Spiesshoefer Jens, Linz Dominik, Skobel Erik, Arzt Michael, Stadler Stefan, Schoebel Christoph, Fietze Ingo, Penzel Thomas, Sinha Anil-Martin, Fox Henrik, Oldenburg Olaf
Institute of Life Sciences, Scuola Superiore Sant Anna, Pisa, Italy.
Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany.
Eur J Prev Cardiol. 2021 Apr 10;28(2):189-200. doi: 10.1177/2047487319879526.
Patients with a wide variety of cardiovascular diseases, including arterial and pulmonary hypertension, arrhythmia, coronary artery disease and heart failure, are more likely to report impaired sleep with reduced sleep duration and quality, and also, sometimes, sleep interruptions because of paroxysmal nocturnal dyspnoea or arrhythmias. Overall, objective short sleep and bad sleep quality (non-restorative sleep) and subjective long sleep duration are clearly associated with major cardiovascular diseases and fatal cardiovascular outcomes. Sleep apnoea, either obstructive or central in origin, represents the most prevalent, but only one, of many sleep-related disorders in cardiovascular patients. However, observations suggest a bidirectional relationship between sleep and cardiovascular diseases that may go beyond what can be explained based on concomitant sleep-related disorders as confounding factors. This makes sleep itself a modifiable treatment target. Therefore, this article reviews the available literature on the association of sleep with cardiovascular diseases, and discusses potential pathophysiological mechanisms. In addition, important limitations of the current assessment, quantification and interpretation of sleep in patients with cardiovascular disease, along with a discussion of suitable study designs to address future research questions and clinical implications are highlighted. There are only a few randomised controlled interventional outcome trials in this field, and some of the largest studies have failed to demonstrate improved survival with treatment (with worse outcomes in some cases). In contrast, some recent pilot studies have shown a benefit of treatment in selected patients with underlying cardiovascular diseases.
患有各种心血管疾病的患者，包括动脉高血压和肺动脉高压、心律失常、冠状动脉疾病和心力衰竭，更有可能报告睡眠受损，睡眠时间和质量下降，有时还会因阵发性夜间呼吸困难或心律失常而出现睡眠中断。总体而言，客观上的短睡眠和差睡眠质量（非恢复性睡眠）以及主观上的长睡眠时间与主要心血管疾病和致命心血管结局明显相关。睡眠呼吸暂停，无论是阻塞性还是中枢性起源，是心血管疾病患者中最常见的，但只是众多与睡眠相关的疾病之一。然而，观察结果表明睡眠与心血管疾病之间存在双向关系，这可能超出了基于伴随的睡眠相关疾病作为混杂因素所能解释的范围。这使得睡眠本身成为一个可改变的治疗靶点。因此，本文回顾了关于睡眠与心血管疾病关联的现有文献，并讨论了潜在的病理生理机制。此外，还强调了目前对心血管疾病患者睡眠评估、量化和解释的重要局限性，以及对解决未来研究问题和临床意义的合适研究设计的讨论。该领域只有少数随机对照干预结局试验，一些最大规模的研究未能证明治疗能改善生存率（在某些情况下结果更差）。相比之下，最近的一些初步研究表明，治疗对某些患有潜在心血管疾病的患者有益。
