Weiss J W, Launois S H, Anand A, Garpestad E
Charles A. Dana Institute, and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Prog Cardiovasc Dis. 1999 Mar-Apr;41(5):367-76. doi: 10.1053/pcad.1999.0410367.
The repetitive respiratory events that characterize obstructive sleep apnea (OSA) are each followed by abrupt increases in heart rate and in pulmonary and systemic artery pressure and by sudden decreases in right and left ventricular stroke volume. The changes in systemic pressure may be profound, with patients who are normotensive while awake having systolic pressures approaching 300 mm Hg after apnea termination. Because of these dramatic hemodynamic oscillations during sleep, many clinicians and investigators have postulated a connection between sleep-disordered breathing and cardiovascular morbidity and even mortality. This review critically examines the evidence for such a causal relationship. We begin, however, by reviewing the normal hemodynamic changes that occur during sleep. We then describe the acute hemodynamic events associated with OSA. Finally, we summarize the evidence for and against a causal connection between sleep apnea and cardiovascular morbidity.
阻塞性睡眠呼吸暂停（OSA）的特征性反复呼吸事件之后，心率、肺和体动脉压力都会突然升高，左右心室每搏输出量会突然下降。体循环压力变化可能很大，清醒时血压正常的患者在呼吸暂停终止后收缩压接近300毫米汞柱。由于睡眠期间这些剧烈的血流动力学波动，许多临床医生和研究人员推测睡眠呼吸紊乱与心血管疾病甚至死亡率之间存在联系。这篇综述批判性地审视了这种因果关系的证据。不过，我们首先回顾睡眠期间发生的正常血流动力学变化。然后我们描述与OSA相关的急性血流动力学事件。最后，我们总结支持和反对睡眠呼吸暂停与心血管疾病之间因果联系的证据。
