阻塞性睡眠呼吸暂停低通气综合征与冠心病的关联及干预策略

Association between Obstructive Sleep Apnea-Hypopnea Syndrome and Coronary Heart Disease and Intervention Strategies

摘要: 阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)是常见的睡眠呼吸障碍，与冠状动脉粥样硬化性心脏病(coronary heart disease, CHD) (简称冠心病)的发生、进展及预后密切相关。其反复上气道阻塞可导致间歇性低氧、睡眠片段化及交感神经持续兴奋，并通过氧化应激、系统性炎症、内皮功能障碍、代谢紊乱及高凝状态等机制促进冠状动脉粥样硬化、心肌缺血和斑块不稳定。CHD患者中OSAHS患病率较高，尤其常见于急性冠脉综合征(Acute coronary syndrome, ACS)及经皮冠状动脉介入治疗人群。持续气道正压通气(continuous positive airway pressure, CPAP)可有效改善呼吸事件、夜间低氧及日间症状，但大型随机试验尚未证实其在所有患者中均能降低主要心脑血管事件。现有证据提示，CPAP依从性、低氧负荷、肥胖程度及患者生理表型可能影响心血管获益。临床管理应在规范CHD二级预防基础上，结合CPAP、减重、生活方式干预、代谢手术、新兴药物、口腔矫治器及其他个体化治疗。本文综述OSAHS与CHD的流行病学关联、主要机制、诊断筛查及干预证据，并对精准风险分层和未来研究方向进行讨论。

Abstract: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep-disordered breathing condition closely associated with the development, progression, and prognosis of coronary heart disease (CHD). Recurrent upper airway obstruction leads to intermittent hypoxia, sleep fragmentation, and sustained sympathetic activation, which promotes coronary atherosclerosis, myocardial ischemia, and plaque instability through mechanisms such as oxidative stress, systemic inflammation, endothelial dysfunction, metabolic disturbances, and hypercoagulability. The prevalence of OSAHS is high among CHD patients, particularly in those with acute coronary syndrome (ACS) and those undergoing percutaneous coronary intervention. Continuous positive airway pressure (CPAP) effectively improves respiratory events, nocturnal hypoxia, and daytime symptoms; however, large randomized trials have not yet demonstrated a reduction in major cardiovascular and cerebrovascular events in all patients. Current evidence suggests that CPAP adherence, hypoxic burden, obesity severity, and patient physiological phenotypes may influence cardiovascular benefits. Clinical management should be based on standard secondary prevention for CHD, combined with CPAP, weight loss, lifestyle interventions, metabolic surgery, emerging pharmacological therapies, oral appliances, and other individualized treatments. This article reviews the epidemiological association, key mechanisms, diagnostic screening, and intervention evidence for OSAHS and CHD, and discusses precise risk stratification and future research directions.