【原】阻塞性呼吸睡眠暂停和心律失常：新进展

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Obstructive sleep apnoea–hypopnoea and arrhythmias:new updates

背景与目的

阻塞性睡眠呼吸暂停（OSAH）是一种在睡眠过程中以咽部反复塌陷，低氧血症，高碳酸血症为特征的疾病，并且针对闭塞的气道，病人持续吸气直到完全苏醒。一些研究表明，OSAH对心血管系统有急性和慢性影响。因此，尽管是呼吸问题，OSAH的最重要的后果是心血管疾病，其中有心律失常。这篇综述的目的是系统地分析了最近发表的关于OSAH与每一种心律失常的关系。

方  法

我们使用'OSAHS arrhythmias’, 'OSAH arrhythmias’ 和'OSA arrhythmias’等关键词，在Pubmed、Scopus、Web of Science、国际询证医学数据库上搜寻。分析了1298篇文章和荟萃分析，不包括已经编辑的综述。

结  果

心律失常，特别是心室起源的，在OSAH中很常见。心力衰竭患者室性早搏，二联律和室性心动过速更为频繁。他们可能是由于左心脏重塑，过度劳累和局部缺血，在午夜到凌晨6点之间可能至少有一些猝死的发生可以被解释。根据受干扰的严重程度，窦性停博和房室传导阻滞加重，持续性正压通气可以减少它们的发生，从而避免使用心脏起搏器。最后，心房颤动，抗心律失常药物的抗药性和外科手术后复发与OSAH密切相关

结  论

 OSAH患者频繁发生心律失常，而OSAH的治疗可以减少心律失常的发生。一些患者应考虑植入心脏除颤器和气道持续性正压通气。

原始文献摘要

Vizzardi E, Sciatti E, Bonadei I, et al. Obstructive sleep apnoea-hypopnoea and arrhythmias: new updates.[J]. Journal of Cardiovascular Medicine, 2017.

Aims Obstructive sleep apnoea–hypopnoea (OSAH) is a prevalent condition characterized by repetitive pharyngeal collapse during sleep, leading to hypoxemia, hypercapnia, and persistent inspiratory efforts against an occluded airway until arousal. Several studies demonstrated that OSAH exerts acute and chronic effects on the cardiovascular system. Thus, although being a respiratory problem, the most important consequences of OSAH are cardiovascular, among which there are arrhythmias. The purpose of this review is to systematically analyse what has been recently published about the relationship between OSAH and every cardiac arrhythmia separately.
Methods We searched Pubmed, Scopus, Web of Science and Cochrane Collaboration databases for 'OSAHS arrhythmias’, 'OSAH arrhythmias’ and 'OSA arrhythmias’. We analyse 1298 articles and meta-analyses, excluding already edited reviews.
Results Arrhythmias, especially of ventricular origin, are frequent in OSAH. Ventricular premature beats, couplets and ventricular tachycardia runs are even more frequent in patients suffering from heart failure. They may be due to left
heart remodelling, overwork and ischaemia and can explain at least some sudden deaths occurring between midnight and 6 a.m. Sinus pauses and atrioventricular blocks are increased according to the severity of the disturbance and may be reduced by continuous positive airway pressure therapy, preventing pace-maker implantation. Finally, atrial fibrillation, resistance against antiarrhythmic drugs and recurrences after surgical procedures are strongly related to OSAH.
Conclusion Arrhythmias are frequent in OSAH. Treatment of OSAH may reduce some of them. An implantable cardioverter-defibrillator and continuous positive airway pressure should be considered in some patients

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