Ramos Alberto R, Seixas Azizi, Dib Salim I
Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL; Sleep Disorders Program, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL.
Center for Healthful Behavior Change, Department of Population Health, New York University, School of Medicine, New York, NY.
Sleep Health. 2015 Dec;1(4):244-248. doi: 10.1016/j.sleh.2015.09.005. Epub 2015 Oct 21.
Obstructive sleep apnea (OSA) is a novel cardiovascular and cerebrovascular risk factor that presents unique opportunities to understand and reduce seemingly intractable stroke disparity among non-Hispanic blacks and Hispanic/Latinos. Individuals from these 2 groups have up to a 2-fold risk of stroke and greater burden of OSA. Obstructive sleep apnea directly and indirectly increases risk of stroke through a variety of autonomic, chemical, and inflammatory mechanisms and vascular risk factors such as hypertension, obesity, and diabetes mellitus. Untreated OSA exacerbates poststroke prognosis, as it may also influence rehabilitation efforts and functional outcomes such as cognitive function after a stroke. Conversely, treatment of OSA may reduce the risk of stroke and may yield better poststroke prognosis. Unfortunately, in racial/ethnic minority groups, there are limited awareness, knowledge, and screening opportunities for OSA. Increasing awareness and improving screening strategies for OSA in minorities may alleviate stroke risk burden and improve stroke outcomes in these populations. This review article is intended to highlight the epidemiology, clinical characteristics, pathophysiology, diagnosis, and treatment of OSA in relation to stroke risk, with an emphasis on race-ethnic disparities.
阻塞性睡眠呼吸暂停（OSA）是一种新的心血管和脑血管危险因素，它为理解和减少非西班牙裔黑人和西班牙裔/拉丁裔人群中看似难以解决的中风差异提供了独特的机会。这两个群体的个体患中风的风险高达两倍，且阻塞性睡眠呼吸暂停的负担更重。阻塞性睡眠呼吸暂停通过多种自主神经、化学和炎症机制以及高血压、肥胖和糖尿病等血管危险因素直接和间接增加中风风险。未经治疗的阻塞性睡眠呼吸暂停会使中风后的预后恶化，因为它也可能影响康复效果和功能结局，如中风后的认知功能。相反，治疗阻塞性睡眠呼吸暂停可能会降低中风风险，并可能产生更好的中风后预后。不幸的是，在种族/族裔少数群体中，对阻塞性睡眠呼吸暂停的认识、了解和筛查机会有限。提高对少数群体阻塞性睡眠呼吸暂停的认识并改进筛查策略可能会减轻这些人群的中风风险负担并改善中风结局。这篇综述文章旨在强调与中风风险相关的阻塞性睡眠呼吸暂停的流行病学、临床特征、病理生理学、诊断和治疗，重点是种族-族裔差异。
