阻塞性睡眠呼吸暂停低通气综合征相关血清学的研究进展

<正>阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS )是近30年才被认识的常见且具有潜在危险的疾患,由上气道解剖学狭窄引起的夜间间歇性低氧、睡眠片段化、睡眠结构紊乱及日间嗜睡、记忆力下降等表现,导致睡眠障碍和慢性间歇性低氧血症的临床综合征^[1-2]。OSAHS对神经系统、呼吸系统、泌尿生殖系统、心血管系统等产生长期慢性损伤甚至也会对生命产生一定的威胁。     

阻塞性睡眠呼吸暂停综合征与心血管疾病

阻塞性睡眠呼吸暂停综合征 (Ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎ ｄｒｏｍｅ,ＯＳＡＳ)是一种以睡眠过程中反复出现呼吸暂停、低通气、血氧饱和度下降和睡眠结构紊乱等为特征的疾病[1 ] 。近年来的研究表明 ,该病如不及时治疗 ,可导致全身多系统器官功能损害 ,如心血管系统、呼吸系统、神经系统、泌尿生殖系统、血液系统、消化系统、内分泌系统等。本文拟就ＯＳＡＳ与心血管疾病的关系作一综述。正常睡眠时心血管系统的变化　根据睡眠时脑电图的变化 ,一般可将睡眠分为快速眼动睡眠 (ＲＥＭ)和非快速眼动睡眠 (ＮＲＥＭ) ,后…     

阻塞性睡眠呼吸暂停与心血管相关疾病的关系研究进展

阻塞性睡眠呼吸暂停(OSA)是一种慢性睡眠呼吸障碍性疾病,其间断缺氧的特征能够损伤血管内皮功能.内皮功能障碍是引起心血管疾病发生发展的早期病理过程.OSA与多种心血管相关疾病的发生密切相关,早期有效地筛查OSA及检测血管内皮功能可评估未来心血管事件的进展,显著减少OSA对心血管健康的损害.现就OSA与血管结构和功能、心...     

睡眠呼吸暂停与心血管疾病研究进展

睡眠呼吸暂停与心血管疾病研究进展解放军第３５９医院慈书平安徽省全椒县人民医院赵新源综述南京军区南京总医院江时森审校睡眠呼吸暂停综合征（ＳｌｅｅｐＡｐｎｅａＳｙｎｄｒｏｍｅｓ，ＳＡＳ）对心血管的危害近年来已引起人们的关注。新近许多研究表明，ＳＡＳ可导致...     

阻塞性睡眠呼吸暂停综合征和心血管事件相关性及其机制探讨

阻塞性失眠呼吸暂停低通气综合征（OSAHS）与心血管系统疾病关系密切;呼吸暂停,低通气可诱发或加重冠心病、心律失常、必力衰竭等心血管事件,甚至发生心源性猝死。本文就OSAHS与心血管事件相关性及其机制做以下综述。     

老年心血管疾病患者阻塞性睡眠呼吸暂停综合征的评价

目的 评价老年心血管疾病患者阻塞性睡眠呼吸暂停综合征(OSAS)的患病情况和特点,为临床决策提供参考. 方法 采用便携式睡眠监测仪对入住在老年心内科的患者,进行睡眠呼吸监测,了解其阻塞性睡眠呼吸暂停(OSA)的患病情况. 结果 共监测了317例老年心血管疾病患者的夜间睡眠呼吸紊乱情况,得出符合OSA[睡眠呼吸紊乱指数(AHI)≥5]的有281例,占88.6%;符合阻塞性睡眠呼吸暂停综合征(OSAS)[AHI≥5,Epworth量表(ESS)≥9分]的有47例,占14.8%.多元回归分析结果 提示,以OSA严重程度作为因变量,对它影响有显著性意义的是最低血氧饱和度和血氧饱和度下降指数(简称氧减指数),而年龄、习惯性打鼾、嗜睡评分、体质指数(BMI)、血氧饱和度平均值和低于90%的时间对其影响无显著性意义. 结论 老年心血管疾病患者中OSAS具有高的患病率,而且无白天嗜睡症状的OSA的老年人患病率更高.对睡眠呼吸暂停严重程度的独立预测因子是最低血氧饱和度氧减指数,而老年人的年龄、BMI、是否经常打鼾、是否白天嗜睡与OSA的严重程度关系不密切.     

