Yaggi Henry, Mohsenin Vahid
Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, 333 Cedar Street, Post Office Box 208057, New Haven, CT 06520-8057, USA.
Clin Chest Med. 2003 Jun;24(2):223-37. doi: 10.1016/s0272-5231(03)00027-3.
Sleep-related breathing disorders are strongly associated with increased risk of stroke independent of known risk factors. The direction of causation favors sleep-disordered breathing leading to stroke rather than the other way around, although definitive proof of this awaits the results of prospective cohort studies. If causal, even a moderately elevated risk of stroke coupled with the high prevalence of sleep-disordered breathing could have significant public health implications. The relationship between sleep-disordered breathing and stroke risk factors is complex, and likely part of the risk for cerebrovascular events is because of higher cardiovascular risk factors in patients with increased RDI. The mechanisms underlying this increased risk of stroke are multi-factorial and include reduction in cerebral blood flow, altered cerebral autoregulation, impaired endothelial function, accelerated atherogenesis, thrombosis, and paradoxic embolism. Because of the effects of sleep-disordered breathing on vascular tone, hypertension is believed to be a major mechanism by which sleep-disordered breathing might influence risk of stroke. Because sleep-related breathing disorders are treatable patients with stroke/TIA should undergo investigation, with a thorough sleep history interview, physical examination, and polysomnography. Treatment of sleep apnea has been shown to improve quality of life, lower blood pressure, improve sleep quality, improve neurocognitive functioning, and decrease symptoms of excessive daytime sleepiness [98]. Further treatment trials are needed to determine whether treatment improves outcome after stroke and whether treatment may serve as secondary prophylaxis and modify the risk of recurrent stroke or death.
睡眠相关呼吸障碍与中风风险增加密切相关，且独立于已知风险因素。因果关系倾向于睡眠呼吸障碍导致中风，而非相反，尽管这一点的确切证据尚有待前瞻性队列研究的结果。如果存在因果关系，即使中风风险适度升高，再加上睡眠呼吸障碍的高患病率，也可能对公共卫生产生重大影响。睡眠呼吸障碍与中风风险因素之间的关系很复杂，脑血管事件风险的一部分可能是由于呼吸紊乱指数（RDI）升高的患者存在较高的心血管风险因素。中风风险增加背后的机制是多因素的，包括脑血流量减少、脑自动调节改变、内皮功能受损、动脉粥样硬化加速、血栓形成和反常栓塞。由于睡眠呼吸障碍对血管张力的影响，高血压被认为是睡眠呼吸障碍可能影响中风风险的主要机制。由于睡眠相关呼吸障碍是可治疗的，中风/短暂性脑缺血发作（TIA）患者应接受调查，包括进行全面的睡眠史访谈、体格检查和多导睡眠监测。已证明治疗睡眠呼吸暂停可改善生活质量、降低血压、改善睡眠质量、改善神经认知功能并减轻日间过度嗜睡症状[98]。需要进一步的治疗试验来确定治疗是否能改善中风后的预后，以及治疗是否可作为二级预防并改变复发性中风或死亡的风险。
