What should the recommendations be for lifestyle factors in obstructive sleep apnea?
What should the recommendations be for lifestyle factors in obstructive sleep apnea?
复制标题
对于阻塞性睡眠呼吸暂停的生活方式因素应该有哪些建议？
DOI：
10.1080/17476348.2022.2099377
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发表时间：
2022
影响因子：
3.9
通讯作者：
Huang,Tianyi
中科院分区：
文献类型：
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作者：
Huang,Tianyi
阻塞性睡眠呼吸暂停(OSA)是一种在成人人群中非常普遍的慢性睡眠障碍，其特征是反复上呼吸道塌陷，间歇性低氧和睡眠中频繁唤醒，导致白天功能受损，心血管疾病和死亡的风险增加。除了年龄和性别，肥胖是流行病学研究中确定的阻塞性睡眠呼吸暂停的最大危险因素。肥胖不仅通过对呼吸道通畅性和肺功能的机械影响增加OSA风险(例如，由于咽部脂肪组织过多导致气道狭窄，由于内脏脂肪增加腹部压力导致肺容量减少)，而且通过肥胖引起的下游生化变化(例如炎症和胰岛素抵抗；图1)。越来越多的证据表明，OSA表现为一种代谢紊乱，与糖尿病、血脂异常、全身性炎症和瘦素抵抗等代谢变化有复杂的关系[1-3]。最近的研究支持阻塞性睡眠呼吸暂停综合征和糖尿病之间的双向联系，而不是肥胖。慢性炎症是肥胖和糖尿病的一个标志，在考虑了肥胖和糖尿病的情况后，OSA的发病率增加是相关的。胰岛素抵抗和瘦素不敏感是代谢综合征患者的两个常见的病理生理特征，已被证明会损害上呼吸道肌肉的神经机械控制，并可能使个人更容易发生OSA。综上所述，这些研究表明，针对肥胖和代谢途径的干预措施有利于OSA的预防和治疗。许多研究证明，促进健康的生活方式(如饮食、运动、睡眠)是对抗肥胖、缓解代谢失调和改善肺功能(如OSA-COPD重叠综合征)的有效策略。令人信服的证据显示，健康的饮食模式和积极的生活方式对体重变化以及炎症和代谢生物标志物的特征有很强的有利影响[4，5](图1)。此外，缺乏运动和久坐的行为可能会导致下肢浮肿，并在睡眠时导致体液向颈部移动，使上呼吸道变窄，增加其塌陷性[6]。尽管这些都是健康生活方式预防阻塞性睡眠呼吸暂停综合征的合理而重要的途径，但关于健康生活方式在阻塞性睡眠呼吸暂停综合征中的作用的研究有限。
Obstructive sleep apnea (OSA) is a highly prevalent chronic sleep disorder in the adult population characterized by recurrent collapses of upper airway, intermittent hypoxia and frequent arousals during sleep, leading to impaired daytime function and increased risk of cardiovascular disease and mortality. In addition to age and sex, obesity is the strongest risk factor for OSA identified in epidemiologic studies. Obesity increases OSA risk not only through the mechanical impact on airway patency and lung function (eg narrowed airways due to excess pharyngeal adipose tissues and reduced lung volumes due to increased abdominal pressure from visceral fat), but also through obesity-induced downstream biochemical alterations (eg inflammation and insulin resistance; Figure 1). Mounting evidence suggests that OSA is manifested as a metabolic disorder, with intricate relationships with metabolic alterations such as diabetes, dyslipidemia, systemic inflammation and leptin resistance [1–3]. Recent studies support a bidirectional association between OSA and diabetes independent of obesity. Chronic inflammation, a hallmark of obesity and diabetes, is associated with increased incidence of OSA after accounting for obesity and diabetes status. Insulin resistance and leptin insensitivity, which are two common pathophysiological features in individuals with metabolic syndrome, have been shown to impair neuromechanical control of upper airway muscles and may predispose individuals to the development of OSA. Taken together, these studies suggest that interventions targeting obesity and metabolic pathways are beneficial for the prevention and treatment of OSA. Promoting healthy lifestyles (eg diet, exercise, sleep) has proved to be an effective strategy to combat obesity, alleviate metabolic dysregulation and improve pulmonary functions (eg the OSA-COPD overlap syndrome) in numerous studies. Compelling evidence reveals strong favorable effects of a healthful dietary pattern and an active lifestyle on weight change and profiles of inflammatory and metabolic biomarkers [4, 5](Figure 1). Further, physical inactivity and sedentary behavior could cause lower-extremity edema and induce body fluid shift toward the neck during sleep, narrowing the upper airway and increasing its collapsibility [6]. Although these are plausible and important pathways through which healthy lifestyles may protect against OSA, there have been limited studies on the role of heathy lifestyles in OSA.