Martins Andrea Barral, Tufik Sérgio, Moura Sonia Maria Guimaraes Pereira Togeiro
Sleep Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.
J Bras Pneumol. 2007 Jan-Feb;33(1):93-100. doi: 10.1590/s1806-37132007000100017.
The physiopathology of obstructive sleep apnea syndrome is multifactorial. Gender and obesity status, as well as genetic, anatomic, and hormonal factors, together with ventilatory drive, interact in a diverse manner in the physiopathology and clinical expression of the disease. Obesity is the main risk factor, since increases in body mass index, visceral fat, and neck circumference are strong predictors of the disease. Progesterone increases the activity of the upper airway dilator muscles and therefore plays a protective role in premenopausal women. This explains the fact that the prevalence of the disease is higher in postmenopausal patients, in patients with polycystic ovary syndrome, as well as in males. Evidence supports the fact that, as individuals grow older, there is a decrease in muscle tonus, with a consequent reduction in the dimensions of the upper airway lumen. Craniofacial anomalies, such as in retrognathia or micrognathia, are accompanied by posterior positioning of the tongue and can result in narrowing of the upper airway lumen. Finally, decreased ventilatory drive has been detected in patients with obstructive sleep apnea syndrome and hypercapnia.
阻塞性睡眠呼吸暂停综合征的生理病理学是多因素的。性别和肥胖状况，以及遗传、解剖和激素因素，与通气驱动一起，在该疾病的生理病理学和临床表现中以多种方式相互作用。肥胖是主要危险因素，因为体重指数、内脏脂肪和颈围的增加是该疾病的有力预测指标。孕酮可增加上呼吸道扩张肌的活性，因此对绝经前女性起保护作用。这就解释了为什么该疾病在绝经后患者、多囊卵巢综合征患者以及男性中的患病率更高。有证据支持这样一个事实，即随着个体年龄的增长，肌肉张力会下降，从而导致上呼吸道管腔尺寸减小。颅面异常，如小颌后缩或小颌畸形，伴有舌后位，可导致上呼吸道管腔狭窄。最后，在阻塞性睡眠呼吸暂停综合征和高碳酸血症患者中检测到通气驱动降低。