阻塞性睡眠呼吸暂停与心血管疾病

阻塞性睡眠呼吸暂停可使心室负荷增加、顺应性降低,肺循环及体循环血管收缩,心输出量减少。与心律失常、高血压、冠心病、肺动脉高压和右心衰竭等有关。     

儿童阻塞性睡眠呼吸暂停低通气综合征与心血管系统疾病的关系

<正>儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS),是指由于睡眠过程中部分或者全部上气道梗阻或阻塞,从而扰乱睡眠过程中的正常通气和睡眠结构,而引起的一系列病理生理改变。目前,有关成人OSAHS的病理生理及临床研究报道较多,而儿童OSAHS研究则相对甚少。OSAHS对机体的影响复杂且广泛,其可导致多系统及各器官损害及病理生理表现,而心脑     

老年男性阻塞性睡眠呼吸暂停综合征与心血管疾病危险因素的相关性

目的分析老年男性阻塞性睡眠呼吸暂停综合征(OSAS)与心血管疾病危险因素相关性。方法老年男性OSAS患者120例和相同年龄段老年男性健康人100例作为对照组进行体重指数(BMI)、颈围、血压、血清胆固醇(TC)、甘油三酯(TG)、内皮素(ET)-1、血糖及C反应蛋白(CRP)及肿瘤坏死因子(TNF)-α等心血管危险因素相关检测。结果 OSAS组基础指标(如BMI、颈围、收缩压和平均动脉压)、呼吸相关指标〔如呼吸紊乱次数、呼吸紊乱指数、平均呼吸暂停时间、最长呼吸暂停时间、低氧频数、低氧指数、最低动脉血氧饱和度(Sa O2)90%时间及Sa O290%时间百分数〕、血生化指标(血糖、纤维蛋白原、TG和血浆降钙素基因相关肽)水平和正常对照组有显著性差异(P0.05)。OSAS组炎性指标血清CRP、ET-1及TNF-α水平均显著高于正常对照组(P0.05)。OSAS组颈围、TG水平、CGRP及低氧指数与阻塞性睡眠呼吸暂停和心血管疾病均呈正相关的关系。结论老年男性OSAS与心血管疾病危险因素有着密切的关系,可能是导致心血管疾病发生的独立危险因素。     

Obstructive sleep apnea: an update on mechanisms and cardiovascular consequences

Background and aimThere is growing recognition of the widespread incidence and health consequences of obstructive sleep apnea (OSA). This review examines the evidence linking sleep apnea with cardiovascular disease and discusses potential mechanisms underlying this link.Data synthesisThe weight of evidence provides increasing support for a causal relationship between OSA and hypertension. Furthermore, OSA may contribute to the initiation and progression of cardiac ischemia, heart failure and stroke. Chronic sympathetic activation appears to be a key mechanism linking OSA to cardiovascular disease. Other potential mechanisms include inflammation, endothelial dysfunction, increased levels of endothelin, hypercoagulability and stimulation of the renin angiotensin system. OSA, hypertension and obesity often coexist and interact, sharing multiple pathophysiological mechanisms and cardiovascular consequences. Effective treatment of OSA may attenuate neural and humoral abnormalities in circulatory control, improve blood pressure control and conceivably reduce the risk of future cardiovascular events.ConclusionPatients with OSA are at increased risk for cardiovascular disease. OSA should be considered in the differential diagnosis of hypertensive patients who are obese. In particular, OSA should be excluded in patients with hypertension resistant to conventional drug therapy.     

阻塞性睡眠呼吸暂停和心血管事件相关性的Mate分析

目的前期研究表明阻塞性睡眠呼吸暂停(OSA)可能会增加心血管疾病的风险,但基于各种条件的限制,该结论尚无定论。本研究旨在于通过系统性评估前瞻性队列研究来进一步分析OSA与心血管事件的相关性。方法系统性检索PubMed与EMbase等电子数据库,查找关于OSA与成年人冠状动脉粥样硬化性心脏病(CHD,冠心病)、卒中及总心血管疾病(CVD)发生率之间的前瞻性队列研究。结果本研究共计纳入14项研究。与对照组相比,OSA组的心血管死亡率(OR=2.16,95%CI:1.4~3.18,P=0.03)、冠心病发病率(OR=1.49,95%CI:1.16~1.91,P=0.002)及高血压发生率(OR=1.82,95%CI:1.24~2.68,P=0.002)上存在统计学差异,而在心血管事件(OR=1.25,95%CI:0.38~4.13,P=0.72)、卒中发生率(OR=1.17,95%CI:0.75~1.82,P=0.50)及高脂血症发生率(OR=2.06,95%CI:0.96~4.44,P=0.06)方面,两组间无统计学差异。在亚组中,体质指数(BMI)≥30的OSA人群(OR=3.82,95%CI:1.90~7.68,P=0.0002)、OSA持续10年以上(OR=3.66,95%CI:2.07~6.47,P<0.00001)及中重度OSA患者(OR=3.52,95%CI:1.59~7.79,P<0.05)具有更高的心血管死亡率。结论这项研究证实OSA会增加心血管事件的死亡率,同时增加心血管事件的相关风险,尤其是中重度OSA患者。     

