睡眠呼吸障碍与肺动脉高压双向关系的研究进展

doi:10.11958/20251155

天津医药 ›› 2025, Vol. 53 ›› Issue (8): 889-896.doi: 10.11958/20251155

• 综述 • 上一篇

睡眠呼吸障碍与肺动脉高压双向关系的研究进展

杜昕桃(), 索莹, 赵晓赟^△()

天津医科大学胸科临床学院（邮编300222）；天津市胸科医院呼吸与危重症医学科

收稿日期:2025-03-21 修回日期:2025-06-05 出版日期:2025-08-15 发布日期:2025-08-12
通讯作者: ^△E-mail：zxydoctor@163.com
作者简介:杜昕桃（2000），女，硕士在读，主要从事呼吸危重症、睡眠呼吸疾病方面研究。E-mail：15536361041@163.com
基金资助:
国家临床重点专科建设项目，天津市医学重点学科（专科）项目(TJYXZDXK-049A);天津市卫生健康科技临床重点专项(TJWJ2024ZK003)

Research progress on the bidirectional relationship between sleep-related breathing disorders and pulmonary hypertension

DU Xintao(), SUO Ying, ZHAO Xiaoyun^△()

Clinical College of Thoracic Medicine, Tianjin Medical University, Tianjin 300222, China; Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital

Received:2025-03-21 Revised:2025-06-05 Published:2025-08-15 Online:2025-08-12
Contact: ^△E-mail：zxydoctor@163.com

杜昕桃, 索莹, 赵晓赟. 睡眠呼吸障碍与肺动脉高压双向关系的研究进展[J]. 天津医药, 2025, 53(8): 889-896.

DU Xintao, SUO Ying, ZHAO Xiaoyun. Research progress on the bidirectional relationship between sleep-related breathing disorders and pulmonary hypertension[J]. Tianjin Medical Journal, 2025, 53(8): 889-896.

摘要/Abstract

摘要：

睡眠呼吸障碍（SBDs）是一组在睡眠期间表现出异常呼吸模式的疾病，其中最常见的是阻塞性睡眠呼吸暂停（OSA）。肺动脉高压（PH）的病理生理特征是肺血管收缩和血管重构，临床上常通过超声心动图初步诊断。SBDs与PH在诸多内容上具有双向关系，缺氧、炎症及氧化应激等是常见的共同病理生理机制。夜间血氧饱和度<0.90的睡眠时间占总睡眠时间的比值（T90）可以评估OSA患者的肺血流动力学及右心功能恶化风险，但该指标在临床应用中仍存在局限性。目前国内关于SBDs与PH的双向关系研究尚少。该文综述了SBDs与PH的流行病学、潜在机制、筛查与治疗方面的双向关系，并就目前国内外临床研究重点分析了OSA与PH的相关性，为深入探索两种疾病提供理论依据。

关键词: 睡眠呼吸暂停, 阻塞性, 肺动脉高压, 睡眠呼吸障碍, 间歇低氧, 低氧负荷, 整体纵向应变

Abstract:

Sleep-related breathing disorders (SBDs) are a group of disorders characterized by abnormal breathing patterns during sleep, with obstructive sleep apnea (OSA) being the most common type. Pulmonary hypertension (PH) is characterized pathophysiologically by pulmonary vasoconstriction and vascular remodeling, with initial clinical diagnosis typically relying on echocardiography. SBDs and PH have a bidirectional relationship in many aspects, with shared pathophysiological mechanisms such as hypoxia, inflammation and oxidative stress being common. The percentage of sleep time with nocturnal oxygen saturation <0.90 (T90) can assess the risk of pulmonary hemodynamic and right ventricular function deterioration in OSA patients, but this indicator still has limitation in clinical application. Currently, there is limited domestic research on the bidirectional relationship between SBDs and PH in China. This article reviews the bidirectional relationship between SBDs and PH in terms of epidemiology, potential mechanisms, screening and treatment. It also analyzes the relevance of OSA and PH based on current domestic and international clinical studies, providing a theoretical basis for further exploration of these two diseases.

