Vanderbilt Heart and Vascular Institute, Vanderbilt Medical Center, Nashville, Tennessee, USA.
Curr Opin Cardiol. 2011 Nov;26(6):541-7. doi: 10.1097/HCO.0b013e32834b806a.
To provide an update on the connection between obstructive sleep apnea (OSA) and cardiovascular disease.
Large prospective studies have established that OSA is associated with an increased incidence of hypertension and, in men, of coronary disease, stroke, and heart failure. Advances in understanding the pathophysiologic basis for these associations include identification of a role for OSA in inducing abnormalities in hepatic lipid-metabolizing enzymes, endothelial dysfunction, and upregulation of pro-inflammatory and pro-thrombotic mediators. A large body of data implicates OSA as playing a significant role in the occurrence and resistance to treatment of atrial fibrillation. Clinical trials have shown small-to-modest improvements in blood pressure associated with continuous positive airway pressure (CPAP) use, with smaller or uncontrolled studies suggesting that CPAP may improve cardiovascular outcomes or intermediate markers.
OSA and cardiovascular disease commonly co-aggregate. Multiple studies indicate that OSA contributes to or exacerbates cardiovascular disease, and thus may be a novel target for cardiovascular risk reduction. Although the evidence supports screening and treatment of OSA in patients at risk for cardiovascular disease, it also underscores a need for well powered clinical trials to examine the role of CPAP and other therapies in these populations.
阐述阻塞性睡眠呼吸暂停（OSA）与心血管疾病之间的关联。
大型前瞻性研究证实 OSA 与高血压发生率增加相关，且在男性中与冠心病、卒中和心力衰竭相关。对这些关联的病理生理学基础的深入理解包括确定 OSA 在诱导肝脂质代谢酶、内皮功能障碍以及促炎和促血栓形成介质的上调方面的作用。大量数据表明 OSA 在房颤的发生和对治疗的抵抗中起重要作用。临床试验显示持续气道正压通气（CPAP）治疗与血压的小到中度改善相关，而较小或不受控制的研究表明 CPAP 可能改善心血管结局或中间标志物。
OSA 和心血管疾病常共同发生。多项研究表明 OSA 导致或加重心血管疾病，因此可能是降低心血管风险的新靶点。尽管有证据支持对有心血管疾病风险的患者进行 OSA 的筛查和治疗，但也强调需要进行更有力的临床试验来研究 CPAP 和其他疗法在这些人群中的作用。
