背景:阻塞性睡眠呼吸暂停(OSA)是心血管疾病的主要危险因素之一,与发病率和死亡率相关。OSA也与心律失常和猝死有关。
目的:评估OSA是否会增加非心脏人群的猝死风险。
方法:这是对文献的系统回顾。在PubMed/Medline和SciELO数据库中搜索描述符“猝死”和“睡眠呼吸暂停”和“快速性心律失常”和“睡眠呼吸暂停”。
结果:13篇文章用患病率数据阐述了OSA与快速性心律失常和/或猝死的发展之间的关系,心电图检查结果,并选择了与其他合并症的关系。在OSA中观察到的气道阻塞会引发几种全身性反应,例如,胸内压的变化,间歇性缺氧,交感神经系统和化学感受器的激活,和儿茶酚胺的释放。这些机制与心律失常因素的出现有关,这可能会导致猝死。
结论:OSA与心律失常之间存在因果关系。鉴于OSA的病理生理学及其致心律失常的作用,研究表明,以前患有心脏病的人猝死的风险更高。另一方面,很少有证据表明OSA患者和无心脏病患者会发生猝死,OSA不是该人群猝死的危险因素。
BACKGROUND: Obstructive sleep apnea (OSA) is one of the main risk factors for cardiovascular diseases and is associated with both morbidity and mortality. OSA has also been linked to arrhythmias and sudden death.
OBJECTIVE: To assess whether OSA increases the risk of sudden death in the non-cardiac population.
METHODS: This is a systematic
review of the literature. The descriptors \"sudden death\" and \"sleep apnea\" and \"tachyarrhythmias\" and \"sleep apnea\" were searched in the PubMed/Medline and SciELO databases.
RESULTS: Thirteen articles that addressed the relationship between OSA and the development of tachyarrhythmias and/or sudden death with prevalence data, electrocardiographic findings, and a relationship with other comorbidities were selected. The airway obstruction observed in OSA triggers several systemic repercussions, e.g., changes in intrathoracic pressure, intermittent hypoxia, activation of the sympathetic nervous system and chemoreceptors, and release of catecholamines. These mechanisms would be implicated in the appearance of arrhythmogenic factors, which could result in sudden death.
CONCLUSIONS: There was a cause-effect relationship between OSA and cardiac arrhythmias. In view of the pathophysiology of OSA and its arrhythmogenic role, studies have shown a higher risk of sudden death in individuals who previously had heart disease. On the other hand, there is little evidence about the occurrence of sudden death in individuals with OSA and no heart disease, and OSA is not a risk factor for sudden death in this population.