Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
Heart. 2022 Oct 28;108(22):1761-1766. doi: 10.1136/heartjnl-2021-319596.
Excessive daytime sleepiness (EDS) is classically viewed as a consequence of insufficient sleep or a symptom of sleep disorders. Epidemiological and clinical evidence have shown that patients reporting EDS in tandem with sleep disorders (e.g., obstructive sleep apnoea) are at greater cardiovascular risk than non-sleepy patients. While this may simply be attributable to EDS being present in patients with a more severe condition, treatment of sleep disorders does not consistently alleviate EDS, indicating potential aetiological differences. Moreover, not all patients with sleep disorders report EDS, and daytime sleepiness may be present even in the absence of any identifiable sleep disorder; thus, EDS could represent an independent pathophysiology. The purpose of this review is twofold: first, to highlight evidence that EDS increases cardiovascular risk in the presence of sleep disorders such as obstructive sleep apnoea, narcolepsy and idiopathic hypersomnia and second, to propose the notion that EDS may also increase cardiovascular risk in the absence of known sleep disorders, as supported by some epidemiological and observational data. We further highlight preliminary evidence suggesting systemic inflammation, which could be attributable to dysfunction of the gut microbiome and adipose tissue, as well as deleterious epigenetic changes, may promote EDS while also increasing cardiovascular risk; however, these pathways may be reciprocal and/or circumstantial. Additionally, gaps within the literature are noted followed by directions for future research.
日间嗜睡（EDS）通常被认为是睡眠不足的结果或睡眠障碍的症状。流行病学和临床证据表明，与非嗜睡患者相比，同时报告 EDS 和睡眠障碍（例如阻塞性睡眠呼吸暂停）的患者心血管风险更高。虽然这可能仅仅归因于 EDS 存在于病情更严重的患者中，但治疗睡眠障碍并不能始终缓解 EDS，这表明潜在的病因学差异。此外，并非所有患有睡眠障碍的患者都报告有 EDS，即使没有任何可识别的睡眠障碍，白天也可能出现嗜睡；因此，EDS 可能代表一种独立的病理生理学。本文综述的目的有两个：首先，强调 EDS 增加了睡眠障碍（如阻塞性睡眠呼吸暂停、发作性睡病和特发性嗜睡症）患者的心血管风险的证据；其次，提出这样一种观点，即即使没有已知的睡眠障碍，EDS 也可能增加心血管风险，一些流行病学和观察性数据支持这一观点。我们进一步强调了初步证据表明，系统性炎症可能是由于肠道微生物组和脂肪组织功能障碍以及有害的表观遗传变化引起的，它可能会促进 EDS 同时增加心血管风险；然而，这些途径可能是相互的和/或间接的。此外，还注意到文献中的空白，并为未来的研究指明了方向。
