Cerebrovascular consequences of obstructive sleep apnea.
Cerebrovascular consequences of obstructive sleep apnea.
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DOI：
10.1161/jaha.111.000091
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发表时间：
2012-08
影响因子：
5.4
通讯作者：
Bryan RM Jr
中科院分区：
文献类型：
--
作者：
Durgan DJ;Bryan RM Jr
阻塞性睡眠呼吸暂停（OSA）是指由于呼吸道阻塞导致睡眠期间呼吸中断，并伴有持续的呼吸努力。在成人中，OSA最常见的是由上气道软组织中的肌张力降低（通畅性所需）引起的。1阻塞性睡眠呼吸暂停综合征的症状包括打鼾、白天嗜睡、早晨头痛、性功能障碍以及情绪和行为障碍。虽然有时被医生忽视，但OSA是心血管疾病的独立预测因子。1-7为了教育医生睡眠呼吸暂停的严重性，美国心脏协会和美国心脏病学会于2008年发表了一份联合声明，目的是传达睡眠呼吸暂停是某些患者心血管疾病的根本原因，而它会加剧其他患者的这种病理状况。1与OSA相关的心血管疾病包括高血压、心力衰竭、中风、心律失常、心肌缺血和梗死以及肺动脉高压。1-3，5，7此外，OSA与代谢失调（胰岛素抵抗和脂质紊乱）有关，这反过来又是心血管疾病的危险因素。1，3，7图1显示了阻塞性睡眠呼吸暂停的特征和可能导致心血管疾病的病理级联反应。本文就阻塞性睡眠呼吸暂停对脑循环及脑血管疾病的影响作一综述。中枢性睡眠呼吸暂停是另一种睡眠呼吸障碍，定义为由于呼吸驱动力丧失而导致的呼吸停止，除非与OSA的讨论相关，否则将不包括在内。
Obstructive sleep apnea (OSA) is defined by interrupted breathing during sleep due to airway obstruction with an ongoing respiratory effort. In adults, OSA most commonly is caused by decreased muscle tone (required for patency) in the soft tissues of the upper airway. 1 Symptoms of OSA include snoring, daytime sleepiness, morning headache, sexual dysfunction, and mood and behavioral disorders. 1 Although sometimes overlooked by physicians, OSA is an independent predictor for cardiovascular disorders. 1–7 In an effort to educate physicians about the seriousness of sleep apnea, the American Heart Association and American College of Cardiology issued a joint statement in 2008 with the purpose of communicating the idea that sleep apnea is the underlying cause of cardiovascular disease in some patients, whereas it exacerbates this pathological condition in others. 1 Cardiovascular diseases associated with OSA include hypertension, heart failure, stroke, cardiac arrhythmias, myocardial ischemia and infarction, and pulmonary arterial hypertension. 1–3, 5, 7 In addition, OSA is associated with metabolic dysregulation (insulin resistance and lipid disorders), which in turn is a risk factor for cardiovascular diseases. 1, 3, 7 Figure 1 shows characteristics of OSA and the pathological cascade that can lead to cardiovascular diseases. In this review, our focus will be the effects of OSA on the cerebral circulation and on cerebrovascular diseases. Central sleep apnea, another form of sleep-disordered breathing that is defined by cessation of breathing due to a loss of ventilatory drive, will not be covered except when pertinent to the discussion of OSA.