Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany
DiBiMIS, University of Palermo, and CNR Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy.
Eur Respir Rev. 2019 Jul 31;28(153). doi: 10.1183/16000617.0114-2018. Print 2019 Sep 30.
Obstructive sleep apnoea (OSA) syndrome affects about 13% of the male and 7-9% of the female population. Hypoxia, oxidative stress and systemic inflammation link OSA and cardiovascular and metabolic consequences, including coronary artery disease. Current research has identified several clinical phenotypes, and the combination of breathing disturbances during sleep, systemic effects and end-organ damage might help to develop personalised therapeutic approaches. It is unclear whether OSA is a risk factor for acute coronary syndrome (ACS) and might affect its outcome. On the one hand, OSA in patients with ACS may worsen prognosis; on the other hand, OSA-related hypoxaemia could favour the development of coronary collaterals, thereby exerting a protective effect. It is unknown whether positive airway pressure treatment may influence adverse events and consequences of ACS. In non-sleepy patients with OSA and stable coronary artery disease, randomised controlled trials failed to show that continuous positive airway pressure (CPAP) treatment protected against cardiovascular events. Conversely, uncontrolled studies suggested positive effects of CPAP treatment in such patients. Fewer data are available in subjects with ACS and OSA, and results of randomised controlled studies on the effects of CPAP are expected shortly. Meanwhile, the search for reliable markers of risk continues. Recent studies suggest that daytime sleepiness may indicate a more severe OSA phenotype with regard to cardiovascular risk. Finally, some studies suggest sex-related differences. The picture is still incomplete, and the potential role of OSA in patients with ACS awaits confirmation, as well as clear definition of subgroups with different degrees of risk.
阻塞性睡眠呼吸暂停（OSA）综合征影响约 13%的男性和 7-9%的女性。低氧血症、氧化应激和全身炎症将 OSA 与心血管和代谢后果联系起来，包括冠心病。目前的研究已经确定了几种临床表型，睡眠期间呼吸障碍、全身效应和终末器官损伤的组合可能有助于开发个性化的治疗方法。目前尚不清楚 OSA 是否是急性冠状动脉综合征（ACS）的危险因素，以及是否会影响其结果。一方面，ACS 患者的 OSA 可能会使预后恶化；另一方面，OSA 相关的低氧血症可能有利于冠状动脉侧支的形成，从而产生保护作用。目前尚不清楚正压通气治疗是否会影响 ACS 的不良事件和后果。在非嗜睡的 OSA 合并稳定型冠状动脉疾病患者中，随机对照试验未能表明持续气道正压通气（CPAP）治疗可预防心血管事件。相反，未经控制的研究表明 CPAP 治疗对这类患者有积极作用。在合并 ACS 和 OSA 的患者中，数据较少，CPAP 治疗效果的随机对照研究结果预计很快就会公布。与此同时，对风险可靠标志物的研究仍在继续。最近的研究表明，日间嗜睡可能表明心血管风险方面的 OSA 表型更严重。最后，一些研究表明存在性别相关差异。目前情况仍不完整，需要进一步证实 OSA 在 ACS 患者中的潜在作用，以及明确不同风险程度亚组的定义。
