Obstructive sleep apnea and hypertension: epidemiology, mechanisms and treatment effects.

Obstructive sleep apnea (OSA) is a highly prevalent disorder of breathing during sleep. A growing body of cvidence suggests that OSA is independently associated with an increased risk of cardiovascular disease, although the extent of this risk and underlying mechanisms remain to be elucidated. However, there is clearer evidence from epidemiological and pathophysiological research of a causal link between OSA and hypertension. The acute hemodynamic and autonomic per turbations that accompany obstructive apneas during sleep, with associated repeated arousals and intermittent hypoxemia, appear to result in sustained hypertension. In addition to the etabolic and humoral effects from obesity, OSA appears to predispose individuals to autonomic imbalance characterized by sympathetic overactivity and altered baroreflex mechanisms as well as alterations to vascular function. Treatment of OSA restores normal sleep architecture and generally mitigates the acute hemodynamic effects of OSA. Treatment of symptomatic OSA, particular at the severe end of the spectrum, appears to be associated with improvements in blood pressure. both during sleep and wakefulness, and there may also be additional gains in subjects who are hypertensive and/or resistant to anti-hypertensive medications. The severe group appears to be particularly at risk for developing fatal and non-fatal cardiovascular events and treatment with continuous positive airway pressure appears to markedly reduce that risk. Future treatment studies will need to be extended for greater than the current average of 1~2 months in order to more fully evaluate any time dependent improvements in blood pressure, and consequent cardiovascular risk.

参考译文

阻塞性陲眠呼吸障碍与高血压

——流行病学、机制及疗效

阻塞性睡眠呼吸暂停是一种高发的睡眠呼吸紊乱。尽管阻塞性睡眠呼吸暂停作为一个独立的危险因素的危险程度和发病机制还有待进一步明确，但是越来越多的证据显示阻塞性睡眠呼吸暂停的确是心血管疾病发病的一个独立危险因素。不管怎样，现在已经有了更确实的流行病学和病理生理学方面的证据证明两者之间的相关性。伴随着阻塞性睡眠呼吸暂停出现的急性的血流动力学和自律性的紊乱，以及与此相关的反复出现的周期性低氧血症都会导致持续性的高血压。除了肥胖引起的代谢和体液作用以外，对于以交感活动过度和压力反射改变引起的自主神经紊乱和血管功能改变，阻塞性睡眠呼吸暂停的个体也表现出易感性。阻塞性睡眠呼吸暂停除了能重建正常的睡眠结构之外通常还能缓解由此引起的急性血流动力学效应。对有症状阻塞性睡眠呼吸暂停患者尤其是重症患者的治疗显示，治疗后，患者睡眠和清醒状态下的血压都有很大的改善。这样的结果对高血压及对高血压药物抵抗的高血压患者来说也是一个意外的收获。阻塞性睡眠呼吸暂停严重组的患者，对于致命或非致命的心血管疾病都显示出显著的危险性，而持续正压通气的治疗则能明显地降低这种危险。相比目前平均1~2个月的治疗时间，未来的治疗研究应该尝试更长期的治疗，以期更全面地评估治疗对于血压改善情况和随之引起的心血管疾病风险改变的情况。

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