Bradley T Douglas, Floras John S
Sleep Research Laboratory of the Toronto Rehabilitation Institute, Toronto, Canada.
Lancet. 2009 Jan 3;373(9657):82-93. doi: 10.1016/S0140-6736(08)61622-0. Epub 2008 Dec 26.
Obstructive sleep apnoea (OSA) is a common disorder in which repetitive apnoeas expose the cardiovascular system to cycles of hypoxia, exaggerated negative intrathoracic pressure, and arousals. These noxious stimuli can, in turn, depress myocardial contractility, activate the sympathetic nervous system, raise blood pressure, heart rate, and myocardial wall stress, depress parasympathetic activity, provoke oxidative stress and systemic inflammation, activate platelets, and impair vascular endothelial function. Epidemiological studies have shown significant independent associations between OSA and hypertension, coronary artery disease, arrhythmias, heart failure, and stroke. In randomised trials, treating OSA with continuous positive airway pressure lowered blood pressure, attenuated signs of early atherosclerosis, and, in patients with heart failure, improved cardiac function. Current data therefore suggest that OSA increases the risk of developing cardiovascular diseases, and that its treatment has the potential to diminish such risk. However, large-scale randomised trials are needed to determine, definitively, whether treating OSA improves cardiovascular outcomes.
阻塞性睡眠呼吸暂停（OSA）是一种常见疾病，其中反复出现的呼吸暂停使心血管系统暴露于缺氧、胸腔内负压过大和觉醒的循环之中。这些有害刺激反过来会抑制心肌收缩力、激活交感神经系统、升高血压、心率和心肌壁压力、抑制副交感神经活动、引发氧化应激和全身炎症、激活血小板并损害血管内皮功能。流行病学研究表明，OSA与高血压、冠状动脉疾病、心律失常、心力衰竭和中风之间存在显著的独立关联。在随机试验中，用持续气道正压通气治疗OSA可降低血压、减轻早期动脉粥样硬化迹象，并且在心力衰竭患者中可改善心脏功能。因此，目前的数据表明，OSA会增加患心血管疾病的风险，并且其治疗有可能降低这种风险。然而，需要大规模随机试验来最终确定治疗OSA是否能改善心血管结局。
