王银梅

阻塞性睡眠呼吸暂停（obstructive sleep apnea,OSA），是睡眠过程中上气道反复完全和/或不完全阻塞引起呼吸暂停和/或低通气的睡眠呼吸紊乱疾病。与OSA相关联的高血压统称为OSA相关性高血压，OSA相关性高血压在难治性、隐匿性高血压中更为常见，但易被忽视或漏诊，本文将对OSA相关高血压的研究进展进行综述。

阻塞性睡眠呼吸暂停；高血压

[1] 马玉娇,王刚,李燕玲,等.阻塞性睡眠呼吸暂停相关性高血压的新进展[J].中国临床研究,2023,36(6):939-943. [2] Nieto F J,Young T B,Lind B K,et al.Association of sleep-disordered breathing,sleep apnea,and hypertension in a large community-based study.Sleep Heart Health Study[J].Jama,2000,283(14):1829-1836. [3] Torres G,Sánchez-de-la-Torre M,BarbéF.Relationship Between OSA and Hypertension[J].Chest,2015,148(3):824-832. [4] Chaudhary S C,Gupta P,Sawlani K K,et al.Obstructive Sleep Apnea in Hypertension[J].Cureus,2023,15(4):e38229. [5] Labarca G,Schmidt A,Dreyse J,et al.Efficacy of continuous positive airway pressure(CPAP)in patients with obstructive sleep apnea(OSA)and resistant hypertension(RH):Systematic review and meta-analysis[J].Sleep medicine reviews,2021,58:101446. [6] Ahmed A M,Nur S M,Xiaochen Y.Association between obstructive sleep apnea and resistant hypertension:systematic review and meta-analysis[J].Frontiers in medicine,2023,10:1200952. [7] Kanclerska J,Wieckiewicz M,Nowacki D,et al.Sleep architecture and vitamin D in hypertensives with obstructive sleep apnea:A polysomnographic study[J].Dental and medical problems,2023. [8] Johnson D A,Thomas S J,Abdalla M,et al.Association Between Sleep Apnea and Blood Pressure Control Among Blacks[J].Circulation, 2019,139(10):1275-1284. [9] 芦方颖,王毅,李庆云.阻塞性睡眠呼吸暂停与难治性高血压[J].中华结核和呼吸杂志,2023,46(2):206-210. [10] Wang G,Miao H,Hao W,et al.Association of obstructive sleep apnoea with long-term cardiovascular events in patients with acute coronary syndrome with or without hypertension:insight from the OSA-ACS project[J].BMJ open respiratory research,2023,10(1). [11] 国家心血管病专家委员会,中国医师协会睡眠医学专业委员会心血管学组,中国老年学和老年医学学会睡眠科学与技术分会老年睡眠障碍与心肺血管学组,等.心血管疾病患者阻塞性睡眠呼吸暂停评估与管理专家共识(2024版)[J].中国循环杂志, 2024,39(5):417-432. [12] 杨宁,侴宏达,魏茂提,等.阻塞性睡眠呼吸暂停与高血压患者血管损伤的相关性研究[J].中华心血管病杂志, 2023,51(11):1137-1144. [13] Liu M,Heizhati M,Li N,et al.The relationship between obstructive sleep apnea and risk of renal impairment in patients with hypertension,a longitudinal study[J].Sleep medicine,2023,109:18-24. [14] Lin R,Zhang Y,Yan W,et al.Effect of different anti-cardiovascular disease treatments on the severity of obstructive sleep apnea[J]. Journal of sleep research,2023. [15] Sánchez-de-la-Torre M,Gracia-Lavedan E,Benitez I D,et al.Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events:A Meta-Analysis[J].Jama,2023,330(13):1255-1265. [16] Wimms A J,Kelly J L,Turnbull C D,et al.Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea(MERGE):a multicentre, randomised controlled trial[J].The Lancet Respiratory medicine,2020,8(4):349-358. [17] Svedmyr S,Hedner J,Bailly S,et al.Blood pressure control in hypertensive sleep apnoea patients of the European Sleep Apnea Database cohort-effects of positive airway pressure and antihypertensive medication[J].European heart journal open,2023,3(6):oead109. [18] Sánchez-de-la-Torre M,Campos-Rodriguez F,BarbéF.Obstructive sleep apnoea and cardiovascular disease[J].The Lancet Respiratory medicine,2013,1(1):61-72. [19] 万南生,陈宝元.交感神经兴奋在慢性间歇性低氧引起高血压发生过程中的作用[J].国际呼吸杂志,2011,31(9):704-707. [20] 叶亮,李庆云,李敏.慢性间歇低氧与交感神经异常兴奋的研究进展[J].中国呼吸与危重监护杂志,2009,8(06):609-611. [21] 陈桂英,周立君,田野.睡眠呼吸暂停与心血管疾病的研究进展[J].中国循环杂志,2010,25(5):397-399. [22] 喻淑慧,李园园,胡克.去肾交感神经术治疗顽固性高血压合并阻塞性睡眠呼吸暂停的研究进展[J].