阻塞性睡眠呼吸暂停与心血管疾病的关系及发病机制探讨

阻塞性睡眠呼吸暂停的发病率有逐年增高趋势,越来越多的研究表明阻塞性睡眠呼吸暂停与心血管疾病（如高血压、肺动脉高压、冠心病、心律失常、心力衰竭等）的发生率与病死率关系密切;为有助于加深心血管病医生对阻塞性睡眠呼吸暂停与心血管疾病的认识,进一步探索阻塞性睡眠呼吸暂停的发病机制,从而提高疾病的防控水平;现就阻塞性睡眠呼吸暂停与心血管病的关系,导致疾病的可能发病机制作一综述。     

阻塞性睡眠呼吸暂停综合征对心血管的影响

阻塞性睡眠呼吸暂停综合征对心血管的影响陈白屏，程显声睡眠医学作为一门新兴的边缘学科，正日益受到人们的广泛重视。自８０年代以来，国外对睡眠呼吸暂停综合征（ＳＡＳ）与心血管病间的关系做了较多的研究，表明ＳＡＳ是一发病率较高、对心血管病有重要影响，而且具有...     

睡眠呼吸暂停低通气综合征与心血管疾病相关性的临床分析

目的临床观察不同程度睡眠呼吸暂停低通气综合征(SAHS)患者心血管病发生率及其两者的相关性,为引起心血管科医生对本病的重视提供临床依据.方法 63例疑似SAHS患者进行睡眠呼吸监测,依据多导睡眠图监测结果,分为正常、轻度、中度、重度睡眠呼吸暂停4组,根据临床表现、血液生化指标、心电图、心脏超声、动态血压及冠状动脉造影等检查诊断心血管疾病,分析不同程度睡眠呼吸暂停与心血管疾病发生率的相关性.结果体重指数与呼吸暂停低通气指数、呼吸紊乱指数显著正相关(r=0.355,0373,P＜0.05);中、重度SAHS组心血管病发生率明显高于正常及轻度SAHS组(P＜0.05或0.01).结论睡眠呼吸暂停的程度与心血管疾病的发生密切相关.     

阻塞性睡眠呼吸暂停综合征与扩张型心肌病

随着对阻塞睡眠呼吸暂停综合征(OSAS)认识的深入,OSAS与各类心血管疾病的相关性也逐渐得到重视。2009年中华医学会呼吸病学分会睡眠学组会同心血管病学会参照国外有关研究发表了《睡眠呼吸暂停与心血管疾病专家共识》,成为进一步促进、密切两个学科之间研究的新起点。文章对如何早期认识、诊断OSAS合并扩张型心肌病(DCM)做一简要介绍,强调DCM患者合并OSAS诊断的临床意义,分析CPAP治疗对DCM患者恢复心脏功能及心脏结构的临床价值。     

男性睡眠呼吸暂停与心肌梗塞的关系

一些流行病学研究提示,打鼾是心血管病尤其是高血压和缺血性心脏病的一种危险因素。男性习惯性打鼾者中,高血压和缺血性心脏病明显增加的原因是睡眠呼吸暂停,而不是打鼾本身。严重打鼾几乎都伴有睡眠呼吸暂停综合征(SAS).作者通过多功能睡眠记录仪观察SAS 与缺血性心脏病之间的关系,同时对男性急性心肌梗塞(AMI)存活者与相同年龄男性无缺血性心脏病者的发作频率加以比较。     

阻塞型睡眠呼吸暂停综合征与心血管疾病

睡眠呼吸暂停综合征是一种常见的睡眠障碍性疾病,其中以阻塞型睡眠呼吸暂停综合征最为常见.国内外研究表明,睡眠呼吸暂停综合征在心血管系统的各类疾病中有重要影响.对睡眠呼吸暂停综合征患者进行及时有效的治疗,能够显著预防心血管疾病.现主要阐述阻塞型睡眠呼吸暂停综合征与心血管常见疾病高血压、冠心病、心力衰竭、心律失常之间的关系.     

睡眠障碍性呼吸与卒中

睡眠障碍性呼吸与缺血性卒中关系密切。睡眠障碍性呼吸包括阻塞性睡眠呼吸暂停和中枢性睡眠呼吸暂停。研究表明,阻塞性睡眠呼吸暂停是卒中的独立危险因素,而卒中又可增高睡眠障碍性呼吸的发生率。文章就睡眠障碍性呼吸和卒中的最新研究进展进行了综述。     