Key words: sleep apnea, obstructive, pulmonary arterial hypertension, sleep-related breathing disorders, intermittent hypoxia, hypoxic burden, global longitudinal strain

中图分类号:

R56，R544.16

图/表 2

参考文献 47

[1]	American Academy of Sleep Medicine. International Classification of Sleep Disorders[M]. 3rd Ed. Darien, IL: American Academy of Sleep Medicine, 2014:49-141.
[2]	REDLINE S, AZARBARZIN A, PEKER Y. Obstructive sleep apnoea heterogeneity and cardiovascular disease[J]. Nat Rev Cardiol, 2023, 20(8):560-573. doi:10.1038/s41569-023-00846-6.
[3]	HUMBERT M, KOVACS G, HOEPER M M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J]. Eur Respir J, 2023, 61(1):2200879. doi:10.1183/13993003.00879-2022.
[4]	MOCUMBI A, HUMBERT M, SAXENA A, et al. Pulmonary hypertension[J]. Nat Rev Dis Primers, 2024, 10(1):1. doi:10.1038/s41572-023-00486-7.
[5]	万钧, 翟振国. 肺动脉高压临床诊治和管理中需要关注的热点问题——基于《2022 ESC/ERS肺动脉高压诊治指南》与《中国肺动脉高压诊断与治疗指南(2021版)》的比较与解读[J]. 中国全科医学, 2023, 26(3):255-261,267.
	WAN J, ZHAI Z G. Hot point problems in clinical diagnosis,treatment and management of pulmonary hypertension:comparison and interpretation of 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension and Chinese Guidelines for the diagnosis and treatment of pulmonary artery hypertension(2021 Edition)[J]. Chinese General Practice, 2023, 26(3):255-261,267. doi:10.12114/j.issn.1007-9572.2022.0692.
[6]	SHARMA S, STANSBURY R, HACKETT B, et al. Sleep apnea and pulmonary hypertension:a riddle waiting to be solved[J]. Pharmacol Ther, 2021;227:107935. doi:10.1016/j.pharmthera.2021.107935.
[7]	ESNAUD R, GAGNADOUX F, BEURNIER A, et al. The association between sleep-related breathing disorders and pre-capillary pulmonary hypertension:a chicken and egg question[J]. Respir Med Res, 2021,80:100835. doi:10.1016/j.resmer.2021.100835.
[8]	MASA J F, BENÍTEZ I D, JAVAHERI S, et al. Risk factors associated with pulmonary hypertension in obesity hypoventilation syndrome[J]. J Clin Sleep Med, 2022, 18(4):983-992. doi:10.5664/jcsm.9760.
[9]	HU B Z, JIANG C, DING Y J, et al. The clinical and hemodynamic characteristics of pulmonary hypertension in patients with OSA-COPD overlap syndrome[J]. Am J Med Sci, 2024, 367(6):375-381. doi:10.1016/j.amjms.2024.03.014.
[10]	MALONEY M A, WARD S L D, SU J A, et al. Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea[J]. J Clin Sleep Med, 2022, 18(6):1629-1637. doi:10.5664/jcsm.9944.
[11]	AKBARI A, RAJI H, ISLAMPANAH M, et al. Sleep apnea in pulmonary hypertension patients:a systematic review and meta-analysis sleep disorders and pulmonary hypertension[J]. Sleep Breath, 2025, 29(1):120. doi:10.1007/s11325-025-03280-9.
[12]	SIMONSON J L, PANDYA D, KHAN S, et al. Comparison of obstructive sleep apnoea prevalence and severity across WHO pulmonary hypertension groups[J]. BMJ Open Respir Res, 2022, 9(1):e001304. doi:10.1136/bmjresp-2022-001304.
[13]	HU M, DUAN A, HUANG Z, et al. Development and validation of a nomogram for predicting obstructive sleep apnea in patients with pulmonary arterial hypertension[J]. Nat Sci Sleep, 2022, 14:1375-1386. doi:10.2147/NSS.S372447.
[14]	KOVACS G, BARTOLOME S, DENTON C P, et al. Definition,classification and diagnosis of pulmonary hypertension[J]. Eur Respir J, 2024, 64(4):2401324. doi:10.1183/13993003.01324-2024.
[15]	李伯君, 裴祥, 陈政杰, 等. 胸腔压力波动对OSAHS动物模型血压的影响[J]. 天津医科大学学报, 2023, 29(6):617-621.
	LI B J, PEI X, CHEN Z J, et al. Effect of intrathoracic pressure fluctuation on blood pressure in animal model of OSAHS[J]. Journal of Tianjin Medical University, 2023, 29(6):617-621. doi:10.20135/j.issn.1006-8147.2023.06.008.
[16]	KHIRFAN G, MELILLO C A, AL ABDI S, et al. Impact of esophageal pressure measurement on pulmonary hypertension diagnosis in patients with obesity[J]. Chest, 2022, 162(3):684-692. doi:10.1016/j.chest.2022.04.002.
