Obstructive sleep apnea and cardiovascular disease

Obstructive sleep apnea (OSA) is a common disorder associated with an increased risk of cardiovascular disease and stroke. As it is strongly associated with known cardiovascular risk factors, including obesity, insulin resistance, and dyslipidemia, OSA is an independent risk factor for hypertension and has also been implicated in the pathogenesis of congestive cardiac failure, pulmonary hypertension, arrhythmias, and atherosclerosis. Obesity is strongly linked to an increased risk of OSA, and weight loss can reduce the severity of OSA. The current standard treatment for OSA-nasal continuous positive airway pressure (CPAP)-eliminates apnea and the ensuing acute hemodynamic changes during sleep. Long-term CPAP treatment studies have shown a reduction in nocturnal cardiac ischemic episodes and improvements in daytime blood pressure levels and left ventricular function. Despite the availability of effective therapy, OSA remains an underdiagnosed and undertreated condition. A lack of physician awareness is one of the primary reasons for this deficit in diagnosis and treatment.     

阻塞性睡眠呼吸暂停与心血管疾病

本文分析关于阻塞性睡眠呼吸暂停与心血管疾病之间的关系、发生发展机制的最新进展,阐述对阻塞性睡眠呼吸暂停合并心血管疾病的患者行经鼻气道持续正压通气治疗能给患者心血管疾病的治疗、预后、康复和生活质量带来益处.本篇综述的目的 在于引起医务工作者对阻塞性呼吸暂停与心血管疾病的关系的重视,从而服务于临床.     

Obstructive sleep apnea and cardiovascular disease

Obstructive sleep apnea (OSA) is a sleep-disordered breathing condition, which is increasingly being recognized as having wide-ranging pathophysiological effects on multiple organ systems. Although multiple factors affect the incidence and severity of OSA, male sex and obesity seem to play an influential role. The apnea-ventilation cycle, characterized by abnormalities in gas exchange, exaggerated respiratory effort and frequent arousals, has been shown to have deleterious effects on circulatory hemodynamics, the autonomic milieu, hormonal balance, inflammatory and coagulation cascades, endothelial function, and the redox state, with potential cardiovascular significance. Consequently, OSA is being increasingly implicated in a multitude of cardiovascular diseases (CVD) such as hypertension, congestive heart failure, atrial fibrillation, stroke, coronary artery disease, pulmonary hypertension, and metabolic syndrome. The strength of association for individual CVD is varied, and outcomes of clinical studies are conflicting. In addition, obesity, which is closely linked to both OSA and CVD, makes it harder to ascertain the independent role of OSA on CVD. Although available evidence is inconclusive, there is an increasing recognition of the direct role for OSA in CVD. Similarly, although several studies have demonstrated the cardiovascular benefits of OSA treatment, further studies are needed to confirm this.     

Obstructive sleep apnea, cardiovascular disease, and pulmonary hypertension

With the growing epidemic of obesity in an aging population, obstructive sleep apnea (OSA) is increasingly encountered in clinical practice. Given the acute cardiopulmonary stressors consequent to repetitive upper airway collapse, as well as evidence for cardiovascular homeostatic dysregulation in subjects with sleep apnea, there is ample biologic plausibility that OSA imparts increased cardiovascular risk, independent of comorbid disease. Indeed, observational studies have suggested strong associations with multiple disorders, such as systemic hypertension, heart failure, cardiac arrhythmias, and pulmonary hypertension. Further data in the form of longitudinal cohort studies and randomized controlled trials are accruing to add to the body of evidence. This review examines pathophysiologic mechanisms and explores current concepts regarding the impact of OSA and its treatment on selected clinical disease states.     

