Obstructive sleep apnea and chronic intermittent hypoxia: a review.
Obstructive sleep apnea and chronic intermittent hypoxia: a review.
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发表时间：
2006-10
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通讯作者：
A. Chiang
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作者：
A. Chiang
缺氧是生理学和临床上的一个重要课题。传统的生理学研究主要集中在急性和慢性持续低氧的影响以及人体对高原的适应性反应。在过去的20年里，许多人的遗传学研究将我们对缺氧的理解扩展到了分子水平。然而，相对于我们对急性和慢性持续性缺氧的广泛了解，我们对慢性间歇性缺氧（CIH）的影响知之甚少。近年来，随着肥胖和阻塞性睡眠呼吸暂停（OSA）在西方国家的日益普遍，CIH引起了越来越多的研究关注。临床上，CIH常见于睡眠呼吸障碍患者，包括OSA、潮式呼吸和夜间通气不足。据估计，一般人群中至少轻度严重程度的OSA的患病率估计范围为3%至28%。阻塞性睡眠呼吸暂停综合征的特征是睡眠期间反复发作的上呼吸道塌陷，导致间歇性夜间缺氧和睡眠片段化。OSA与显著的死亡率和发病率相关，包括神经认知功能障碍、高血压、许多心血管疾病和代谢疾病如糖尿病和代谢综合征。OSA的间歇性缺氧与缺血再灌注损伤非常相似。从实验上看，CIH没有普遍接受的定义。实验室方案在缺氧暴露持续时间、每天缺氧发作次数和暴露总天数方面差异很大。尽管缺乏一个统一的定义，但最近的数据表明，CIH可能导致多种长期的病理生理学后果，类似于我们在OSA患者中所看到的。近年来的研究还表明，生理系统对持续低氧和间歇低氧的反应存在显著差异。本文就睡眠呼吸障碍的临床意义及目前对CIH的认识作一综述。
Hypoxia is an important topic both physiologically and clinically. Traditionally, physiology research has been focusing on the effect of acute and chronic sustained hypoxia and human adaptive response to high altitude. In the past 20 years, genetic studies by many have expanded our understanding of hypoxia to the molecular level. However, in contrast to our extensive knowledge about acute and chronic sustained hypoxia, we know relatively little about the effect of chronic intermittent hypoxia (CIH). In recent years, CIH has attracted more research attention because of the increasing prevalence of obesity and obstructive sleep apnea (OSA) in the western countries. Clinically, CIH is commonly seen in patients with sleep-disordered breathing including OSA, Cheyne-Stokes respiration and nocturnal hypoventilation. It was estimated that for OSA of at least mild severity prevalence estimates range from 3 to 28% in the general population. OSA is characterized by recurrent upper airway collapse during sleep leading to intermittent nocturnal hypoxia and sleep fragmentation. OSA is associated with significant mortality and morbidity including neurocognitive dysfunction, hypertension, many cardiovascular disorders and metabolic disorders such as diabetes and metabolic syndrome. The intermittent hypoxia in OSA closely mimics what is seen in the ischemia-reperfusion injury. Experimentally, there is no universally accepted definition for CIH. Laboratory protocols vary greatly in duration of hypoxia exposure, numbers of hypoxia episodes per day and the total number of days of exposure. Despite the lack of a uniform definition, recent data suggest that CIH may lead to multiple long-term pathophysiologic consequences similar to what we see in patients with OSA. Recent evidences also demonstrate that there are remarkable differences in the response of the physiologic systems to sustained hypoxia and intermittent hypoxia. This review is aimed to briefly discuss the clinical significance of sleep-disordered breathing and our current understanding of CIH.