Balcan Baran, Akdeniz Bahri, Peker Yüksel
Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey.
Department of Cardiology, Dokuz Eylül University Faculty of Medicine, Izmir 35340, Turkey.
J Clin Med. 2024 May 17;13(10):2961. doi: 10.3390/jcm13102961.
Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep, and it is closely linked to several cardiovascular issues due to intermittent hypoxia, nocturnal hypoxemia, and disrupted sleep patterns. Pulmonary hypertension (PH), identified by elevated pulmonary arterial pressure, shares a complex interplay with OSA, contributing to cardiovascular complications and morbidity. The prevalence of OSA is alarmingly high, with studies indicating rates of 20-30% in males and 10-15% in females, escalating significantly with age and obesity. OSA's impact on cardiovascular health is profound, particularly in exacerbating conditions like systemic hypertension and heart failure. The pivotal role of hypoxemia increases intrathoracic pressure, inflammation, and autonomic nervous system dysregulation in this interplay, which all contribute to PH's pathogenesis. The prevalence of PH among OSA patients varies widely, with studies reporting rates from 15% to 80%, highlighting the variability in diagnostic criteria and methodologies. Conversely, OSA prevalence among PH patients also remains high, often exceeding 25%, stressing the need for careful screening and diagnosis. Treatment strategies like continuous positive airway pressure (CPAP) therapy show promise in mitigating PH progression in OSA patients. However, this review underscores the need for further research into long-term outcomes and the efficacy of these treatments. This review provides comprehensive insights into the epidemiology, pathophysiology, and treatment of the intricate interplay between OSA and PH, calling for integrated, personalized approaches in diagnosis and management. The future landscape of OSA and PH management hinges on continued research, technological advancements, and a holistic approach to improving patient outcomes.
阻塞性睡眠呼吸暂停（OSA）的特征是睡眠期间上呼吸道反复阻塞，由于间歇性缺氧、夜间低氧血症和睡眠模式紊乱，它与多种心血管问题密切相关。肺动脉高压（PH）通过肺动脉压力升高来确定，与OSA存在复杂的相互作用，会导致心血管并发症和发病率增加。OSA的患病率高得惊人，研究表明男性患病率为20%-30%，女性为10%-15%，且随着年龄和肥胖显著上升。OSA对心血管健康的影响深远，尤其是在加重系统性高血压和心力衰竭等疾病方面。低氧血症在这种相互作用中起着关键作用，它会增加胸腔内压力、炎症和自主神经系统失调，所有这些都有助于PH的发病机制。OSA患者中PH的患病率差异很大，研究报告的患病率从15%到80%不等，这突出了诊断标准和方法的变异性。相反，PH患者中OSA的患病率也仍然很高，通常超过25%，这强调了仔细筛查和诊断的必要性。持续气道正压通气（CPAP）治疗等治疗策略有望减轻OSA患者的PH进展。然而，本综述强调需要进一步研究这些治疗的长期结果和疗效。本综述全面深入地探讨了OSA和PH之间复杂相互作用的流行病学、病理生理学和治疗方法，呼吁在诊断和管理中采用综合、个性化的方法。OSA和PH管理的未来前景取决于持续的研究、技术进步以及改善患者预后的整体方法。