[17]	BJORK S, JAIN D, MARLIERE M H, et al. Obstructive sleep apnea,obesity hypoventilation syndrome,and pulmonary hypertension:a state-of-the-art review[J]. Sleep Med Clin, 2024, 19(2):307-325. doi:10.1016/j.jsmc.2024.02.009.
[18]	HANNEMANN J, BÖGER R. Dysregulation of the nitric oxide/dimethylarginine pathway in hypoxic pulmonary vasoconstriction-molecular mechanisms and clinical significance[J]. Front Med(Lausanne), 2022,9:835481. doi:10.3389/fmed.2022.835481.
[19]	BALCAN B, AKDENIZ B, PEKER Y, et al. Obstructive sleep apnea and pulmonary hypertension:a chicken-and-egg relationship[J]. J Clin Med, 2024, 13(10):2961. doi:10.3390/jcm13102961.
[20]	PAN Z, WU X, ZHANG X, et al. Phosphodiesterase 4B activation exacerbates pulmonary hypertension induced by intermittent hypoxia by regulating mitochondrial injury and cAMP/PKA/p-CREB/PGC-1α signaling[J]. Biomed Pharmacother, 2023,158:114095. doi:10.1016/j.biopha.2022.114095.
[21]	LI X, ZHANG X, HOU X, et al. Obstructive sleep apnea-increased DEC1 regulates systemic inflammation and oxidative stress that promotes development of pulmonary arterial hypertension[J]. Apoptosis, 2023, 28(3/4):432-446. doi:10.1007/s10495-022-01797-y.
[22]	JIANG P, HUANG H, LIU Z, et al. STAT6 deficiency mitigates the severity of pulmonary arterial hypertension caused by chronic intermittent hypoxia by suppressing Th2-inducing cytokines[J]. Respir Res, 2025, 26(1):13. doi:10.1186/s12931-024-03062-z.
[23]	CASTILLO-GALÁN S, ARENAS G A, ITURRIAGA R. Contribution of STIM-activated TRPC-ORAI channels in pulmonary hypertension induced by chronic sustained and intermittent hypoxia[J]. Curr Vasc Pharmacol, 2022, 20(3):272-283. doi:10.2174/1570161120666220321141805.
[24]	HU J, SINGH P, LI J, et al. Persistent hypoxia with intermittent aggravation causes imbalance in Smad3/Myocardin-related transcription factor signaling with consequent endothelial senescence and pulmonary arterial remodeling[J]. Biomedicines, 2023, 11(9):2351. doi:10.3390/biomedicines11092351.
[25]	ADIR Y, HUMBERT M, CHAOUAT A. Sleep-related breathing disorders and pulmonary hypertension[J]. Eur Respir J, 2021, 579(1):2002258. doi:10.1183/13993003.02258-2020.
[26]	CHAO H Y, YEE B J, HSU C H, et al. Sleep-related disorders in patients with precapillary pulmonary hypertension[J]. Sleep Med Rev, 2024,77:101972. doi:10.1016/j.smrv.2024.101972.
[27]	HUANG Z, DUAN A, HU M, et al. Implication of prolonged nocturnal hypoxemia and obstructive sleep apnea for pulmonary hemodynamics in patients being evaluated for pulmonary hypertension: a retrospective study[J]. J Clin Sleep Med, 2023, 19(2):213-223. doi:10.5664/jcsm.10286.
[28]	LOWERY M M, HILL N S, WANG L, et al. Sleep-related hypoxia,right ventricular dysfunction,and survival in patients with group 1 pulmonary arterial hypertension[J]. J Am Coll Cardiol, 2023, 82(21):1989-2005. doi:10.1016/j.jacc.2023.09.806.
[29]	HUANG Z, DUAN A, ZHAO Z, et al. Sleep-disordered breathing patterns and prognosis in pulmonary arterial hypertension:a cluster analysis of nocturnal cardiorespiratory signals[J]. Sleep Med, 2024, 113:61-69. doi:10.1016/j.sleep.2023.11.016.
[30]	MARTINEZ-GARCIA M A, SÁNCHEZ-DE-LA-TORRE M, WHITE D P, et al. Hypoxic burden in obstructive sleep apnea:present and future[J]. Arch Bronconeumol, 2023, 59(1):36-43. doi:10.1016/j.arbres.2022.08.005.
[31]	AZARBARZIN A, SANDS S A, STONE K L, et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality:the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study[J]. Eur Heart J, 2019, 40(14):1149-1157. doi:10.1093/eurheartj/ehy624.
[32]	LI C, GAO Y, HUANG W, et al. The use of the sleep apnea-specific hypoxic burden to predict obstructive sleep apnea hypopnea syndrome:evidence from a large cross-sectional study[J]. Sleep Med, 2023, 111:94-100. doi:10.1016/j.sleep.2023.09.007.
