Ferini-Strambi Luigi, Lombardi Giulia Elisabetta, Marelli Sara, Galbiati Andrea
Sleep Disorders Center, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
Curr Treat Options Neurol. 2017 Apr;19(4):16. doi: 10.1007/s11940-017-0451-8.
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repetitive episodes of complete or partial obstruction of the upper airway. The prevalence of this disorder is strictly dependent on its gravity. At ≥15 events/h apnea-hypopnea index (AHI), it ranges from 6 to 17% in the general population, with higher rates in men and increasing with age. The hypoxia induced by OSA severely affects the structure and function of blood vessels, culminating in mortality and morbidity. Its negative impact influences also cognitive functioning. Recent papers showed the relationship between OSA and some neurological disorders, such as neurodegenerative diseases, stroke, epilepsy, and headache. OSA may accelerate the onset of mild cognitive impairment and Alzheimer's disease (AD) and might also represent an independent risk factor for Parkinson's disease (PD). OSA is also frequent in multisystem atrophy. In the early stages of AD, continuous positive airway pressure (CPAP) treatment might slow down the progression of the disease, thus highlighting the potential importance of OSA screening and a timely intervention in these patients. Moreover, CPAP is effective in reducing daytime sleepiness in PD. OSA may induce seizures by means of sleep disruption and deprivation, as well as cerebral hypoxemia with consequent oxidative stress. It has been demonstrated that CPAP treatment is efficacious in controlling epileptic seizures. OSA can represent a risk factor for stroke and death, mainly related to the endothelial dysfunction, with the formation of atherosclerosis caused by hypoxia through oxidative stress. CPAP treatment in patients with OSA and stroke, if delivered in the early stages, is able to increase the magnitude of neurologic improvement after the vascular accident. There is a strong association between OSA and headache. In particular, there is a "sleep apnea headache" described as a recurrent morning headache, with resolution after effective treatment of sleep apnea. This review clearly shows the importance of taking a sleep history in neurological patients and considering the diagnosis and specific treatment of OSA in these patients.
阻塞性睡眠呼吸暂停（OSA）是最常见的与睡眠相关的呼吸障碍，其特征为上气道反复出现完全或部分阻塞发作。这种疾病的患病率严格取决于其严重程度。呼吸暂停低通气指数（AHI）≥15次/小时时，在普通人群中的患病率为6%至17%，男性患病率更高且随年龄增长而增加。OSA引起的缺氧严重影响血管的结构和功能，最终导致死亡率和发病率上升。其负面影响还会影响认知功能。近期论文显示了OSA与一些神经系统疾病之间的关系，如神经退行性疾病、中风、癫痫和头痛。OSA可能会加速轻度认知障碍和阿尔茨海默病（AD）的发病，也可能是帕金森病（PD）的独立危险因素。OSA在多系统萎缩中也很常见。在AD的早期阶段，持续气道正压通气（CPAP）治疗可能会减缓疾病进展，从而凸显了对这些患者进行OSA筛查和及时干预的潜在重要性。此外，CPAP在减轻PD患者的日间嗜睡方面有效。OSA可能通过睡眠中断和剥夺以及脑缺氧及随之而来的氧化应激诱发癫痫发作。已证明CPAP治疗在控制癫痫发作方面有效。OSA可能是中风和死亡的危险因素，主要与内皮功能障碍有关，缺氧通过氧化应激导致动脉粥样硬化形成。OSA合并中风患者若在早期接受CPAP治疗，能够增加血管意外后神经功能改善的程度。OSA与头痛之间存在密切关联。特别是有一种“睡眠呼吸暂停性头痛”，表现为反复出现的晨起头痛，在有效治疗睡眠呼吸暂停后可缓解。这篇综述清楚地表明了在神经科患者中了解睡眠病史以及考虑对这些患者进行OSA诊断和特定治疗的重要性。
