Department of Statistics and Quantitative Methods, University Milano-Bicocca.
National Centre for Healthcare Research and Pharmacoepidemiology.
J Hypertens. 2022 Jan 1;40(1):15-23. doi: 10.1097/HJH.0000000000003045.
Neuroadrenegic overdrive occurs in obstructive sleep apnoea syndrome (OSAS). However, the small sample size of the microneurographic studies, heterogeneity of the patients examined, presence of comorbidities, represented major weaknesses not allowing to precisely define the main features of the phenomenon, particularly in nonobese patients.
This meta-analysis detected 14 microneurographic studies based on muscle sympathetic nerve activity (MSNA) quantification in uncomplicated OSAS of different clinical severity.
The evaluation was extended to the relationships of MSNA with heart rate, anthropometric and blood pressure values, metabolic variables, apnoea-hypopnea index and oxygen saturation.
MSNA is activated markedly and almost homogeneously between studies, showing a progressive increase from the healthy state to mild, moderate and severe OSAS (46.03, 48.32, 71.84, 69.27 bursts/100 heart beats). Of special interest are the findings that MSNA is significantly related to the apnoea-hypopnea index, a marker of OSAS severity (r = 0.55, P = 0.04) but not to BMI, as it occurs in OSAS associated with obesity, and heart rate is significantly and directly related to MSNA and apnoea-hypopnea index (r = 0.68 and r = 0.60, respectively P = 0.03 and P = 0.02), thus representing a surrogate marker of the sympathetic overdrive.
OSAS, even when uncomplicated by other cardiometabolic disease, displays a marked sympathetic activation, reflected by the MSNA and heart rate behaviour, becoming a target of therapeutic interventions aimed at exerting sympathomoderating effects, such as continuous positive airway pressure.
神经肾上腺素过度活跃发生在阻塞性睡眠呼吸暂停综合征（OSAS）中。然而，由于微神经记录研究的样本量小、检查患者的异质性、合并症的存在，这些都是主要的弱点，无法准确定义该现象的主要特征，特别是在非肥胖患者中。
本荟萃分析基于肌肉交感神经活动（MSNA）的定量检测，对不同临床严重程度的单纯 OSAS 患者的 14 项微神经记录研究进行了检测。
评估范围扩展到 MSNA 与心率、人体测量学和血压值、代谢变量、呼吸暂停-低通气指数和血氧饱和度的关系。
MSNA 在研究之间明显且几乎均匀地激活，从健康状态到轻度、中度和重度 OSAS 呈逐渐增加趋势（46.03、48.32、71.84、69.27 次/100 次心跳）。特别值得关注的是，MSNA 与呼吸暂停-低通气指数显著相关，呼吸暂停-低通气指数是 OSAS 严重程度的标志物（r=0.55，P=0.04），而与 BMI 无关，因为它发生在与肥胖相关的 OSAS 中，心率与 MSNA 和呼吸暂停-低通气指数呈显著直接相关（r=0.68 和 r=0.60，分别为 P=0.03 和 P=0.02），因此是交感神经过度活跃的替代标志物。
即使没有其他心脏代谢疾病合并，OSAS 也会表现出明显的交感神经激活，这反映在 MSNA 和心率的行为上，成为旨在发挥交感神经调节作用的治疗干预的目标，如持续气道正压通气。
