阻塞性睡眠呼吸暂停综合征、肥胖、代谢综合征的病理生理联系及治疗进展

Progress in pathophysiology and treatment of obstructive sleep apnea syndrome,obesity,and metabolic syndrome

全球范围内超重和肥胖发生率持续上升,阻塞性睡眠呼吸暂停综合征(OSAS)的首要危险因素是肥胖,在全世界肥胖人口数量升高的同时,OSAS患病率也不断上调。OSAS与肥胖密切相关,肥胖通过促进气道的可塌陷性等原因导致OSAS,OSAS通过睡眠减少、食欲亢进等机制加重肥胖。肥胖极易引发代谢综合征(MS),OSAS对于MS具有促发效应,逆转肥胖可能是打破这一恶性循环的关键。对于OSAS,主要的传统疗法为无创呼吸机持续正压通气治疗,此疗法虽然可使OSAS患者睡眠时的缺氧问题及呼吸暂停症状得到改善,但并不能改善患者的代谢状态。目前,对于OSAS治疗的最新进展包括运动、饮食控制等生活方式的干预,使用一些新上市的减肥药物及中药和中医点穴,同时使用设计的唱歌训练法等方式,以及目前仍处于研究阶段的棕色脂肪、基因靶向治疗等,这些新进展的发现可能是改善OSAS合并MS及肥胖患者预后的有效手段。

The prevalence of overweight and obesity continues to rise globally,and the leading risk factor for obstructive sleep apnea syndrome(OSAS)is obesity,while the number of obese people worldwide has increased,the prevalence of OSAS has also increased.OSAS is closely related to obesity.Obesity leads to the pathogenesis of OSAS by promoting airway collapsibility,and OSAS can aggravate obesity through mechanisms such as decreased sleep and increased appetite.Obesity is highly susceptible to metabolic syndrome(MS),OSAS has a precipitating effect on MS,and reversing obesity may be the key to break this vicious cycle.For OSAS,the main traditional therapy is non-invasive ventilator continuous positive airway pressure therapy.Although this therapy can improve the hypoxia and apnea symptoms of OSAS patients during sleep,it can not improve the metabolic status of patients.At present,the latest advances in the treatment of OSAS include lifestyle intervention such as exercise and diet control,the use of some newly marketed weight loss drugs,traditional Chinese medicine and Chinese acupoints,and the use of designed singing training methods and other methods,as well as brown fat and gene targeted therapy,etc,which are still in the research stage.These new findings may be an effective means to improve the prognosis of OSAS patients with MS and obesity.