Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components.
Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components.
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DOI：
10.5664/jcsm.27191
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发表时间：
2008-06
期刊：
影响因子：
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通讯作者：
G. Jean-Louis;F. Zizi;L. Clark;C. Brown;Samy I McFarlane
中科院分区：
文献类型：
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作者：
G. Jean-Louis;F. Zizi;L. Clark;C. Brown;Samy I McFarlane
虽然阻塞性睡眠呼吸暂停和心血管疾病有共同的危险因素，但流行病学研究表明，睡眠呼吸暂停会增加心血管疾病的风险，而不受个人的人口统计特征(即年龄、性别和种族)或风险标记物(如吸烟、酒精、肥胖、糖尿病、血脂异常、房颤和高血压)的影响。患有严重睡眠呼吸暂停的人患冠状动脉疾病、充血性心力衰竭和中风的风险增加。解释阻塞性睡眠呼吸暂停和心血管疾病之间联系的潜在机制尚未完全阐明。可能涉及几种中介机制，包括持续的交感神经激活、胸腔内压力变化和氧化应激。其他异常，如凝血因子紊乱、内皮损伤、血小板活化和炎性介质增加，也可能在心血管疾病的发病机制中发挥作用。阻塞性睡眠呼吸暂停和心血管疾病之间的联系得到了证据的证实，即睡眠呼吸暂停持续正压治疗降低了收缩压，改善了左心室收缩功能，并减少了血小板的激活。为了阐明睡眠呼吸暂停和心血管疾病之间的复杂联系，有必要进行几项系统研究，而包括代谢综合征的疾病(即中心性肥胖、高血压、糖尿病和血脂异常)可能会使这种联系更加复杂。需要大规模的、以人群为基础的研究，测试睡眠呼吸暂停、心血管发病率和代谢综合征之间的因果模型。
Although obstructive sleep apnea and cardiovascular disease have common risk factors, epidemiologic studies show that sleep apnea increases risks for cardiovascular disease independently of individuals' demographic characteristics (i.e., age, sex, and race) or risk markers (i.e., smoking, alcohol, obesity, diabetes, dyslipidemia, atrial fibrillation, and hypertension). Individuals with severe sleep apnea are at increased risk for coronary artery disease, congestive heart failure, and stroke. The underlying mechanisms explaining associations between obstructive sleep apnea and cardiovascular disease are not entirely delineated. Several intermediary mechanisms might be involved including sustained sympathetic activation, intrathoracic pressure changes, and oxidative stress. Other abnormalities such as disorders in coagulation factors, endothelial damage, platelet activation, and increased inflammatory mediators might also play a role in the pathogenesis of cardiovascular disease. Linkage between obstructive sleep apnea and cardiovascular disease is corroborated by evidence that treatment of sleep apnea with continuous positive airway pressure reduces systolic blood pressure, improves left ventricular systolic function, and diminishes platelet activation. Several systematic studies are necessary to explicate complex associations between sleep apnea and cardiovascular disease, which may be compounded by the involvement of diseases comprising the metabolic syndrome (i.e., central obesity, hypertension, diabetes, and dyslipidemia). Large-scale, population-based studies testing causal models linking among sleep apnea, cardiovascular morbidity, and metabolic syndrome are needed.