王亚芬 旷湘楠 尹玉洁 韩宁馨 郝苑洁 魏亚茹 王晓琪 贾振华

摘要 阻塞性睡眠呼吸暂停综合征（OSAS）是一种常见的以睡眠时上气道反复塌陷为特征的慢性睡眠呼吸疾病，与高脂血症、动脉粥样硬化和心血管风险相关。近年来，已有研究证实OSAS是动脉粥样硬化（AS）形成的独立危险因素，会加速AS的发生和发展。目前有理论提出动脉粥样硬化发生的关键因素之一是动脉壁氧供需不平衡，而OSAS的典型特征是慢性间歇性缺氧（CIH），所以推测CIH可能是OSAS加速AS形成的中间机制，然而其具体机制尚未完全明确，因此现就其可能的机制进行综述，以期为临床治疗和研究提供启示。

关键词 间歇性缺氧;阻塞性睡眠呼吸暂停综合征;动脉粥样硬化;炎症;内皮功能障碍;氧化应激;代谢失调;血小板聚集和活化;交感神经活动

Abstract Obstructive sleep apnea syndrome（OSAS） is a common chronic sleep breathing disorder characterized by repeated upper airway collapse during sleep，and is associated with hyperlipidemia，atherosclerosis，and cardiovascular risks.In recent years，studies have confirmed that OSAS is an independent risk factor for the formation of atherosclerosis（AS） and will accelerate the occurrence and development of AS.At present，there are theories that one of the key factors in the occurrence of atherosclerosis is the imbalance between the supply and demand of oxygen in the arterial wall，and the typical feature of OSAS is chronic intermittent hypoxia（CIH），so it is speculated that CIH may be an intermediate mechanism for OSAS to accelerate the formation of AS.However，the specific mechanism has not yet been fully clarified，so this paper summarizes its possible mechanism as follows，in order to provide enlightenment for clinical treatment and research.

Keywords Intermittent hypoxia; Obstructive sleep apnea syndrome; Atherosclerosis; Inflammation; Endothelial dysfunction; Oxidative stress; Metabolic dysregulation; Platelet Aggregation and activation; Sympathetic nerve activity

中圖分类号：R666;R543.1文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.11.002

阻塞性睡眠呼吸暂停综合征（Obstructive Sleep Apnea Syndrome，OSAS）是一种常见的睡眠呼吸障碍性疾病，其主要表现是在睡眠过程中上气道完全或部分阻塞和（或）呼吸中枢驱动降低，导致呼吸暂停为特征的一组临床综合征。有研究已经证实OSAS是动脉粥样硬化形成的独立危险因素[1-3]。它也可能会促使高血压、中风等一系列心血管疾病（CVD）的发生，增加潜在的心血管死亡率[4-6]。慢性间歇性缺氧（CIH）作为OSAS的重要病理特征，以反复急性缺氧然后迅速复氧为主要特点，比持续性缺氧的损伤更重（机体对持续性缺氧的反应以适应为主，而对间歇性缺氧的反应则更多的是损伤的过程）。……