Red Cross Hospital, Athens, Greece.
Patras University School of Medicine, Patras, Greece.
Curr Vasc Pharmacol. 2021;19(2):210-232. doi: 10.2174/1570161118666200325102411.
Sleep is essential to and an integral part of life and when lacking or disrupted, a multitude of mental and physical pathologies ensue, including cardiovascular (CV) disease, which increases health care costs. Several prospective studies and meta-analyses show that insomnia, short (<7h) or long (>9h) sleep and other sleep disorders are associated with an increased risk of hypertension, metabolic syndrome, myocardial infarction, heart failure, arrhythmias, CV disease risk and/or mortality. The mechanisms by which insomnia and other sleep disorders lead to increased CV risk may encompass inflammatory, immunological, neuro-autonomic, endocrinological, genetic and microbiome perturbations. Guidelines are emerging that recommend a target of >7 h of sleep for all adults >18 years for optimal CV health. Treatment of sleep disorders includes cognitive-behavioral therapy considered the mainstay of non-pharmacologic management of chronic insomnia, and drug treatment with benzodiazepine receptor agonists binding to gamma aminobutyric acid type A (benzodiazepine and non-benzodiazepine agents) and some antidepressants. However, observational studies and meta-analyses indicate an increased mortality risk of anxiolytics and hypnotics, although bias may be involved due to confounding and high heterogeneity in these studies. Nevertheless, it seems that the risk incurred by the non-benzodiazepine hypnotic agents (Z drugs) may be relatively less than the risk of anxiolytics, with evidence indicating that at least one of these agents, zolpidem, may even confer a lower risk of mortality in adjusted models. All these issues are herein reviewed.
睡眠是生命所必需的，也是生命的一个组成部分，当睡眠缺失或受到干扰时，会导致许多精神和身体疾病，包括心血管疾病，从而增加医疗保健成本。几项前瞻性研究和荟萃分析表明，失眠、睡眠时间过短（<7 小时）或过长（>9 小时）以及其他睡眠障碍与高血压、代谢综合征、心肌梗死、心力衰竭、心律失常、心血管疾病风险和/或死亡率增加有关。失眠和其他睡眠障碍导致心血管风险增加的机制可能包括炎症、免疫、神经自主、内分泌、遗传和微生物组的改变。越来越多的指南建议，所有 18 岁以上的成年人的目标睡眠时间应>7 小时，以获得最佳心血管健康。睡眠障碍的治疗包括认知行为疗法，被认为是慢性失眠非药物管理的主要方法，以及药物治疗，包括与γ-氨基丁酸 A 型受体结合的苯二氮䓬受体激动剂（苯二氮䓬类和非苯二氮䓬类药物）和一些抗抑郁药。然而，观察性研究和荟萃分析表明，抗焦虑药和催眠药的死亡率风险增加，尽管由于这些研究中存在混杂因素和高度异质性，可能存在偏倚。尽管如此，似乎非苯二氮䓬类催眠药物（Z 药物）的风险相对小于抗焦虑药的风险，有证据表明，这些药物中的至少一种，唑吡坦，甚至可能在调整后的模型中降低死亡率风险。本文综述了所有这些问题。