Serum gamma-glutamyl transferase activity is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome

Gamma glutamyl transferase (GGT) is a new marker for predicting myocardial infarction, stroke, cardiac death and inflammation. There is also a strong relationship between Obstructive Sleep Apnea Syndrome (OSAS) and cardiovascular disease. This study was designed to investigate the association between serum GGT levels and cardiovascular disease in patients with OSAS, and relationship between severity of OSAS and serum GGT level. We evaluated the medical records of 166 subjects who were admitted for sleep study. OSAS was diagnosed by polysomnography if Apnea-Hypopnea Index (AHI) > 5. According to AHI, individuals in whom AHI< 5 were recruited as group 1 (OSAS negative group), AHI = 5-15: group 2 (mild OSAS group), AHI = 15-30: group 3 (moderate OSAS group), AHI >30: group 4 (severe OSAS group). Cardiovascular disease was defined if the patients had heart failure, coronary artery disease or arrhythmia. Of the subjects, 112 (67.5%) were male and the mean age was 54.3 ± 12.2 years. There were 22 patients (13.2%), 17 patients (10.2%), 34 patients (20.4%) and 93 patients (56.2%) in group 1, 2, 3 and 4, respectively. There is a significant increase in serum GGT levels while AHI score increases (group 1 = 28.0 ± 10.1, group 2 = 33.8 ± 13.2, group 3 = 35.2 ± 8.5, group 4 = 40.0 ± 22.0; p for trend = 0.024). However, serum C-reactive protein (CRP), alanine aminotransferase and aspartate aminotransferase levels were similar in all groups (p > 0.05). There was a significant independent association between serum GGT levels and the severity of OSAS. Moreover, serum GGT levels were significantly high in patients with cardiovascular disease compared with patients without cardiovascular disease in severe-moderate-mild OSAS (p < 0.05) and OSAS negative groups while CRP levels were not. This was a significant independent association. The present study suggests that high serum GGT level, regardless of the other traditional risk factors, is an independent predictor of cardiovascular disease in patients with OSAS. The results should be confirmed with other randomized prospective studies.     

阻塞性睡眠呼吸暂停低通气综合征导致心血管疾病相关机制

阻塞性睡眠呼吸暂停低通气综合征的发病率逐年增加,人们逐渐认识到阻塞性睡眠呼吸暂停低通气综合征是一种会引起全身多系统损伤的疾病.大量研究证实阻塞性睡眠呼吸暂停低通气综合征与包括高血压、冠心病、心律失常、心力衰竭等在内的心血管疾病之间具有显著相关性.本文针对胸腔负压改变、自主神经紊乱、氧化应激及炎症反应、细胞凋亡等阻塞性睡...     

关于阻塞性睡眠呼吸暂停治疗方法的新探讨

阻塞性睡眠呼吸暂停(obstructive sleep apnoea,OSA)是临床常见的疾病,主要表现为打鼾,夜间睡眠反复出现呼吸暂停,白天过度嗜睡等症状.目前有许多的临床研究和流行病学的结果都显示了OSA是一种对多器官和多系统都有损害的睡眠呼吸疾病,它是高血压、冠状动脉粥样硬化性心脏病、心律失常、充血性心力衰竭、脑卒中等多种疾病的独立危险因素[1].严重影响着患者的生活质量,其发病率也越来越高.因此,这就使得进一步的研究探讨OSA的治疗方法成为必要.     

Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies

Background

The association between obstructive sleep apnea (OSA) and the incidence of cardiovascular disease (CVD) has been examined in many studies. However, the findings are not entirely consistent across studies. Our goal was to evaluate the association between OSA and risk of CVD and all-cause mortality by performing a meta-analysis of prospective cohort studies.

Methods

We used generalized least squares regression models to estimate the dose–response relationship. Heterogeneity, subgroup, and sensitivity analyses and publication bias were performed.

Results

Twelve prospective cohort studies involving 25,760 participants were included in the meta-analysis. The overall combined relative risks for individuals with severe OSA compared with individuals with an AHI of < 5 were 1.79 (95% confidence interval [CI]: 1.47 to 2.18) for CVD, 1.21 (95% CI: 0.75 to 1.96) for incident fatal and non-fatal coronary heart disease, 2.15 (95% CI: 1.42 to 3.24) for incident fatal and non-fatal stroke, and 1.92 (95% CI: 1.38 to 2.69) for deaths from all-causes. A positive association with CVD was observed for moderate OSA but not for mild OSA. The results of the dose–response relationship indicated that per 10-unit increase in the apnea–hypopnea index was associated with a 17% greater risk of CVD in the general population.

