Central sleep apnea and cardiovascular disease state-of-the-art.

IF 5.6 2区 医学 Q1 Medicine
Sleep Pub Date : 2025-03-11 DOI:10.1093/sleep/zsae307
Shahrokh Javaheri, Alberto Giannoni, Virend K Somers, Atul Malhotra, Michele Emdin, Maria R Costanzo
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Abstract

Central sleep apnea, a rare polysomnographic finding in the general population, is prevalent in certain cardiovascular conditions including systolic and diastolic left ventricular dysfunction, atrial fibrillation, coronary artery disease, carotid artery stenosis, stroke, and use of certain cardiac-related medications. Polysomnographic findings of central sleep apnea with adverse cardiovascular impacts include nocturnal hypoxemia and arousals, which can lead to increased sympathetic activity both at night and in the daytime. Among cardiovascular diseases, central sleep apnea is most prevalent in patients with left ventricular systolic dysfunction; a large study of more than 900 treated patients has shown a dose-dependent relationship between nocturnal desaturation and mortality. Multiple small randomized controlled trials have shown mitigation of sympathetic activity when central sleep apnea is treated with nocturnal oxygen, continuous positive airway pressure, and adaptive servoventilation. However, two early randomized controlled trials with positive airway pressure devices have shown either a neutral effect on survival or excess premature mortality in the active treatment arm, compared to untreated central sleep apnea. In contrast, the results of the most recent trial using an advanced adaptive servoventilation device showed improved quality of life and no signal for mortality suggesting that treatment of central sleep apnea was at least safe. In addition to positive airway pressure devices, multiple medications have been shown to improve central sleep apnea, but no long-term trials of pharmacologic therapy have been published. Currently, phrenic nerve stimulation is approved for the treatment of central sleep apnea, and the results of a randomized controlled trial showed significant improvement in sleep metrics and quality of life.

中枢性睡眠呼吸暂停和心血管疾病。
中枢性睡眠呼吸暂停(CSA)是一种罕见的多导睡眠图发现,在某些心血管疾病中很普遍,包括收缩期和舒张期左心室功能障碍、心房颤动、冠状动脉疾病、颈动脉狭窄、中风和使用某些心脏相关药物。CSA的多导睡眠图结果与心血管不良影响包括夜间低氧血症和觉醒,这可导致夜间和白天交感神经活动增加。在心血管疾病中,CSA最常见于左心室收缩功能不全的患者;一项对900多名接受治疗的患者进行的大型研究表明,夜间去血饱和度与死亡率之间存在剂量依赖关系。多个小型随机对照试验显示,夜间吸氧、持续气道正压通气和适应性伺服通气治疗CSA可减轻交感神经活动。然而,与未治疗的CSA相比,两项早期使用气道正压装置的随机对照试验显示,积极治疗组对生存率或过早死亡率的影响为中性。相比之下,最近使用先进的自适应伺服通气装置的试验结果显示,生活质量得到改善,没有死亡率的迹象,这表明CSA的治疗至少是安全的。除了气道正压装置外,多种药物已被证明可以改善CSA,但尚未发表药物治疗的长期试验。目前,膈神经刺激被批准用于治疗CSA,一项随机对照试验的结果显示睡眠指标和生活质量显著改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Sleep
Sleep Medicine-Neurology (clinical)
CiteScore
8.70
自引率
10.70%
发文量
0
期刊介绍: SLEEP® publishes findings from studies conducted at any level of analysis, including: Genes Molecules Cells Physiology Neural systems and circuits Behavior and cognition Self-report SLEEP® publishes articles that use a wide variety of scientific approaches and address a broad range of topics. These may include, but are not limited to: Basic and neuroscience studies of sleep and circadian mechanisms In vitro and animal models of sleep, circadian rhythms, and human disorders Pre-clinical human investigations, including the measurement and manipulation of sleep and circadian rhythms Studies in clinical or population samples. These may address factors influencing sleep and circadian rhythms (e.g., development and aging, and social and environmental influences) and relationships between sleep, circadian rhythms, health, and disease Clinical trials, epidemiology studies, implementation, and dissemination research.
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