Centre de Pneumologie Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.
Drugs. 2009;69 Suppl 2:77-91. doi: 10.2165/11532000-000000000-00000.
Sleep-disordered breathing (SDB) encompasses a group of disorders that include obstructive sleep apnoea (OSA), central sleep apnoea (CSA) and nocturnal hypoventilation. SDB commonly coexists with sleep disorders such as insomnia and restless legs syndrome, and sleep deprivation has been shown to play a role in the pathogenesis of SDB. Participants of a workshop, held at the 6th annual meeting of The International Sleep Disorders Forum: The Art of Good Sleep in 2008, evaluated whether the effective management of sleep disorders could result in a reduction in SDB. Following the workshop, a critical review of the literature in the field of sleep and SDB was conducted in order to assess the impact of improving sleep on SDB, and to determine whether measures taken to improve sleep result in a subsequent improvement in SDB. Results showed that studies evaluating the influence of improved sleep on respiratory abnormalities in patients with SDB are lacking. Studies in patients with OSA, with or without obesity-hypoventilation syndrome, show that therapy with continuous positive airways pressure and non-invasive ventilation improves sleep parameters with beneficial effects on SDB. Studies involving small numbers of patients have shown that the antidepressants fluoxetine and mirtazapine produce improvements in sleep parameters and the apnoea-hypopnoea index, and that acetazolamide may improve CSA. The benzodiazepines flurazepam, temazepam and nitrazepam, the hypnotic zolpidem, the melatonin receptor agonist ramelteon and gamma-hydroxybutyrate have all been shown to improve sleep, but are not associated with reductions or worsening in SDB. It is clear that there is a distinct knowledge gap with regard to the benefit of improving sleep disturbances for subsequent improvements in SDB. Randomized controlled clinical trials investigating the effect of pharmacological and non-pharmacological improvement of sleep disorders focusing on whether there is improvement in coexisting OSA/SDB are clearly needed. Furthermore, well-designed clinical trials investigating the role of hypnotic agents in improving SDB in certain phenotypes will enable the development of treatment recommendations for primary care physicians managing these patients in routine clinical practice.
睡眠障碍呼吸（SDB）包括一组疾病，包括阻塞性睡眠呼吸暂停（OSA）、中枢性睡眠呼吸暂停（CSA）和夜间通气不足。SDB 通常与睡眠障碍如失眠和不安腿综合征共存，睡眠剥夺已被证明在 SDB 的发病机制中起作用。2008 年在第六届国际睡眠障碍论坛年度会议：良好睡眠的艺术研讨会上举行的一个研讨会的参与者评估了有效管理睡眠障碍是否会导致 SDB 的减少。在研讨会之后，对睡眠和 SDB 领域的文献进行了批判性回顾，以评估改善睡眠对 SDB 的影响，并确定为改善睡眠而采取的措施是否会导致 SDB 的随后改善。结果表明，评估改善睡眠对 SDB 患者呼吸异常影响的研究缺乏。在患有 OSA 的患者中，无论是否患有肥胖低通气综合征，研究表明，持续气道正压通气和无创通气治疗可改善睡眠参数，并对 SDB 产生有益影响。涉及少数患者的研究表明，抗抑郁药氟西汀和米氮平可改善睡眠参数和呼吸暂停低通气指数，乙酰唑胺可能改善 CSA。苯二氮䓬类药物氟西泮、替马西泮和硝西泮、催眠药唑吡坦、褪黑素受体激动剂雷美尔酮和γ-羟基丁酸均已被证明可改善睡眠，但与 SDB 的减少或恶化无关。显然，在改善睡眠障碍对随后改善 SDB 的益处方面存在明显的知识差距。需要进行随机对照临床试验，以调查改善睡眠障碍的药理学和非药理学治疗效果，重点关注是否存在共存的 OSA/SDB 改善。此外，设计良好的临床试验调查催眠药物在改善某些表型的 SDB 中的作用，将使开发针对在常规临床实践中管理这些患者的初级保健医生的治疗建议成为可能。