[33]	HUI X, CAO W, XU Z, et al. Hypoxic indices for obstructive sleep apnoea severity and cardiovascular disease risk prediction:a comparison and application in a community population[J]. Respirology, 2024, 29(9):825-834. doi:10.1111/resp.14754.
[34]	MUKHERJEE M, RUDSKI L G, ADDETIA K, et al. Guidelines for the echocardiographic assessment of the right heart in adults and special considerations in pulmonary hypertension:recommendations from the American Society of Echocardiography[J]. J Am Soc Echocardiogr, 2025, 38(3):141-186. doi:10.1016/j.echo.2025.01.006.
[35]	CHETAN I M, DOMOKOS GERGELY B, ALBU A, et al. Understanding the role of echocardiography in patients with obstructive sleep apnea and right ventricular subclinical myocardial dysfunction-comparison with other conditions affecting RV deformation[J]. Med Ultrason, 2021, 23(2):213-219. doi:10.11152/mu-2727.
[36]	TADIC M, CUSPIDI C. Obstructive sleep apnea and right ventricular remodeling:do we have all the answers?[J]. J Clin Med, 2023, 12(6):2421. doi:10.3390/jcm12062421.
[37]	CHETAN I M, GERGELY-DOMOKOS B, BEYER R, et al. The role of 3D speckle tracking echocardiography in the diagnosis of obstructive sleep apnea and its severity[J]. Sci Rep, 2022, 12(1):22347. doi:10.1038/s41598-022-26940-2.
[38]	TADIC M, GHERBESI E, FAGGIANO A, et al. Obstructive sleep apnea and right ventricular function:a meta-analysis of speckle tracking echocardiographic studies[J]. J Clin Hypertens (Greenwich), 2022, 24(10):1247-1254. doi:10.1111/jch.14550.
[39]	FRIŠČIĆ T, GALIĆ E, VIDOVIĆ D, et al. The curious role of PAI-1 in severe obstructive sleep apnea[J]. Biomedicines, 2024, 12(6):1197. doi:10.3390/biomedicines12061197.
[40]	FERNÁNDEZ-BELLO I, MONZÓN MANZANO E, GARCÍA RÍO F, et al. Procoagulant state of sleep apnea depends on systemic inflammation and endothelial damage[J]. Arch Bronconeumol, 2022, 58(2):117-124. doi:10.1016/j.arbres.2020.11.017.
[41]	PALOMARES D E, TRAN P L, JERMAN C, et al. Vibro-acoustic platelet activation: an additive mechanism of prothrombosis with applicability to snoring and obstructive sleep apnea[J]. Bioengineering(Basel), 2023, 10(12):1414. doi:10.3390/bioengineering10121414.
[42]	GENUARDI M V, RATHORE A, OGILVIE R P, et al. Incidence of VTE in patients with OSA:a cohort study[J]. Chest, 2022, 161(4):1073-1082. doi:10.1016/j.chest.2021.12.630.
[43]	LE MAO R, JIMÉNEZ D, BIKDELI B, et al. Prognostic impact of obstructive sleep apnea in patients presenting with acute symptomatic pulmonary embolism[J]. Thromb Haemost, 2021, 121(6):808-815. doi:10.1055/s-0040-1721506.
[44]	ÇıNAR C, YıLDıZELI Ş O, BALCAN B, et al. Determinants of severe nocturnal hypoxemia in adults with chronic thromboembolic pulmonary hypertension and sleep-related breathing disorders[J]. J Clin Med, 2023, 12(14):4639. doi:10.3390/jcm12144639.
[45]	王乐, 陈杏, 梁茂丽, 等. 阻塞性睡眠呼吸暂停合并肥胖相关睡眠低通气的影响因素和预测指标分析[J]. 天津医药, 2022, 50(9): 953-958.
	WANG L, CHEN X, LIANG M L, et al. Analysis of influencing factors and predictive indicators of obstructive sleep apnea combined with obesity-related sleep hypoventilation[J]. Tianjin Med J, 2022, 50(9):953-958. doi:10.11958/20212745.
[46]	黄志华, 赵智慧, 赵青. 心血管疾病患者阻塞性睡眠呼吸暂停评估与管理专家共识(2024版)[J]. 中国循环杂志, 2024, 39(5):417-432.
	HUANG Z H, ZHAO Z H, ZHAO Q. Expert consensus on the evaluation and management of obstructive sleep apnea in patients with cardiovascular disease(2024 edition)[J]. Chinese Circulation Journal, 2024, 39(5):417-432. doi:10.3969/j.issn.1000-3614.2024.05.001.
[47]	JAIN S, YINGCHONCHAROEN P, NUGENT K. Effect of continuous positive airway pressure therapy in patient with obstructive sleep apnea and pulmonary hypertension:a literature review[J]. Cardiol Rev,2023 May 5. doi:10.1097/CRD.0000000000000564.

