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阻塞性睡眠呼吸暂停:探寻精准治疗方法

Obstructive sleep apnea: in search of precision.

作者信息

Sânchez-de-la-Torre Manuel, Gozal David

机构信息

Hospital Universitari Arnau de Vilanova and Santa Maria. Group of Translational Research in Respiratory Medicine, IRBLleida, Lleida, Spain.

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain, Hospital San Pedro de Alcántara, Cáceres, Spain.

出版信息

Expert Rev Precis Med Drug Dev. 2017;2(4):217-228. doi: 10.1080/23808993.2017.1361319. Epub 2017 Aug 9.

DOI:10.1080/23808993.2017.1361319
PMID:31548993
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6756790/
Abstract

INTRODUCTION

Obstructive sleep apnea (OSA) is a highly prevalent condition that is viewed as a major global health concern, while affecting approximately 10% of the middle-aged population. OSA is a chronic disease that has been conclusively associated with poor quality of life, cognitive impairments and mood alterations, enhanced cardiovascular and metabolic morbidity, thereby leading to marked increments in healthcare costs.

AREAS COVERED

The authors have reviewed the current evidence on the pathophysiology of OSA and its consequences, the heterogeneity of its phenotypic expression, the current therapeutic applications and their efficacy, and the implications for diagnosis, treatment and follow-up strategies in the context of the clinical management of OSA.

EXPERT COMMENTARY

Personalized medicine in OSA identifies different needs and approaches: i) phenotyping and defining the different and segregated clusters of OSA patients whose recognition may improve prognostic predictions and guide therapeutic strategies; ii) to further characterize and predict the impact of OSA and its treatment, particularly revolving around mortality and the processes closely related to ageing (cardiovascular diseases, cancer and neurocognitive diseases); iii) the introduction of new technologies including telemedicine that have shown promise in the implementation of personalized medicine approaches.

摘要

引言

阻塞性睡眠呼吸暂停(OSA)是一种高度普遍的病症,被视为全球主要的健康问题,影响着约10%的中年人群。OSA是一种慢性病,已被确凿地证明与生活质量差、认知障碍和情绪改变、心血管和代谢发病率增加有关,从而导致医疗费用显著增加。

涵盖领域

作者回顾了关于OSA病理生理学及其后果、表型表达的异质性、当前治疗应用及其疗效的现有证据,以及在OSA临床管理背景下对诊断、治疗和随访策略的影响。

专家评论

OSA的个性化医疗确定了不同的需求和方法:i)对OSA患者进行表型分析并定义不同的、相互隔离的群体,识别这些群体可能会改善预后预测并指导治疗策略;ii)进一步表征和预测OSA及其治疗的影响,特别是围绕死亡率以及与衰老密切相关的过程(心血管疾病、癌症和神经认知疾病);iii)引入包括远程医疗在内的新技术,这些技术在实施个性化医疗方法方面已显示出前景。

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J Thorac Dis. 2020 Sep;12(9):5020-5038. doi: 10.21037/jtd-sleep-2020-003.
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Circulating microRNA profile as a potential biomarker for obstructive sleep apnea diagnosis.循环 microRNA 谱作为阻塞性睡眠呼吸暂停诊断的潜在生物标志物。
Sci Rep. 2019 Sep 17;9(1):13456. doi: 10.1038/s41598-019-49940-1.
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Identification and validation of circulating miRNAs as endogenous controls in obstructive sleep apnea.鉴定和验证阻塞性睡眠呼吸暂停中循环 miRNA 作为内参。
PLoS One. 2019 Mar 13;14(3):e0213622. doi: 10.1371/journal.pone.0213622. eCollection 2019.

本文引用的文献

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P4 medicine approach to obstructive sleep apnoea.阻塞性睡眠呼吸暂停的精准医学方法。
Respirology. 2017 Jul;22(5):849-860. doi: 10.1111/resp.13063. Epub 2017 May 5.
2
Endothelial Dysfunction in Children With Obstructive Sleep Apnea Is Associated With Elevated Lipoprotein-Associated Phospholipase A2 Plasma Activity Levels.阻塞性睡眠呼吸暂停儿童的内皮功能障碍与脂蛋白相关磷脂酶A2血浆活性水平升高有关。
J Am Heart Assoc. 2017 Feb 9;6(2):e004923. doi: 10.1161/JAHA.116.004923.
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Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea.使用远程监测技术管理阻塞性睡眠呼吸暂停患者持续气道正压通气治疗的依从性。
Eur Respir J. 2017 Feb 8;49(2). doi: 10.1183/13993003.01128-2016. Print 2017 Feb.
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Pediatric OSA Syndrome Morbidity Biomarkers: The Hunt Is Finally On!小儿阻塞性睡眠呼吸暂停综合征发病生物标志物:搜寻终于开始了!
Chest. 2017 Feb;151(2):500-506. doi: 10.1016/j.chest.2016.09.026. Epub 2016 Oct 6.
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CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea.持续气道正压通气治疗阻塞性睡眠呼吸暂停对心血管事件的预防作用。
N Engl J Med. 2016 Sep 8;375(10):919-31. doi: 10.1056/NEJMoa1606599. Epub 2016 Aug 28.
6
Application of Personalized, Predictive, Preventative, and Participatory (P4) Medicine to Obstructive Sleep Apnea. A Roadmap for Improving Care?个性化、预测性、预防性和参与性(P4)医学在阻塞性睡眠呼吸暂停中的应用。改善护理的路线图?
Ann Am Thorac Soc. 2016 Sep;13(9):1456-67. doi: 10.1513/AnnalsATS.201604-235PS.
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Obstructive Sleep Apnea: A Cluster Analysis at Time of Diagnosis.阻塞性睡眠呼吸暂停:诊断时的聚类分析。
PLoS One. 2016 Jun 17;11(6):e0157318. doi: 10.1371/journal.pone.0157318. eCollection 2016.
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Characterization of obstructive sleep apnea-hypopnea syndrome (OSA) population by means of cluster analysis.通过聚类分析对阻塞性睡眠呼吸暂停低通气综合征(OSA)人群进行特征描述。
J Sleep Res. 2016 Dec;25(6):724-730. doi: 10.1111/jsr.12429. Epub 2016 May 18.
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Circulating Plasma Extracellular Microvesicle MicroRNA Cargo and Endothelial Dysfunction in Children with Obstructive Sleep Apnea.阻塞性睡眠呼吸暂停患儿循环血浆细胞外微泡微小RNA含量与内皮功能障碍
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