Department of Respiratory and Sleep Medicine, St. Vincent’s University Hospital, Dublin, Ireland
School of Medicine, University College Dublin, Dublin, Ireland
Pol Arch Intern Med. 2021 Jun 29;131(6):550-560. doi: 10.20452/pamw.16041.
Obstructive sleep apnea (OSA) is an increasingly prevalent health concern characterized by repeated episodes of pharyngeal collapse during sleep. It is frequently associated with daytime sleepiness and impaired functional capacity, but it is also linked to cardiovascular disease by a growing body of epidemiological, clinical, and translational research. The severity of OSA is traditionally evaluated by the apnea‑hypopnea index (AHI), but the value of this marker as a predictor of cardiovascular outcomes is limited. Thus, there is an increasing focus on alternative classification methods such as the hypoxic burden, other polysomnographic traits, and phenotypic subgroups based on clinical symptoms. There is a need to identify subgroups of patients with OSA who will benefit most from treatment, as recent large randomized controlled trials in selected populations have failed to show benefit in reducing overall cardiovascular mortality. Obstructive sleep apnea adversely affects cardiovascular structure and function by several distinct mechanisms such as intermittent hypoxia, sleep fragmentation, and intrathoracic pressure swings. These mechanisms lead to sympathetic activation, inflammation, and oxidative stress, which may result in the clinical consequences of OSA such as hypertension, coronary artery disease, heart failure, and cerebrovascular disease. This review focuses on the epidemiology and potential mechanisms of cardiovascular diseases in OSA. Furthermore, we will briefly discuss the role of personalized medicine, alternative treatment options, and precise phenotyping to optimize treatment of this complex condition and its associated cardiovascular risk.
阻塞性睡眠呼吸暂停（OSA）是一种日益普遍的健康问题，其特征是睡眠期间咽腔反复塌陷。它常伴有日间嗜睡和功能能力受损，但越来越多的流行病学、临床和转化研究表明，它与心血管疾病也有关联。OSA 的严重程度传统上通过呼吸暂停-低通气指数（AHI）来评估，但该指标作为心血管结局预测因子的价值有限。因此，人们越来越关注替代分类方法，如缺氧负担、其他多导睡眠图特征和基于临床症状的表型亚组。需要确定 OSA 患者中哪些亚组最能从治疗中受益，因为最近在选定人群中进行的大型随机对照试验未能显示出降低总体心血管死亡率的益处。OSA 通过多种不同的机制对心血管结构和功能产生不利影响，如间歇性缺氧、睡眠碎片化和胸腔内压力波动。这些机制导致交感神经激活、炎症和氧化应激，可能导致 OSA 的临床后果，如高血压、冠状动脉疾病、心力衰竭和脑血管疾病。这篇综述重点介绍 OSA 中心血管疾病的流行病学和潜在机制。此外，我们将简要讨论个性化医学、替代治疗选择和精确表型的作用，以优化这种复杂疾病及其相关心血管风险的治疗。
