Jhamb Manisha, Unruh Mark
aRenal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania bNephrology Division, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
Curr Opin Pulm Med. 2014 Nov;20(6):558-64. doi: 10.1097/MCP.0000000000000102.
Hypertension (HTN) and obstructive sleep apnea (OSA) are coexistent in millions of people, and both have been associated with heart disease, stroke, and premature death. OSA is an important risk factor for HTN. However, the relationship between OSA and HTN may be bidirectional, with high blood pressure (BP) contributing to an increased risk and severity of OSA. The aim of this review is to summarize the current literature supporting a bidirectional relationship of sleep apnea and HTN.
The treatment of HTN to a lower BP target may improve sleep apnea by improving upper airway tone, by targeting hormone pathways (aldosterone, renin-angiotensin system) that may exacerbate OSA, and by reducing the nocturnal rostral fluid shifts through the use of a low-sodium diet, diuretics, and dialysis.
Intensive BP and volume overload control may be a promising approach to treat OSA. Future studies examining the hormonal mechanisms and comparing the effect of different antihypertensive medications on OSA are needed.
高血压（HTN）和阻塞性睡眠呼吸暂停（OSA）在数百万人中并存，且二者均与心脏病、中风和过早死亡相关。OSA是HTN的一个重要危险因素。然而，OSA与HTN之间的关系可能是双向的，高血压（BP）会增加OSA的风险和严重程度。本综述的目的是总结支持睡眠呼吸暂停与HTN双向关系的当前文献。
将HTN治疗至更低的血压目标可通过改善上气道张力、针对可能加重OSA的激素途径（醛固酮、肾素-血管紧张素系统）以及通过使用低钠饮食、利尿剂和透析减少夜间头向液体转移来改善睡眠呼吸暂停。
强化血压和容量超负荷控制可能是治疗OSA的一种有前景的方法。未来需要研究激素机制并比较不同抗高血压药物对OSA的影响。
