Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA.
Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA.
Sleep Med Rev. 2024 Dec;78:101996. doi: 10.1016/j.smrv.2024.101996. Epub 2024 Aug 30.
Despite the commonly-accepted paradigm that patients with obstructive sleep apnea (OSA) also invariably have obesity, OSA prevalence extends beyond obesity. This necessitates a reevaluation of screening strategies, biomarkers of increased OSA risk, and heightened awareness among healthcare providers about the array of OSA treatments for diverse adult populations. While obesity contributes importantly to OSA pathogenesis, there is substantial evidence that non-anatomical factors also play a crucial role, especially in patients who do not have obesity. In recent years, notwithstanding the recognition of diverse contributors to OSA pathogenesis, research has frequently focused on weight reduction to address OSA. Insights from past experiences with bariatric surgery in OSA serve as a lens to anticipate potential outcomes of emerging anti-obesity pharmacotherapies. Pharmacological alternatives, particularly incretin agonists, exhibit promise in weight reduction and OSA improvement, but encounter obstacles such as potential side effects and high costs. With this comprehensive narrative review, we delve into the complex epidemiological and pathophysiological connections between OSA and obesity. Additionally, we emphasize the importance of a multifaceted approach to OSA treatment, recognizing that while weight management is crucial, there is a need for comprehensive strategies that go beyond traditional weight-centric perspectives.
尽管普遍接受的观点认为阻塞性睡眠呼吸暂停（OSA）患者也必然肥胖，但 OSA 的患病率超出了肥胖的范围。这需要重新评估筛查策略、增加 OSA 风险的生物标志物，以及提高医疗保健提供者对不同成年人群体的 OSA 治疗方法的认识。虽然肥胖对 OSA 的发病机制有重要贡献，但有大量证据表明非解剖因素也起着至关重要的作用，特别是在没有肥胖的患者中。尽管近年来认识到 OSA 发病机制的多种因素，但研究仍经常侧重于减肥来解决 OSA 问题。过去肥胖症手术治疗 OSA 的经验为预测新兴抗肥胖药物治疗的潜在结果提供了一个视角。药物替代疗法，特别是肠促胰岛素激动剂，在减轻体重和改善 OSA 方面显示出希望，但面临着潜在副作用和高成本等障碍。通过本次全面的叙述性综述，我们深入探讨了 OSA 和肥胖之间复杂的流行病学和病理生理学联系。此外，我们强调了 OSA 治疗的多方面方法的重要性，认识到虽然体重管理至关重要，但需要超越传统以体重为中心的观点的全面策略。