睡眠呼吸暂停低通气综合征与脑卒中

近年来大量流行病学及前瞻性研究显示睡眠呼吸暂停低通气综合征与脑卒中关系密切：睡眠呼吸暂停低通气综合征是脑卒中的独立危险因素,合并睡眠呼吸暂停低通气综合征的卒中患者预后较差。因此了解睡眠呼吸暂停低通气综合征与脑卒中之间的联系对于脑卒中的一、二级预防具有重要的意义。本文就近些年睡眠呼吸暂停低通气综合征与脑卒中的相关研究进行讨论。     

阻塞性睡眠呼吸暂停综合征与代谢综合征

阻塞性睡眠呼吸暂停综合征是一种常见的睡眠呼吸调节障碍性疾病。国内外研究表明,阻塞性睡眠呼吸暂停综合征对代谢综合征有重要影响。对阻塞性睡眠呼吸暂停综合征患者进行及时有效的治疗,能够显著预防代谢性疾病。现主要阐述阻塞性睡眠呼吸暂停综合征与代谢综合征之间的关系。     

持续气道正压通气对于阻塞性睡眠呼吸暂停相关性高血压的治疗效果研究进展

阻塞性睡眠呼吸暂停常影响睡眠质量并引起心血管疾病,其中高血压发病率最高。目前对于阻塞性睡眠呼吸暂停与高血压之间的关系及机制仍在探索中,而持续气道正压通气作为阻塞性睡眠呼吸暂停的有效治疗方法,对于血压的降压作用说法不一。了解阻塞性睡眠呼吸暂停与高血压之间的关系机制及持续气道正压通气的治疗效果,将有助于更好的临床实践。     

Sleep apnea syndrome in chronic renal disease

PURPOSE: We performed this study in order to expand on an earlier report indicating a high prevalence of the sleep apnea syndrome in male patients with end-stage renal disease treated with hemodialysis and to determine whether patients with chronic renal insufficiency (prior to the initiation of therapy for end-stage renal disease) and female patients with end-stage renal disease treated with hemodialysis were affected. PATIENTS AND METHODS: Polysomnography was performed in 26 male and female patients with chronic renal insufficiency and end-stage renal disease treated with hemodialysis who were not receiving testosterone. They included 22 whose histories were suggestive of sleep apnea ("symptomatic") and four whose histories were not ("asymptomatic"). RESULTS: Sixteen of the symptomatic (73 percent) and none of the asymptomatic patients were found to have clinically significant sleep apnea syndrome (p less than 0.02). Both female patients and patients with chronic renal insufficiency had sleep apnea. In nine of these 16 cases, the disorder was primarily of the obstructive type. CONCLUSION: These preliminary data raise the possibility of an association of chronic renal disease and the sleep apnea syndrome, and suggest that some of the daytime sleepiness and disturbed nocturnal sleep in such patients may be related to sleep apnea. They also indicate that questioning patients with chronic renal disease and symptoms suggestive of a sleep disorder is useful in determining who are at high risk for the sleep apnea syndrome. Further study is required to establish a causal relationship between chronic renal disease and the sleep apnea syndrome, and to determine the prevalence of the latter in patients with end-stage renal disease.     

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...     

Correlation between severity of endoscopic findings and apnea-hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea

AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea. METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: "mild-moderate" (A)-AHI 5≥5-30, n=27, "severe" (B)-AHI >30, n=30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms. RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in "severe" group (P = 0.0001). Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups. CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.     

Cardiovascular consequences of obstructive sleep apnea

Sleep apnea is associated with several cardiovascular disease conditions. A causal relationship between sleep apnea and each of these diseases is likely, but remains to be proven. The clearest evidence implicating OSA in the development of new cardiovascular disease involves data that show an increased prevalence of new hypertension in patients with OSA followed over 4 years [3]. Circumstantial evidence and data from small study samples suggest that OSA, in the setting of existing cardiovascular disease, may exacerbate symptoms and accelerate disease progression. The diagnosis of OSA always should be considered in patients with refractory heart failure, resistant hypertension, nocturnal cardiac ischemia, and nocturnal arrhythmias, especially in individuals with risk factors for sleep apnea (e.g., central obesity, age, and male gender). Treating sleep apnea may help to achieve better clinical control in these diseases and may improve long-term cardiovascular prognosis.     

