Obstructive Sleep Apnea as a Cardiovascular Risk Factor-Beyond CPAP.
Obstructive Sleep Apnea as a Cardiovascular Risk Factor-Beyond CPAP.
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DOI：
10.1016/j.cjca.2021.01.027
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Somers VK
中科院分区：
文献类型：
--
作者：
Bock JM;Vungarala S;Karim S;Somers VK
阻塞性睡眠呼吸暂停（OSA）患者在睡眠中反复出现部分或完全气道塌陷，导致夜间缺氧-常氧循环，心血管风险增加。每小时睡眠呼吸暂停和呼吸不足指数（AHI）的数量以及相关的间歇性缺氧预测心血管风险的增加；因此，它们的衰减或预防是OSA治疗的目标。持续气道正压通气（CPAP）是OSA的金标准治疗方法，如果有效，可以减轻AHI和低氧血症。因此，预期CPAP会降低心血管风险是合理的。然而，最近的三项CPAP与常规治疗的随机临床试验并未发现CPAP在减少OSA患者心血管事件发生率方面有任何显著作用。在这篇综述中，我们讨论了这些研究以及CPAP的潜在补充治疗选择（如神经刺激），并总结了未来介入性研究的治疗靶点（如自主神经系统）。虽然这些领域的研究令人兴奋，但它们还没有经过与CPAP类似程度的严格测试。有证据表明阻塞性睡眠呼吸暂停（OSA）是心血管风险增加的中介。病理上，夜间低氧-常氧循环通过全身性炎症、氧化应激和交感神经激活引起OSA的许多有害影响。最近的数据表明，持续气道正压通气（CPAP）， OSA的标准治疗，并不能降低这些患者的心血管风险。我们回顾了这些发现的潜在原因，包括CPAP的疗效，强调了未来介入工作的潜在治疗靶点，并讨论了与CPAP互补的OSA新治疗方法。
Patients with obstructive sleep apnea (OSA) experience repetitive partial or complete airway collapse during sleep resulting in nocturnal hypoxia-normoxia cycling, and are at increased cardiovascular risk. The number of apneas and hypopneas indexed per hour of sleep (AHI) along with the associated intermittent hypoxia predict the increased cardiovascular risk; thus, their attenuation or prevention are objectives of OSA therapy. Continuous positive airway pressure (CPAP) is the gold-standard treatment for OSA and, when effective, mitigates both the AHI and hypoxemia. As such, it is reasonable to expect CPAP would decrease cardiovascular risk. However, three recent randomized clinical trials of CPAP versus usual care did not find any significant effects of CPAP in attenuating incident cardiovascular events in patients with OSA. In this review, we discuss these studies in addition to potential complementary therapeutic options to CPAP (e.g., neurostimulation) and conclude with suggested therapeutic targets for future interventional studies (e.g., the autonomic nervous system). While these areas of research are exciting, they have yet to be tested to any similar degree of rigor as CPAP. Evidence implicates obstructive sleep apnea (OSA) as a mediator of increased cardiovascular risk. Pathologically, nocturnal hypoxia-normoxia cycling causes many of the deleterious effects of OSA via systemic inflammation, oxidative stress, and sympathetic activation. Recent data suggest continuous positive airway pressure (CPAP), the standard treatment for OSA, does not attenuate cardiovascular risk in these patients. We review potential reasons for these findings including efficacy of CPAP, highlight potential therapeutic targets for future interventional works, and discuss emerging treatments complementary to CPAP for OSA.
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期刊：
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影响因子：
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