中国呼吸与危重监护杂志, 2015,14(3):317-320. [23] Zong D,Liu X,Shen C,et al.Involvement of Galectin-3 in neurocognitive impairment in obstructive sleep apnea via regulating inflammation and oxidative stress through NLRP3[J].Sleep medicine,2023,101:1-10. [24] Wu X,Gong L,Xie L,et al.NLRP3 Deficiency Protects Against Intermittent Hypoxia-Induced Neuroinflammation and Mitochondrial ROS by Promoting the PINK1-Parkin Pathway of Mitophagy in a Murine Model of Sleep Apnea[J].Frontiers in immunology, 2021,12:628168. [25] Song J Q,Jiang L Y,Fu C P,et al.Heterozygous SOD2 deletion deteriorated chronic intermittent hypoxia-induced lung inflammation and vascular remodeling through mtROS-NLRP3 signaling pathway[J].Acta pharmacologica Sinica,2020,41(9):1197-1207. [26] Jin Z N,Wei Y X.Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensin-aldosterone system[J].Journal of geriatric cardiology:JGC,2016,13(4):333-343. [27] Pratt-Ubunama M N,Nishizaka M K,Boedefeld R L,et al.Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension[J].Chest,2007,131(2):453-459. [28] Wang L,Li N,Yao X,et al.Detection of Secondary Causes and Coexisting Diseases in Hypertensive Patients:OSA and PA Are the Common Causes Associated with Hypertension[J].BioMed research international,2017,2017:8295010. [29] Qian X,Yin T,Li T,et al.High levels of inflammation and insulin resistance in obstructive sleep apnea patients with hypertension[J]. Inflammation,2012,35(4):1507-1511. [30] Ka Maz H Y,Akutay S,Kahraman H,et al.Diagnostic Value of Neutrophil to Lymphocyte Ratio for Assessing Obstructive Sleep Apnea Risk in Surgical Patients[J].Journal of perianesthesia nursing:official journal of the American Society of PeriAnesthesia Nurses, 2023,38(6):e1-e6. [31] Lu D,Xu S,Dai P,et al.Gut microbiota in hypertensive patients with versus without obstructive sleep apnea[J].Journal of clinical hypertension(Greenwich,Conn),2022,24(12):1598-1605. [32] Song R,Baker T L,Watters J J,et al.Obstructive Sleep Apnea-Associated Intermittent Hypoxia-Induced Immune Responses in Males, Pregnancies,and Offspring[J].International journal of molecular sciences,2024,25(3). [33] Li C,Zhao Z,Jin J,et al.NLRP3-GSDMD-dependent IL-1βSecretion from Microglia Mediates Learning and Memory Impairment in a Chronic Intermittent Hypoxia-induced Mouse Model[J].Neuroscience,2024,539:51-65. [34] Zhao J,Lu N,Qu Y,et al.Calcium-sensing receptor-mediated macrophage polarization improves myocardial remodeling in spontaneously hypertensive rats[J].Experimental biology and medicine(Maywood,NJ),2024,249:10112. [35] Li C,Shi S.Gut microbiota and metabolic profiles in chronic intermittent hypoxia-induced rats:disease-associated dysbiosis and metabolic disturbances[J].Front Endocrinol(Lausanne),2023, 14:1224396. [36] Zhang Y,Luo H,Niu Y,et al.Chronic intermittent hypoxia induces gut microbial dysbiosis and infers metabolic dysfunction in mice[J]. Sleep medicine,2022,91:84-92. [37] Durgan D J,Ganesh B P,Cope J L,et al.Role of the Gut Microbiome in Obstructive Sleep Apnea-Induced Hypertension[J]. Hypertension(Dallas,Tex:1979),2016,67(2):469-474. [38] Sapiña-Beltrán E,Torres G,Benitez I,et al.Prevalence,Characteristics,and Association of Obstructive Sleep Apnea with Blood Pressure Control in Patients with Resistant Hypertension[J].Annals of the American Thoracic Society,2019,16(11):1414-1421. [39] Kario K,Hettrick D A,Prejbisz A,et al.Obstructive Sleep Apnea-Induced Neurogenic Nocturnal Hypertension:A Potential Role of Renal Denervation?[J].Hypertension(Dallas,Tex:1979),2021,77(4):1047-1060. [40] Hla K M,Young T,Finn L,et al.Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin Sleep Cohort Study[J].Sleep,2008,31(6):795-800. [41] Hla K M,Skatrud J B,Finn L,et al.The effect of correction of sleep-disordered breathing on BP in untreated hypertension[J]. Chest, 2002,122(4):1125-1132. [42] 王慧珍,陆虹.高血压合并阻塞性睡眠呼吸暂停的动态血压特点[J].天津医药,2005,(12):775-776.

点击下载PDF