PDF(Pubmed)
Abstract：
Both obstructive sleep apnea (OSA) and acute lower respiratory tract infections (LRTIs) are important global health issues. The pathophysiological links between OSA and LRTIs include altered immune responses due to chronic intermittent hypoxia and sleep fragmentation, increased aspiration risk, and a high burden of comorbidities. In this narrative review, we evaluated the current evidence on the association between OSA and the incidence and outcomes of acute LRTIs in adults, specifically community-acquired pneumonia and viral pneumonia caused by influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies have demonstrated that OSA patients are more likely to develop bacterial pneumonia and exhibit a higher risk of invasive pneumococcal disease. The risk intensifies with the severity of OSA, influencing hospitalization rates and the need for intensive care. OSA is also associated with an increased risk of contracting influenza and suffering more severe disease, potentially necessitating hospitalization. Similarly, OSA contributes to increased COVID-19 disease severity, reflected by higher rates of hospitalization, longer hospital stays, and a higher incidence of acute respiratory failure. The effect of OSA on mortality rates from these infections is, however, somewhat ambiguous. Finally, we explored antibiotic therapy for OSA patients with LRTIs, addressing care settings, empirical regimens, risks, and pharmacokinetic considerations. Given the substantial burden of OSA and its significant interplay with acute LRTIs, enhanced screening, targeted vaccinations, and optimized management strategies for OSA patients should be prioritized.
摘要：
阻塞性睡眠呼吸暂停（OSA）和急性下呼吸道感染（LRTIs）都是重要的全球健康问题。OSA和LRTIs之间的病理生理联系包括慢性间歇性缺氧和睡眠片段化导致的免疫反应改变。吸入风险增加，和高负担的合并症。在这篇叙述性评论中，我们评估了目前关于OSA与成人急性LRTIs的发病率和结局之间的相关性的证据，特别是由流感和严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）引起的社区获得性肺炎和病毒性肺炎。研究表明，OSA患者更容易发生细菌性肺炎，并表现出较高的侵袭性肺炎球菌疾病风险。风险随着OSA的严重程度而加剧，影响住院率和重症监护的需要。OSA还与感染流感和患更严重疾病的风险增加有关，可能需要住院治疗。同样，OSA有助于增加COVID-19疾病的严重程度，更高的住院率反映了这一点，住院时间更长，急性呼吸衰竭的发病率较高。OSA对这些感染的死亡率的影响是，然而,有点模棱两可。最后,我们探索了OSALRTIs患者的抗生素治疗，解决护理设置，经验方案，风险,和药代动力学的考虑。鉴于OSA的沉重负担及其与急性LRTI的重要相互作用，加强筛查,有针对性的疫苗接种，应优先考虑OSA患者的优化管理策略。
