阻塞性睡眠呼吸暂停与视网膜病变的研究现状和展望

Research status and prospect of obstructive sleep apnea and retinopathy

阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)综合征是常见的以慢性间歇性缺氧为主要特征的睡眠疾病,它是2型糖尿病(type 2 diabetes mellitus,T2DM)、高血压及心脑血管疾病等多种慢性病的“源头病”。OSA的异质性高,不仅体现在诱因多种、机制多变、临床表现多样,更突出在合并症的个体差异和错综复杂的交互作用。因此对OSA患者进行精准诊疗,除了针对临床表现、发病因素的分层外,对靶器官损伤的精准归因及合并症预后的精准预测也十分重要。眼底视网膜是耗氧量高、对缺氧敏感度最高的组织之一,视网膜的血管和神经是缺氧损害重要的靶器官,也是监测疾病发生发展的直视“窗口”。OSA可能通过低氧、氧化应激、炎症反应、内皮损伤等多种机制,导致视网膜和脉络膜直接及间接损害,减弱视神经和视网膜血管的自我调节能力,从而在疾病的不同阶段及不同个体中引发视网膜病变,其中既包括突发的致盲性视网膜神经血管疾病,又包括慢性进展性视网膜改变。这篇论文将回顾视网膜作为OSA靶器官的临床和研究现状,并展望新检测技术下视网膜作为生物标志物,助力评估OSA发病风险、筛查OSA相关并发症、实现精准分层干预及防治的前景。

Obstructive sleep apnea(OSA)syndrome is a common sleep disorder characterized by chronic inter-mittent hypoxia.It serves as the"primary disease"for various chronic conditions such as type 2 diabetes mellitus(T2DM),hypertension,and cardiovascular diseases.OSA exhibits high heterogeneity,not only in its multifactorial etiol-ogy and diverse mechanisms but also in the individual differences in complications and intricate interactions.Therefore,accurate diagnosis and treatment of OSA patients are crucial,requiring stratification based not only on clinical manifesta-tions and predisposing factors but also on precise attribution of target organ damage and accurate prediction of complica-tions'prognosis.The retinal fundus,being one of the tissues with high oxygen consumption and sensitivity to hypoxia,har-bors vital blood vessels and nerves susceptible to hypoxic damage.It serves as a direct"window"for monitoring the occur-rence and progression of diseases.OSA may lead to direct and indirect damage to the retina and choroid through various mechanisms such as hypoxia,oxidative stress,inflammation,and endothelial injury.This weakens the autoregulation abil ity of retinal vessels and optic nerves,leading to retinal pathology at different stages of the disease and in different individ-uals,including both acute blinding retinal neurovascular diseases and chronic progressive retinal changes.This article re-views the current clinical and research status of the retina as a target organ in OSA and prospects the role of retinal imaging as a biomarker under new detection technologies,facilitating the assessment of OSA risk,screening for OSA-related com-plications,and achieving precise stratified intervention and prevention.