肥厚型心肌病合并阻塞型睡眠呼吸暂停的研究现状

Hypertrophic cardiomyopathy coexsiting with obstructive sleep apnea

阻塞性睡眠呼吸暂停（obstructive sleep apnea,OSA）是一种常见但较少被发现的因上气道狭窄或阻塞引起反复睡眠中断、微觉醒及白天嗜睡的综合征。其中大部分同时伴有肥胖、高血压、代谢综合症及其他心血管疾病,包括肥厚型心肌病（hypertrophic cardiomyopathy,HCM）。HCM是青少年猝死的最常见原因。近有研究发现HCM合并睡眠呼吸紊乱（sleep-disordered breathing,SDB）（包括阻塞性、中枢性及混合型睡眠呼吸暂停）的发生率在40%~80%左右。交感神经兴奋性增加、迷走神经兴奋性下降、心脏后负荷增加、胰岛素抵抗和血管内皮功能受损被认为是二者潜在联系。本文主要呈现HCM合并OSA的临床特征及研究现状,为进一步的研究及治疗提供方向。

Obstructive sleep apnea（OSA） is a common but often unrecognized disorder caused by the upper airway narrow or empraxis during sleep and characterized by frequent awakenings,disrupted sleep and consequent excessive daytime sleepiness. OSA is often present in a large proportion of patients with hypertension/obese/metabolic syndrome and in those with other cardiovascular disorders,including hypertrophic cardiomyopathy（HCM）.HCM is the most common cause of adolescent sudden death.Recent studies revealed that the incidence of HCM complicated with sleep-disordered breathing（SDB） including OSA,central sleep apnea,mixed sleep apnea ranged from 40% to80%. Increased sympathetic activity,impaired vagal activity,increased after load,insulin resistance and endothelial dysfunction have been proposed as potential mechanisms for the association between HCM and SDB. This review aims to highlight the current literature available on the association of OSA and HCM,to provide directions for future research and to summarize the key features related to this association based on the authors＇ best understanding and experience.