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[睡眠呼吸暂停中的心律失常]

[Arrhythmia in sleep apnea].

作者信息

Gamer A-K, Grebmer C

机构信息

Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz.

出版信息

Herzschrittmacherther Elektrophysiol. 2024 Sep;35(3):193-198. doi: 10.1007/s00399-024-01031-z. Epub 2024 Aug 7.

Abstract

BACKGROUND

Sleep apnea is a widespread and yet still underdiagnosed condition. Various studies from the past have provided evidence that there is a link between sleep apnea and various cardiovascular diseases, including arrhythmias.

OBJECTIVE

The aim of this article is to provide an overview of the current study situation and to point out possible consequences relevant to everyday life.

MATERIAL AND METHODS

A systematic search was carried out in various databases using the keywords sleep apnea (OSAS/SA) and arrhythmias/dysrhythmias.

RESULTS

There are several pathophysiological links between sleep-related breathing disorders and cardiac arrhythmias, the most important of which appear to be intrathoracic pressure, increased adrenergic tone as well as recurrent hypoxia and hypercapnia. This results in an increased occurrence of clinically relevant arrhythmias, such as atrial fibrillation, symptomatic bradycardia, high-grade atrioventricular (AV) blocks as well as ventricular arrhythmias in patients with untreated sleep apnea. These pathologies also appear to be positively influenced by the treatment of sleep apnea.

CONCLUSION

A close correlation between sleep apnea and cardiac arrhythmias is undisputed. Large randomized studies in this respect are so far rare but it is undisputed that a thorough search should be carried out for sleep apnea and consistently treated in patients with a history of cardiac disease as this can have a relevant influence on the treatment and ultimately the prognosis of the patient.

摘要

背景

睡眠呼吸暂停是一种普遍存在但仍未得到充分诊断的病症。过去的各种研究已提供证据表明,睡眠呼吸暂停与包括心律失常在内的各种心血管疾病之间存在关联。

目的

本文旨在概述当前的研究状况,并指出与日常生活相关的可能后果。

材料与方法

使用关键词睡眠呼吸暂停(阻塞性睡眠呼吸暂停/睡眠呼吸暂停)和心律失常/心律不齐在各种数据库中进行系统检索。

结果

睡眠相关呼吸障碍与心律失常之间存在多种病理生理联系,其中最重要的似乎是胸腔内压力、肾上腺素能张力增加以及反复出现的缺氧和高碳酸血症。这导致未经治疗的睡眠呼吸暂停患者出现临床相关心律失常的发生率增加,如心房颤动、症状性心动过缓、高度房室传导阻滞以及室性心律失常。这些病症似乎也受到睡眠呼吸暂停治疗的积极影响。

结论

睡眠呼吸暂停与心律失常之间的密切相关性是无可争议的。迄今为止,这方面的大型随机研究很少,但无可争议的是,对于有心脏病史的患者,应彻底筛查睡眠呼吸暂停并持续进行治疗,因为这可能对治疗以及最终患者的预后产生相关影响。

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