阻塞性睡眠呼吸暂停中的心血管疾病
Cardiovascular diseases in obstructive sleep apnea.
作者信息
Dursunoğlu Dursun, Dursunoğlu Neşe
机构信息
Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey, and Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
出版信息
Tuberk Toraks. 2006;54(4):382-96.
Obstructive sleep apnea (OSA) affects approximately 5% of women and 15% of men in the middle-aged adults, and associated with adverse health outcomes. Cardiovascular disturbances are the most serious complications of OSA. These complications include heart failure, left/right ventricular dysfunction, acute myocardial infarction, arrhythmias, stroke, systemic and pulmonary hypertension. All these cardiovascular complications increase morbidity and mortality of OSA. Several epidemiologic studies have demonstrated that sleep related breathing disorders are an independent risk factor for hypertension, probably resulting from a combination of intermittent hypoxia and hypercapnia, arousals, increased sympathetic activity, and altered baroreflex control during sleep. Arterial hypertension, obesity, diabetes mellitus and coronary artery disease (CAD) which are independent predictors of left ventricular dysfunction, often have co-existence with OSA. Especially severe OSA patients having diastolic dysfunction might have an increased risk of heart failure, since diastolic dysfunction might be combined with systolic dysfunction. Early recognition and appropriate therapy of ventricular dysfunction is advisable to prevent further progression to heart failure and death. Patients with acute myocardial infarction, especially if they had apneas and hypoxemia without evident heart failure should be evaluated for sleep disorders. So, patients with CAD should be evaluated for OSA and vice versa. Early recognition and treatment of OSA may improve cardiovascular functions. Continuous positive airway pressure (CPAP) applied by nasal mask, is still the gold standard method for treatment of the disease and prevention of complications.
阻塞性睡眠呼吸暂停(OSA)影响约5%的中年女性和15%的中年男性,并与不良健康后果相关。心血管紊乱是OSA最严重的并发症。这些并发症包括心力衰竭、左/右心室功能障碍、急性心肌梗死、心律失常、中风、系统性和肺动脉高压。所有这些心血管并发症都会增加OSA的发病率和死亡率。多项流行病学研究表明,睡眠相关呼吸障碍是高血压的独立危险因素,这可能是由于睡眠期间间歇性缺氧和高碳酸血症、觉醒、交感神经活动增加以及压力反射控制改变共同作用的结果。动脉高血压、肥胖、糖尿病和冠状动脉疾病(CAD)是左心室功能障碍的独立预测因素,它们常与OSA并存。尤其是患有舒张功能障碍的重度OSA患者,心力衰竭风险可能会增加,因为舒张功能障碍可能与收缩功能障碍同时存在。建议尽早识别并适当治疗心室功能障碍,以防止其进一步发展为心力衰竭和死亡。急性心肌梗死患者,尤其是那些有呼吸暂停和低氧血症但无明显心力衰竭的患者,应评估是否存在睡眠障碍。因此,CAD患者应评估是否患有OSA,反之亦然。尽早识别和治疗OSA可能会改善心血管功能。通过鼻罩应用持续气道正压通气(CPAP)仍然是治疗该疾病和预防并发症的金标准方法。