Weiss J W, Remsburg S, Garpestad E, Ringler J, Sparrow D, Parker J A
Charles A. Dana Institute, Boston, Massachusetts, USA.
Sleep. 1996 Jun;19(5):388-97. doi: 10.1093/sleep/19.5.388.
Patients with obstructive sleep apnea demonstrate both acute and chronic hemodynamic changes attributable to their disease. Acutely, these patients experience repetitive nocturnal hemodynamic oscillations. Sudden increases in heart rate and arterial pressure occur in association with decreases in left ventricular stroke volume immediately following apnea termination. These hemodynamic changes are likely attributable primarily to the effects of oxygen desaturation and arousal, an abrupt change in state. These acute changes occur against a background of altered cardiovascular control. Patients with sleep apnea, even when sleeping without obstructions, fail to display the normal nocturnal decline in arterial pressure of 10-15% from the waking value. The absence of a nocturnal decline may have chronic consequences, such as development of left ventricular hypertrophy. Another chronic hemodynamic consequence of sleep apnea may be sustained diurnal hypertension. Epidemiologic studies suggest individuals with sleep disordered breathing are at greater risk of daytime hypertension, even after controlling for other risk factors. Although sleep apnea may contribute to pulmonary, as well as systemic hypertension, sleep apnea alone does not appear to be a cause of decompensated right heart failure. Although knowledge of the hemodynamic consequences of sleep apnea has grown in recent years, much remains to be learned.
阻塞性睡眠呼吸暂停患者表现出与其疾病相关的急性和慢性血流动力学变化。急性发作时，这些患者会经历重复性夜间血流动力学波动。呼吸暂停终止后，心率和动脉压突然升高，同时左心室每搏输出量减少。这些血流动力学变化可能主要归因于氧饱和度下降和觉醒的影响，即状态的突然改变。这些急性变化发生在心血管控制改变的背景下。睡眠呼吸暂停患者即使在无阻塞睡眠时，也不会出现动脉压从清醒值夜间正常下降10 - 15%的情况。夜间血压无下降可能会产生慢性后果，如左心室肥厚的发展。睡眠呼吸暂停的另一个慢性血流动力学后果可能是持续性日间高血压。流行病学研究表明，即使在控制了其他危险因素后，睡眠呼吸障碍个体患日间高血压的风险更高。虽然睡眠呼吸暂停可能导致肺动脉高压以及全身性高血压，但单独的睡眠呼吸暂停似乎不是失代偿性右心衰竭的原因。尽管近年来对睡眠呼吸暂停血流动力学后果的认识有所增加，但仍有许多有待了解。
