Conte G, Rigon N, Perrone A, Lauro S
Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi, Padova.
Minerva Cardioangiol. 1999 Jun;47(6):195-202.
Respiratory sleep disorders are a risk factor, sometimes independent, for acute cardiovascular diseases which are the most frequent cause of death among populations of industrialized countries. Snoring and obstructive sleep apnea (OSA) are generally involved, while the pathogenetic role of acute exacerbation of COPD seems less evident. The most important acute cardiovascular events related to sleep respiratory disorders are angina pectoris, acute myocardial infarction, cardiac arrhythmias (in some instances as paroxysmal attacks), systemic hypertension with hypertensive crisis, ischemic stroke. A respiratory sleep disorder should be suspected in all obese, cigarette smokers, alcoholics, hypertensives, who present symptoms of obstructive sleep apnea, where snoring may be a marker, and in patients with COPD. The diagnosis is readily established by performing polysomnography and, when needed, by 24-hour Holter monitoring and blood pressure ambulatory recording. Therapy aims at correcting risk factors with particular attention to weight reduction in obese patients. Furthermore, upper airway anatomic abnormalities should be eliminated. In obstructive sleep apnea, nasal continuous positive airway pressure during sleep is to be used, when necessary, while tracheostomy must be performed only in more severe cases.
呼吸睡眠障碍是急性心血管疾病的一个危险因素，有时是独立危险因素，而急性心血管疾病是工业化国家人群中最常见的死亡原因。打鼾和阻塞性睡眠呼吸暂停（OSA）通常与之相关，而慢性阻塞性肺疾病（COPD）急性加重的致病作用似乎不太明显。与睡眠呼吸障碍相关的最重要的急性心血管事件是心绞痛、急性心肌梗死、心律失常（在某些情况下为阵发性发作）、伴有高血压危象的系统性高血压、缺血性中风。所有肥胖者、吸烟者、酗酒者、高血压患者，以及出现阻塞性睡眠呼吸暂停症状（打鼾可能是一个标志）的患者和COPD患者，都应怀疑存在呼吸睡眠障碍。通过进行多导睡眠图检查，必要时通过24小时动态心电图监测和动态血压记录，很容易做出诊断。治疗旨在纠正危险因素，尤其要关注肥胖患者的体重减轻。此外，应消除上呼吸道解剖异常。在阻塞性睡眠呼吸暂停中，必要时应在睡眠期间使用鼻持续气道正压通气，而仅在更严重的情况下才必须进行气管切开术。
