Sleep Apnea and Cardiovascular Disease: An Enigmatic Risk Factor

被引:137
作者
Floras, John S. [1 ,2 ]
机构
[1] Univ Toronto, Univ Hlth Network, Toronto, ON, Canada
[2] Univ Toronto, Sinai Hlth Syst, Div Cardiol, Dept Med, Toronto, ON, Canada
基金
加拿大健康研究院;
关键词
cardiovascular risk factors; heart failure; humans; sleep apnea; central; obstructive; POSITIVE AIRWAY PRESSURE; CHEYNE-STOKES RESPIRATION; ADAPTIVE SERVO-VENTILATION; SYSTOLIC HEART-FAILURE; ACUTE MYOCARDIAL-INFARCTION; SYMPATHETIC-NERVE ACTIVITY; RANDOMIZED CONTROLLED-TRIAL; CORONARY-ARTERY-DISEASE; CARDIAC RESYNCHRONIZATION THERAPY; ATRIAL-FIBRILLATION RECURRENCE;
D O I
10.1161/CIRCRESAHA.118.310783
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Synchronization of molecular, metabolic, and cardiovascular circadian oscillations is fundamental to human health. Sleep-disordered breathing, which disrupts such temporal congruence, elicits hemodynamic, autonomic, chemical, and inflammatory disturbances with acute and long-term consequences for heart, brain, and circulatory and metabolic function. Sleep apnea afflicts a substantial proportion of adult men and women but is more prevalent in those with established cardiovascular diseases and especially fluid-retaining states. Despite the experimental, epidemiological, observational, and interventional evidence assembled in support of these concepts, this substantial body of work has had relatively modest pragmatic impact, thus far, on the discipline of cardiology. Contemporary estimates of cardiovascular risk still are derived typically from data acquired during wakefulness. The impact of sleep-related breathing disorders rarely is entered into such calculations or integrated into diagnostic disease-specific algorithms or therapeutic recommendations. Reasons for this include absence of apnea-related symptoms in most with cardiovascular disease, impediments to efficient diagnosis at the population level, debate as to target, suboptimal therapies, difficulties mounting large randomized trials of sleep-specific interventions, and the challenging results of those few prospective cardiovascular outcome trials that have been completed and reported. The objectives of this review are to delineate the bidirectional interrelationship between sleep-disordered breathing and cardiovascular disease, consider the findings and implications of observational and randomized trials of treatment, frame the current state of clinical equipoise, identify principal current controversies and potential paths to their resolution, and anticipate future directions.
引用
收藏
页码:1741 / 1764
页数:24
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