Department of Cardiology, Royal Brompton Hospital (Guy's & St Thomas's NHS Foundation Trust), London, United Kingdom.
Department of Cardiology, Maastricht University Medical Centre & Cardiovascular Research Institute, Maastricht, the Netherlands. Electronic address: https://twitter.com/Dominik_Linz.
J Am Coll Cardiol. 2021 Aug 10;78(6):608-624. doi: 10.1016/j.jacc.2021.05.048.
Sleep disordered breathing causes repetitive episodes of nocturnal hypoxemia, sympathetic nervous activation, and cortical arousal, often associated with excessive daytime sleepiness. Sleep disordered breathing is common in people with, or at risk of, cardiovascular (CV) disease including those who are obese or have hypertension, coronary disease, heart failure, or atrial fibrillation. Current therapy of obstructive sleep apnea includes weight loss (if obese), exercise, and positive airway pressure (PAP) therapy. This improves daytime sleepiness. Obstructive sleep apnea is associated with increased CV risk, but treatment with PAP in randomized trials has not been shown to improve CV outcome. Central sleep apnea (CSA) is not usually associated with daytime sleepiness in heart failure or atrial fibrillation and is a marker of increased CV risk, but PAP has been shown to be harmful in 1 randomized trial. The benefits of better phenotyping, targeting of higher-risk patients, and a more personalized approach to therapy are being explored in ongoing trials.
睡眠呼吸障碍导致夜间反复发生低氧血症、交感神经激活和皮质觉醒，常伴有日间嗜睡。睡眠呼吸障碍在心血管疾病（CV）患者或有心血管疾病风险的人群中很常见，包括肥胖或患有高血压、冠心病、心力衰竭或心房颤动的人群。阻塞性睡眠呼吸暂停的当前治疗包括减肥（如果肥胖）、运动和气道正压通气（PAP）治疗。这可以改善日间嗜睡。阻塞性睡眠呼吸暂停与 CV 风险增加相关，但随机试验中 PAP 治疗并未显示改善 CV 结局。心力衰竭或心房颤动患者中，中枢性睡眠呼吸暂停（CSA）通常不伴有日间嗜睡，是 CV 风险增加的标志物，但一项随机试验表明 PAP 治疗有害。正在进行的试验正在探索更好的表型分型、针对高危患者以及更个性化的治疗方法的益处。