Conclusions

This meta-analysis of prospective cohort studies suggests that severe OSA significantly increases CVD risk, stroke, and all-cause mortality. A positive association with CVD was observed for moderate OSA but not for mild OSA.     

Obesity-related cardiovascular disease: implications of obstructive sleep apnea

Obesity and obstructive sleep apnea (OSA) often coexist. OSA has been linked to cardiovascular disease. Thus, OSA may contribute to the cardiovascular consequences of obesity. In this review, we explore clinical and pathophysiological interactions between obesity, cardiovascular disease and OSA. We discuss the mechanisms whereby OSA may contribute to hypertension, atherosclerosis, insulin resistance and atrial fibrillation associated with obesity, and emphasize the potential implications for understanding why only a subgroup of obese patients develop cardiovascular disease. Identification of the OSA-dependent and OSA-independent pathways in the cardiovascular pathophysiology of obesity may hold clinical and therapeutic promise.     

阻塞性睡眠呼吸暂停综合征与血管内皮功能障碍研究进展

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是高血压、动脉粥样硬化等心血管疾病发病的重要危险因素之一,虽然目前机制尚未完全阐明,但与内皮功能障碍密切相关.本文就正常血管内皮功能、内皮功能障碍及评价方法 发、OSAHS与内皮功能障碍及治疗等进行综述.     

Central serous chorioretinopathy and risk for obstructive sleep apnea

Patients with obstructive sleep apnea (OSA), in comparison to controls, have increased levels of circulating epinephrine and norepinephrine, both of which are risk factors for the development of central serous chorioretinopathy (CSCR). The aim of this pilot study was to investigate the frequency of symptoms that suggest OSA in CSCR patients and normal controls. The Berlin Questionnaire, a validated research tool to assess risk for OSA, was administered to 29 patients who met the criteria for active, acute, non-steroid-induced CSCR and 29 controls matched for age and sex. In this retrospective case-controlled study, the main outcome measure was increased risk for OSA. The mean age of the patients was 47.8 years (range 29–72) and the mean age of controls was 47.3 years (range 25–70). Seventy-six percent (22) of both groups were men. Survey scores showed 58.6% (17) of patients with CSCR to be at an increased risk for OSA compared to 31.0% (nine) of controls. A conditional logistic regression analysis showed that the CSCR group had a higher proportion with an increased risk for OSA compared to the control group (odds ratio=3.67; 95% CI: 1.02, 13.14; P = 0.046). Patients with CSCR may be more likely than other adults to have OSA, and screening for this sleep disorder should be considered in this population. Further research is warranted to determine whether sleep apnea may contribute to the development of CSCR, and to assess whether treatment of sleep apnea might offer a new therapeutic option for some patients with CSCR.     

Coagulability in obstructive sleep apnea

BACKGROUND:

Obstructive sleep apnea (OSA) is a common disorder that affects both quality of life and cardiovascular health. The causal link between OSA and cardiovascular morbidity/mortality remains elusive. One possible explanation is that repeated episodes of nocturnal hypoxia lead to a hypercoagulable state that predisposes patients to thrombotic events. There is evidence supporting a wide array of hematological changes that affect hemostasis (eg, increased hematocrit, blood viscosity, platelet activation, clotting factors and decreased fibrinolytic activity).

OBJECTIVE:

To provide a comprehensive review of the current evidence associating OSA with increased coagulability, and to highlight areas for future research.

METHODS:

Keyword searches in Ovid Medline were used to identify relevant articles; all references in the articles were searched for relevant titles. The Web of Science was used to identify articles citing the relevant articles found using the Ovid Medline search. All original peer-reviewed articles, meta-analyses and systematic reviews regarding the pertinent topics between 1990 and present were selected for review.

RESULTS:

Hematocrit, blood viscosity, certain clotting factors, tissue factor, platelet activity and whole blood coagulability are increased in patients with OSA, while fibrinolysis is impaired.

CONCLUSION:

There is considerable evidence that OSA is associated with a procoagulant state. Several factors are involved in the procoagulant state associated with OSA. There is a need for adequately powered clinical studies involving well-matched control groups to address potential confounding variables, and to accurately delineate the individual factors involved in the procoagulant state associated with OSA and their response to treatment.