睡眠呼吸暂停综合征与高血压的综合分析

睡眠呼吸暂停综合征(SAS)和高血压是威胁人类健康的常见疾病,临床上,SAS与高血压常合并发生,有相关资料表明,高血压和SAS有很大的共存性,同时,SAS是引发高血压的危险因素之一,很大程度上降低了降压药的治疗效果,临床上对此类型高血压患者可通过治疗SAS来缓解或治愈高血压病症,以期降低高血压的患病率以及提高高血压的治愈率。本文就SAS的临床表现和高血压的关系进行简单阐述,为今后的临床治疗和研究提供相关依据。     

Hyperinflation is Associated with Lower Sleep Efficiency in COPD with Co-existent Obstructive Sleep Apnea

ABSTRACT

Prior research has shown that individuals with obstructive lung disease are at risk for sleep fragmentation and poor sleep quality. We postulated that patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (known as overlap syndrome) who have more severe lung disease, as measured by lung hyperinflation (inspiratory capacity/total lung capacity), would have greater sleep disturbances independent of traditional measures of sleep apnea. We performed a retrospective chart review of consecutive patients evaluated and treated in an academic pulmonary clinic for overlap syndrome. Pulmonary function tests and polysomnogram data were collected. Thirty patients with overlap syndrome were included in the analysis. We found significant univariable associations between sleep efficiency and apnea/hypopnea index (β = ?0.285, p = 0.01) and between sleep efficiency and lung hyperinflation (β = 0.654, p = 0.03). Using multivariable linear regression, the relationship between sleep efficiency and lung hyperinflation remained significant (β = 1.13, p = 0.02) after adjusting for age, sex, body mass index, apnea/hypopnea index, FEV₁% predicted, oxygen saturation nadir, medications, and cardiac disease. We conclude that increased severity of hyperinflation is associated with worse sleep efficiency, independent of apnea and nocturnal hypoxemia. The mechanisms underlying this observation are uncertain. We speculate that therapies aimed at reducing lung hyperinflation may improve sleep quality in patients with overlap syndrome.     

Sleep in COPD patients

An estimated 14 million Americans are afflicted with COPD and are at risk for significant abnormalities in gas exchange and ventilation that are exacerbated by sleep. In addition 10-15% of COPD patients concomitantly suffer from sleep apnea. The term "Overlap Syndrome" was originally coined by Flenley to describe the relationship between COPD and sleep apnea. Patients with overlap syndrome are characterized by having lower PaO2 during wakefulness, higher PaCO2, elevated pulmonary artery pressure and more significant episodes of nocturnal hypoxemia than sleep apnea patients without COPD. COPD and sleep apnea have long been individually recognized for having significantly detrimental affects on the respiratory physiology of patients. The mechanisms of both diseases compromise the gas exchange, oxygenation, and overall mortality and morbidity in the affected patients. While both of these diseases individually represent significant detriment to affected patients, the combination of these two diseases has been shown to have an even more profound affect on patients' oxygenation, gas exchange, and breathing patterns. As our understanding of the physiological processes of sleep develops, the relationship between obstructive sleep apnea and obstructive lung disease has become progressively more apparent. Identification and appropriate management of these patients is particularly important because the 5 year survival of patients with overlap syndrome is lower than that of patients with sleep apnea alone as shown in prospective trials.     

阻塞型睡眠呼吸暂停综合征与肥胖相关性心血管疾病关系

阻塞型睡眠呼吸暂停综合征是一种常见的睡眠障碍性疾病。阻塞型睡眠呼吸暂停综合征常与肥胖症共存,且已证实阻塞型睡眠呼吸暂停综合征与心血管疾病有联系。因此,阻塞型睡眠呼吸暂停综合征可能对肥胖相关性心血管疾病发生发展起作用。这篇综述主要阐述阻塞型睡眠呼吸暂停综合征、肥胖症、心血管疾病之间的病理生理学的交互作用,以及进一步关于阻塞型睡眠呼吸暂停综合征研究的潜在暗示含义．     

Hypercapnia and ventilatory periodicity in obstructive sleep apnea syndrome

Prevention of acute hypercapnia during obstructive events in obstructive sleep apnea requires a balance between carbon dioxide (CO(2)) loading during the event and CO(2) unloading in the interevent period. Earlier studies have demonstrated that acute CO(2) retention may occur despite high interevent ventilation when the interevent duration is short relative to the duration of the preceding event. The present study examines the relationship between apnea and interapnea durations and relates this assessment of ventilatory periodicity to the degree of chronic hypercapnia in subjects with severe sleep apnea. A total of 18 subjects with sleep apnea (> 40 apnea/hour; chronic awake Pa(CO2) 36-62 mm Hg) and without underlying lung disease underwent polysomnography. For each event, apnea duration, interapnea duration, and apnea/interapnea duration ratio were determined. No relationship was observed between chronic Pa(CO2) and mean apnea or interapnea duration (p > 0.1). However, Pa(CO2) was directly related to apnea/interapnea duration ratio (r = 0.48; p < 0.05) such that with increasing chronic hypercapnia the interapnea duration shortens relative to the apnea duration. The present study suggests that control of the interapnea ventilatory duration relative to the duration of the preceding apnea, is an important component of the integrated ventilatory response to CO(2) loading during apnea and may contribute toward the development and/or maintenance of chronic hypercapnia in obstructive sleep apnea/hypopnea syndrome.