Reimagining obstructive sleep apnoea: a new era for sleep medicine.
Reimagining obstructive sleep apnoea: a new era for sleep medicine.
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重新想象阻塞性睡眠呼吸暂停：睡眠医学的新时代。
DOI：
10.1016/s2213-2600(23)00372-7
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Shah,Neomi
中科院分区：
文献类型：
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作者：
Kundel,Vaishnavi;Cohen,Oren;Shah,Neomi
在《柳叶刀呼吸医学》杂志创刊10周年之际，阻塞性睡眠呼吸暂停（OSA）成为人们关注的焦点。过去的十年重塑了我们对OSA病理生理学的理解，并引发了与OSA治疗作用有关的问题。随着我们的理解的发展，迫切的问题出现了：所有OSA患者都需要治疗吗？如果需要，哪些人最迫切需要治疗？此外，不同的OSA治疗如何影响健康结果？研究人员对阻塞性睡眠呼吸暂停（OSA）治疗对以患者为中心的心血管结局的影响取得了重要见解，使用创新的生理指标以及结合机器学习算法和组学在阻塞性睡眠呼吸暂停（OSA）分类方面取得了实质性进展，为阻塞性睡眠呼吸暂停（OSA）的精准健康铺平了未来。全球有近10亿人患有阻塞性睡眠呼吸暂停（OSA），其特征是睡眠期间重复性上呼吸道塌陷，导致间歇性低氧血症和睡眠片段。OSA与各种心血管疾病和病症相关，包括高血压、心房纤颤、心力衰竭和中风。目前，OSA是使用呼吸暂停-呼吸不足指数（AHI）定义的，该指数捕捉每小时睡眠呼吸事件的频率。持续气道正压通气（CPAP）是阻塞性睡眠呼吸暂停（OSA）治疗的基础，可有效改善日间嗜睡。然而，过去十年的多项随机对照试验并未显示CPAP治疗在预防中重度OSA非嗜睡患者复合心血管事件方面的益处。在过去的十年中，临床睡眠医学已经从使用详尽的夜间多导睡眠图过渡到简化的一晚家庭研究。这种转变主要是由AHI作为OSA严重程度的唯一度量标准的重要性所驱动的。然而，过分强调这一指数忽略了重要的生理数据，阻碍了心血管风险的准确预测和对患者健康状况的全面了解，包括大脑、心脏和肺之间复杂的睡眠相关相互作用。特别是，AHI未能捕捉到一系列重复的生理干扰，
As The Lancet Respiratory Medicine marks its 10-year anniversary, the spotlight on obstructive sleep apnoea (OSA) has never been brighter. This past decade has reshaped our understanding of OSA pathophysiology and incited questions pertaining to the role of OSA therapy. As our understanding evolves, pressing questions emerge: do all OSA patients need treatment and, if so, which individuals require it most urgently? Moreover, how do different OSA treatments influence health outcomes? Researchers have made important insights into the effects of OSA therapy on patientcentred and cardiovascular outcomes, with substantial advancements in OSA classification using innovative physiological metrics and the incorporation of machinelearning algorithms and omics, paving the future for precision health in OSA.OSA affects nearly 1 billion individuals worldwide and is characterised by repetitive upper-airway collapse during sleep, resulting in intermittent hypoxaemia and sleep fragmentation. OSA is associated with various cardiovascular diseases and conditions, including hypertension, atrial fibrillation, heart failure, and stroke. Currently, OSA is defined using the apnoea–hypopnoea index (AHI), which captures the frequency of respiratory events per hour of sleep. Continuous positive airway pressure (CPAP) is the cornerstone of OSA therapy and is effective at improving daytime sleepiness. However, multiple randomised controlled trials over the past decade have not shown a benefit of CPAP therapy in the prevention of composite cardiovascular events among non-sleepy patients with moderate-to-severe OSA. 1, 2 In the past decade, clinical sleep medicine has transitioned from the use of exhaustive overnight polysomnography to streamlined one-night home studies. This transformational shift was mainly driven by the perceived importance of the AHI as the sole metric of OSA severity. However, overemphasising this index neglects crucial physiological data, hindering accurate prediction of cardiovascular risk and a holistic understanding of patient health—including the intricate sleep-related interplay between the brain, heart, and lungs. In particular, the AHI fails to capture the array of repetitive physiological disruptions,