McNicholas W T, Bonsigore M R
Respiratory Sleep Disorders Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Eur Respir J. 2007 Jan;29(1):156-78. doi: 10.1183/09031936.00027406.
Considerable evidence is available in support of an independent association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular disease, which is particularly strong for systemic arterial hypertension and growing for ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac sudden death. The pathogenesis of cardiovascular disease in OSAS is not completely understood but likely to be multifactorial, involving a diverse range of mechanisms including sympathetic nervous system overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. The present report, which arose out of a European Union Cooperation in the field of Scientific and Technical Research (COST) action on OSAS (COST B26), reviews the current evidence for an independent association and proposes research priorities to identify the underlying mechanisms involved, with a view to identifying novel therapeutic strategies. Large-scale collaborative studies of carefully defined patient populations with obstructive sleep apnoea syndrome, adequately controlled for potential confounders, are needed. Such studies carry the prospect of evaluating potential interactions between different basic mechanisms operating in obstructive sleep apnoea syndrome and cardiovascular disease, and interactions with other related disorders, such as obesity, diabetes and dyslipidaemia. Furthermore, translational studies involving cell culture and animal models linked to studies of obstructive sleep apnoea syndrome patients are necessary to integrate basic mechanisms with the clinical disorder.
现有大量证据支持阻塞性睡眠呼吸暂停综合征（OSAS）与心血管疾病之间存在独立关联，这种关联在系统性动脉高血压方面尤为显著，在缺血性心脏病、中风、心力衰竭、心房颤动和心源性猝死方面也日益明显。OSAS中心血管疾病的发病机制尚未完全明确，但可能是多因素的，涉及多种机制，包括交感神经系统过度活跃、炎症分子途径的选择性激活、内皮功能障碍、异常凝血和代谢失调，后者尤其涉及胰岛素抵抗和脂质代谢紊乱。本报告源自欧盟在OSAS领域的科技研究合作行动（COST）（COST B26），回顾了目前关于独立关联的证据，并提出了研究重点，以确定其中涉及的潜在机制，从而确定新的治疗策略。需要对定义明确的阻塞性睡眠呼吸暂停综合征患者群体进行大规模协作研究，并对潜在混杂因素进行充分控制。此类研究有望评估阻塞性睡眠呼吸暂停综合征和心血管疾病中不同基本机制之间的潜在相互作用，以及与其他相关疾病（如肥胖、糖尿病和血脂异常）的相互作用。此外，涉及细胞培养和动物模型的转化研究与阻塞性睡眠呼吸暂停综合征患者的研究相关联，对于将基本机制与临床疾病相结合是必要的。
