Division of Sleep Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02215, USA.
Respir Care. 2010 Oct;55(10):1322-32; discussion 1330-2.
Compelling data demonstrate a strong association between sleep-disordered breathing (SDB) and cardiovascular disorders. The association is most consistent between obstructive sleep apnea (OSA) and hypertension. Epidemiologic and clinic-based studies provide evidence for an etiological role of OSA in hypertension, independent of obesity. Furthermore, several studies suggest amelioration of hypertension with therapy for sleep apnea. Emerging data also suggest a role for OSA in causing coronary artery disease. This association is bolstered by evidence suggesting that continuous positive airway pressure (CPAP) therapy improves early signs of atherosclerosis and may impede progression to clinically important cardiovascular disease. SDB (both OSA and central sleep apnea) is frequently observed in patients with heart failure. OSA may be a risk factor for incident heart failure. The current data do not provide consistent evidence for whether treatment of SDB will improve survival or other end points in patients with heart failure, and larger trials are currently underway to better elucidate that relationship. Substantial evidence also links SDB to an increased risk of various arrhythmias. Treatment of SDB with CPAP appears to significantly attenuate that risk. Finally, several studies suggest SDB as a risk factor for stroke. Whether treatment of SDB reduces stroke risk, however, remains to be determined. In conclusion, persuasive data provide evidence for an association, probably causal, between sleep-disordered breathing and several cardiovascular disorders. Large randomized controlled trials will further help confirm the association and elucidate the cardiovascular benefits of SDB therapy.
大量数据表明睡眠呼吸障碍（SDB）与心血管疾病之间存在密切关联。其中，阻塞性睡眠呼吸暂停（OSA）与高血压之间的关联最为紧密。流行病学和临床研究为 OSA 在高血压中的病因学作用提供了证据，且这一作用独立于肥胖。此外，多项研究表明，针对睡眠呼吸暂停的治疗可改善高血压。新出现的数据还表明 OSA 在引起冠状动脉疾病方面发挥作用。这一关联得到了以下证据的支持：持续气道正压通气（CPAP）治疗可改善动脉粥样硬化的早期迹象，并可能阻止其向具有临床意义的心血管疾病发展。心力衰竭患者常伴有睡眠呼吸障碍（包括 OSA 和中枢性睡眠呼吸暂停）。OSA 可能是心力衰竭发生的一个危险因素。目前的数据并未提供一致的证据表明治疗睡眠呼吸暂停是否会改善心力衰竭患者的生存率或其他终点，目前正在进行更大规模的试验以更好地阐明这种关系。大量证据还表明 SDB 与各种心律失常的风险增加相关。CPAP 治疗睡眠呼吸暂停似乎显著降低了这种风险。最后，有几项研究表明 SDB 是中风的一个危险因素。然而，治疗 SDB 是否能降低中风风险仍有待确定。总之，有说服力的数据为睡眠呼吸障碍与几种心血管疾病之间存在关联（可能具有因果关系）提供了证据。大规模的随机对照试验将进一步帮助确认这种关联，并阐明 SDB 治疗对心血管的益处。
