Jean-Louis Girardin, Zizi Ferdinand, Clark Luther T, Brown Clinton D, McFarlane Samy I
Brooklyn Center for Health Disparities, SUNY Downstate Medical Center Brooklyn, NY 11203-2098, USA.
J Clin Sleep Med. 2008 Jun 15;4(3):261-72.
Although obstructive sleep apnea and cardiovascular disease have common risk factors, epidemiologic studies show that sleep apnea increases risks for cardiovascular disease independently of individuals' demographic characteristics (i.e., age, sex, and race) or risk markers (i.e., smoking, alcohol, obesity, diabetes, dyslipidemia, atrial fibrillation, and hypertension). Individuals with severe sleep apnea are at increased risk for coronary artery disease, congestive heart failure, and stroke. The underlying mechanisms explaining associations between obstructive sleep apnea and cardiovascular disease are not entirely delineated. Several intermediary mechanisms might be involved including sustained sympathetic activation, intrathoracic pressure changes, and oxidative stress. Other abnormalities such as disorders in coagulation factors, endothelial damage, platelet activation, and increased inflammatory mediators might also play a role in the pathogenesis of cardiovascular disease. Linkage between obstructive sleep apnea and cardiovascular disease is corroborated by evidence that treatment of sleep apnea with continuous positive airway pressure reduces systolic blood pressure, improves left ventricular systolic function, and diminishes platelet activation. Several systematic studies are necessary to explicate complex associations between sleep apnea and cardiovascular disease, which may be compounded by the involvement of diseases comprising the metabolic syndrome (i.e., central obesity, hypertension, diabetes, and dyslipidemia). Large-scale, population-based studies testing causal models linking among sleep apnea, cardiovascular morbidity, and metabolic syndrome are needed.
尽管阻塞性睡眠呼吸暂停与心血管疾病有共同的风险因素，但流行病学研究表明，睡眠呼吸暂停会增加心血管疾病的风险，且独立于个体的人口统计学特征（即年龄、性别和种族）或风险标志物（即吸烟、饮酒、肥胖、糖尿病、血脂异常、心房颤动和高血压）。患有严重睡眠呼吸暂停的个体患冠状动脉疾病、充血性心力衰竭和中风的风险增加。解释阻塞性睡眠呼吸暂停与心血管疾病之间关联的潜在机制尚未完全阐明。可能涉及几种中间机制，包括持续的交感神经激活、胸内压力变化和氧化应激。其他异常情况，如凝血因子紊乱、内皮损伤、血小板激活和炎症介质增加，也可能在心血管疾病的发病机制中起作用。阻塞性睡眠呼吸暂停与心血管疾病之间的联系得到了以下证据的证实：用持续气道正压通气治疗睡眠呼吸暂停可降低收缩压、改善左心室收缩功能并减少血小板激活。需要进行几项系统性研究来阐明睡眠呼吸暂停与心血管疾病之间的复杂关联，这种关联可能因代谢综合征（即中心性肥胖、高血压、糖尿病和血脂异常）所包含的疾病的参与而更加复杂。需要开展大规模的基于人群的研究，以检验将睡眠呼吸暂停、心血管发病率和代谢综合征联系起来的因果模型。