Obstructive sleep apnea syndrome and cardiovascular diseases

Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by recurrent episodes of partial or complete upper airway collapse and obstruction during sleep, associated with intermittent oxygen desaturation, sleep fragmentation, and symptoms of disruptive snoring and daytime sleepiness. Increasing focus is being placed on the relationship between OSAS and all-cause and cardiovascular disease-related mortality, but it still largely unclear whether this association is causative or simply speculative and epidemiological. Basically, reliable clinical evidence supports the hypothesis that OSAS might be associated with essential and resistant hypertension, as well as with an incremental risk of developing stroke, cardiac rhythm perturbations (e.g., atrial fibrillation, bradyarrhythmias, supraventricular and ventricular arrhythmias), coronary artery disease, acute myocardial infarction, and heart failure. Although it is still unclear whether OSAS might represent an independent risk factor for several acute or chronic conditions, or rather might trigger cardiovascular disease in the presence of traditional cardiovascular risk factors (e.g., obesity, diabetes, and dyslipidemia), there is a plausible biological background underlying this association, in that most of the mechanisms implicated in the pathogenesis of OSAS (i.e., hypoxia, hypercapnia, negative intrathoracic pressure, micro-arousal, sympathetic hyperactivity, metabolic and hormonal changes, oxidative stress, phlogosis, endothelial dysfunction, hypercoagulability, and genetic predisposition) might also be involved in the pathogenesis of cardiovascular disorders. In this article we discuss the different aspects of the relationship between OSAS and pathogenically different conditions such as systemic hypertension, coronary artery disease, stroke, metabolic abnormalities, arrhythmias, and heart failure, and we also discuss the kaleidoscope of phenomena implicated in the pathogenesis of this challenging disease.     

阻塞性睡眠呼吸暂停低通气综合征与心血管疾病

阻塞性睡眠呼吸暂停低通气综合征(Obstructivesleep apnea hypopnea syndrome,OSAHS)在睡眠呼吸疾病中发病率最高,对健康和生命危害最大。OSAHS的合并症众多,其中属心血管合并症最为严重,是OS-AHS最终造成患者致残和死亡的主要原因,它包括高血压、冠心病、心律失常、肺动脉高压和心力衰竭等。OSAHS与心血管疾病的相关关系1.高血压:流行病学调查发现约30%高血压患者合并OSAHS,45%~48%OSAHS患者伴有高血压,而一般人群中高血压患病率约为20%。多项研究认为OSAHS是独立于年龄、肥胖、饮食、吸烟、遗传等因素的高血压重要危险因素…     

Obstructive sleep apnea: the new cardiovascular disease. Part I: obstructive sleep apnea and the pathogenesis of vascular disease

Obstructive sleep apnea (OSA) is increasingly recognized as a novel cardiovascular risk factor. OSA is implicated in the pathogenesis of hypertension, left ventricular dysfunction, coronary artery disease and stroke. OSA exerts its negative cardiovascular consequences through its unique pattern of intermittent hypoxia. Endothelial dysfunction, oxidative stress, and inflammation are all consequences of OSA directly linked to intermittent hypoxia and critical pathways in the pathogenesis of cardiovascular disease in patients with OSA. This review will discuss the known mechanisms of vascular dysfunction in patients with OSA and their implications for cardiovascular disease.     

阻塞性睡眠呼吸暂停低通气综合征、血管疾病与晚期糖基化终末产物

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种常见病和多发病,表现为低氧、高碳酸血症,可引起血管疾病及糖尿病等多种疾病,其发病机制是多方面的。而晚期糖基化终末产物(AGEs)是导致血管疾病及糖尿病并发证的重要因素,其致病机制是多途径的,AGEs是否参与OSAHS的发病机制值得研究。现将OSAHS引起心血管疾病、糖尿病的机制及AGEs参与了糖尿病微血管病变、机体动脉粥样硬化致病机制作一综述。     

Obstructive sleep apnoea and cardiovascular disease

Obstructive sleep apnoea (OSA) leads to both acute and chronic physiological effects on the cardiovascular system. There is now a large amount of evidence showing that OSA is independently associated with a wide spectrum of clinical cardiovascular disease (CVD). Evidence for a causative effect of OSA is strongest for hypertension, but is weaker for other cardiovascular disorders. Large prospective trials are ongoing and when results become available the link between OSA and CVD is likely to be strengthened. Treatment of OSA with continuous positive airway pressure has been shown to improve blood pressure, particularly in those with hypertension, and also left ventricular ejection fraction in those with congestive heart failure. Given the high prevalence of OSA in the community and its effects on the cardiovascular system, symptoms of this disorder should be sought in patients being investigated or treated for CVD.     

Obstructive sleep apnea

Purpose

Attempts to understand the causes of cognitive impairment in obstructive sleep apnea (OSA) are complicated by the overlap among clinical and demographic factors that may impact cognition. The goal of the current study was to isolate the contribution of hypoxemia to cognitive impairment in OSA.

