get people’s attention. They may say I can’t tolerate this so I will just suffer and be sleepy and not wear this mask. If you explain to them that it is doing damage to their heart and that they may be able to control their blood pressure without adding additional medications and that it may prevent long-term sequelae， then that may motivate some patients to wearing CPAP. For others， there are alternative treatments depending on the cause of the obstructive sleep apnea. There are palatal surgeries that can be done to create a more patent airway assuming the patient meets the criteria for that surgery.

　　《国际循环》：睡眠呼吸暂停综合征诊断之后最有效的治疗措施是什么？
　　Viera教授：一旦确诊睡眠呼吸暂停综合征，大多数患者可以通过气道持续正压通气（CPAP）来治疗，在夜间佩戴CPAP设备。该设备不仅有助于患者的夜间睡眠更好，不出现影响睡眠的呼吸暂停发作，还有助于降低患者的血压。例如，在难治性高血压患者，血压更难控制的常见原因之一是睡眠呼吸暂停综合征的诊断不足和/或未治疗。有些患者对佩戴CPAP设备有抵触，因此依从性是个问题。所以，强调佩戴CPAP设备不但能够帮助他们获得良好的睡眠质量，还能够预防心脏的损害，这些益处可能会吸引患者的注意。患者可能会说我没法忍受这个设备，所以我只能受苦了，就算白天昏昏欲睡，我也不想面罩。如果你跟患者解释说睡眠呼吸暂停综合征对心脏有损害，患者佩戴CPAP设备后不用增加额外的降压药物就能够控制好血压，还有可能预防远期并发症的发生，那么就可能促使某些患者佩戴CPAP设备。对于其他患者，根据睡眠呼吸暂停的病因还可以给予其他治疗。如果患者符合颚部外科手术标准，可以对患者实施手术，以便建立更为通畅的气道。

　　<International Circulation>:What is the best way to evaluate the risk for secondary hypertension in a simple way?
　　Prof. Viera: The simplest strategy is one we published in a journal called the American Family Physician last year or the year before. That strategy is to have an age-based approach to it. The prevalence of secondary hypertension and its etiology varies by age group. If you have a young child， the prevalence of secondary hypertension is higher than for a middle-aged adult and the etiologies are different. The same causes of secondary hypertension in children are commonly not the same ones that are causing secondary hypertension in a middle-aged adult. Using that kind of strategy， one can think about the most common etiologies of secondary hypertension by age group and consider testing in a rational way based on the most common etiologies. I like this because it avoids doing all the tests at once and wasting resources.

　　《国际循环》：简单地评价继发性高血压风险的最佳方法是什么？
　　Viera教授：最简单的策略是去年我们在《美国家庭医师杂志》上发表的一种策略，该策略就是针对不同年龄采取相应的方法。不同年龄组的继发性高血压的患病率和病因有所不同。年纪小的孩子的继发性高血压的患病率要高于中年人，两者的高血压病因也不同。导致儿童继发性高血压的原因通常并不是导致中年人继发性高血压的原因。采用这一策略，我们可以思考不同年龄组的继发性高血压的最常见病因，同时基于最常见的病因来理性地考虑检测手段。我喜欢这个策略，因为这可以避免一下子做所有的检查所造成的资源浪费。

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