AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil du Département R3S, F-75013, Paris, France.
AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pathologies du Sommeil du Département R3S, F-75013, Paris, France.
Sleep Med Rev. 2018 Dec;42:160-170. doi: 10.1016/j.smrv.2018.07.008. Epub 2018 Aug 4.
Sleep apnea is a common condition associated with increased morbidity and mortality. Continuous positive airway pressure and oral appliances are efficient for treating sleep apnea; however, they are often poorly tolerated. Therefore, alternative therapies are needed. Overnight rostral fluid shift has been implicated in the pathogenesis of sleep apnea, particularly in conditions associated with fluid overload. Fluid shift predisposes to both obstructive and central sleep apnea, with the type of sleep apnea being related to whether the fluid shifts from the legs into the neck or chest, respectively. The amount of fluid that shifts from the legs to the upper part of the body at night is correlated with the severity of sleep apnea. As a result of this observation, it has been suggested that the prevention of overnight fluid shift may reduce sleep apnea severity. It has recently been shown that interventions targeting fluid overload and daytime fluid accumulation in the legs consistently attenuate nocturnal fluid shift and sleep apnea, as greater reductions in fluid shift are correlated with greater reductions in sleep apnea severity. This review will focus on interventions that counteract fluid shift, such as diuretics, ultrafiltration/dialysis, physical activity, compression stockings and salt/fluid restriction, which have been shown to have efficacy in reducing sleep apnea severity.
睡眠呼吸暂停是一种常见的疾病，与发病率和死亡率的增加有关。持续气道正压通气和口腔器具是治疗睡眠呼吸暂停的有效方法；然而，它们往往很难被患者接受。因此，需要替代疗法。夜间颅前液移位与睡眠呼吸暂停的发病机制有关，特别是与液体过载有关的情况。液移位易引起阻塞性和中枢性睡眠呼吸暂停，睡眠呼吸暂停的类型与液体从腿部转移到颈部或胸部有关。夜间从腿部转移到身体上部的液体量与睡眠呼吸暂停的严重程度相关。基于这一观察结果，有人提出预防夜间液移位可能会降低睡眠呼吸暂停的严重程度。最近的研究表明，针对液体过载和日间腿部液体积聚的干预措施可以持续减轻夜间液移位和睡眠呼吸暂停，因为液移位的减少与睡眠呼吸暂停严重程度的降低成正比。这篇综述将重点介绍对抗液移位的干预措施，如利尿剂、超滤/透析、体育活动、压缩袜和盐/液体限制，这些措施已被证明可有效降低睡眠呼吸暂停的严重程度。