Methods

Two groups of 20 patients with newly diagnosed OSA were compared. The groups differed on severity of hypoxemia but not other demographic (e.g., age, gender, education, estimated premorbid IQ) or clinical (e.g., sleep related respiratory disturbances, daytime sleepiness, depressive symptoms) variables. Participants completed polysonmography and cognitive assessment.

Results

We compared patients with high and low hypoxemia on measures of memory, attention, executive functioning, and motor coordination using independent sample t-tests. The high hypoxemia group performed significantly better on immediate recall (Hopkins Verbal Learning Test — Revised; t?=??2.50, p?<?0.02) than the low hypoxemia group. No group differences were observed on other neuropsychological measures.

Conclusions

This study is one of the first to compare the cognitive performance of patients with high and low hypoxemia after controlling for demographic factors and aspects of OSA severity that could confound the relationship. In our carefully matched sample, we observed an unexpected advantage of higher hypoxemia on memory. These preliminary findings are discussed in the context of basic science literature on the protective effects of adaptation to intermittent hypoxemia. Our data suggest that the association between hypoxemia and cognition may not straightforward. Future research targeting the effects of hypoxemia on cognition controlling for other clinical factors in large groups of patients with OSA will be important.     

Obstructive sleep apnea syndrome in adults and cardiovascular risk]

Sleep obstructive apnea syndrome (SOAS) is a common condition with a strong male predominance. Its incidence is more than 1 percent in the population as a whole. It exists in snorers. Both snoring and SOAS are linked to the presence of abnormalities (congenital or acquired) of the upper respiratory tract. The nocturnal cardiovascular consequences of SOAS are directly linked to apnea. Bradycardia occurs during apnea and tachycardia when ventilation restarts. Paroxysmal nocturnal hypertension is a constant feature. Even in individuals who are normotensive during the day, each restarting of ventilation is accompanied by peaking of blood pressure. The pulmonary artery pressure curve follows that of systemic blood pressure. Complications begin when SOAS has been present for several years: 1) Chronic: permanent systemic hypertension is common (56 percent of SOAS). It is often refractory to antihypertensive treatment. 2) Acute: the onset of myocardial infarction and of cerebrovascular accidents explains the heavy mortality of SOAS (37 percent at 8 years in untreated individuals with a number of episodes of apnea exceeding 20 per hour of sleep). Other acute complications are less common: acute pulmonary edema, nocturnal sudden death. These events may be prevented by treatment suppressing apnea: actuarial survival curves are then superimposable upon those of the population as a whole. Thus SOAS is a cardiovascular risk factor which is remarkably reversible by specific treatment, though which most often passes unrecognized.     

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阻塞性睡眠呼吸暂停综合征(obstructive sleep apneasyndrome,OSAS)是由于睡眠中周期性上气道塌陷,导致呼吸暂停和(或)通气不足,引起复杂多变的低氧血症、高碳酸血症、跨胸压的异常改变及频繁的微觉醒,影响到全身多个系统或器官,其中最为突出和严重的是心脑血管并发症。因此,OS     

阻塞性睡眠呼吸暂停低通气综合征与甲状腺疾病的相关性研究进展

研究提示OSAHS与甲状腺疾病并存,目前发现OSAHS与甲状腺功能减退症、亚临床甲状腺功能减退症、桥本甲状腺炎之间具有一定的相关性,因此对OSAHS伴发甲状腺疾病的患者进行早期诊断并积极治疗,对提高治疗效果尤为重要.     

儿童阻塞性睡眠呼吸暂停低通气综合征与代谢性疾病

随着儿童肥胖发病率的增加,儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的发病率也明显增加.肥胖已成为继腺样体和(或)扁桃体肥大后儿童OSAHS发病的第二大危险因素.儿童OSAHS和肥胖可能共同导致了代谢性疾病.OSAHS导致代谢异常可能与氧化应激、炎性反应和脂肪因子的释放有关.手术治疗是儿童OSAHS的首选治疗方法,而且能有效改善代谢异常,减少炎性反应因子的释放,改善血脂紊乱、呼吸暂停低通气指数和睡眠结构异常.     

Obstructive sleep apnea

This chapter provides an account of obstructive sleep apnea that is designed for clinicians. Current ideas about the mechanism of upper airway obstruction are reviewed, and the clinical features are discussed in a manner intended to facilitate the clinical assessment of such patients. Various forms of treatment are reviewed, with major emphasis given to the use of nasal positive airway pressure, a form of therapy developed by the authors.