血流动力学分类	界定标准	临床分类
毛细血管前PH	mPAP>20 mmHg，且PAWP≤ 15 mmHg、PVR>2 WU	第1组：PAH；第3组：肺部疾病和/或缺氧相关PH；第4组：肺动脉阻塞相关PH（如CTEPH）；第5组：原因未明和/或多因素所致PH
毛细血管后PH	mPAP>20 mmHg且PAWP> 15 mmHg	第2组：左心疾病相关PH；第5组：原因未明和/或多因素所致PH
孤立性毛细血管后PH	PVR≤2 WU
毛细血管后和毛细血管前混合性PH	PVR>2 WU

血流动力学分类	界定标准	临床分类
毛细血管前PH	mPAP>20 mmHg，且PAWP≤ 15 mmHg、PVR>2 WU	第1组：PAH；第3组：肺部疾病和/或缺氧相关PH；第4组：肺动脉阻塞相关PH（如CTEPH）；第5组：原因未明和/或多因素所致PH
毛细血管后PH	mPAP>20 mmHg且PAWP> 15 mmHg	第2组：左心疾病相关PH；第5组：原因未明和/或多因素所致PH
孤立性毛细血管后PH	PVR≤2 WU
毛细血管后和毛细血管前混合性PH	PVR>2 WU

睡眠呼吸障碍与肺动脉高压双向关系的研究进展

Research progress on the bidirectional relationship between sleep-related breathing disorders and pulmonary hypertension

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 2

参考文献 47

相关文章 15

编辑推荐

Metrics

本文评价

[1]	余辉, 刘浩, 蔡凤丽, 赵婧, 白相森, 田国梁, 张含悦, 张丽媛. 基于声学信息检测阻塞性睡眠呼吸暂停的研究进展[J]. 天津医药, 2025, 53(7): 776-784.
[2]	贾建波, 孙根, 顾媛媛. 持续气道正压通气对合并阻塞性睡眠呼吸暂停综合征的脑梗死患者平均气道压及神经功能的影响[J]. 天津医药, 2025, 53(6): 639-643.
[3]	张小庆, 赵慧霞, 曹鄂洪, 张连霞, 宫秀娟. PIV、HCAR、PCT/PLT在老年COPD肺部感染中的应用价值[J]. 天津医药, 2025, 53(2): 170-175.
[4]	张兰英, 张福安, 刘茂茂, 陈杰, 周健, 刘钰婷, 欧阳瑶. CD1a⁺和CD83⁺树突状细胞在COPD小鼠肺组织中的分布及意义[J]. 天津医药, 2024, 52(9): 913-916.
[5]	李冬生, 秦艺榕, 乔曼, 迟航, 崔青敏, 李晓秋. 清咳平喘颗粒对COPD急性加重期的临床疗效[J]. 天津医药, 2024, 52(8): 854-857.
[6]	武才鑫, 闫彦, 邓瑗琳, 杜雅敏, 杨振文, 潘晴, 杨帆. 心脏磁共振评估结缔组织病伴重度肺动脉高压的价值[J]. 天津医药, 2024, 52(7): 691-694.
[7]	王慧, 潘晴, 王宙明, 张娜, 杨振文, 魏蔚. 混合性结缔组织病相关肺动脉高压临床特点分析[J]. 天津医药, 2024, 52(7): 701-703.
[8]	钱洪春, 张萍淑, 元小冬, 袁建新, 曹凌云, 段丽琴. 卒中伴阻塞性睡眠呼吸暂停患者认知功能损害与睡眠参数的关系[J]. 天津医药, 2024, 52(6): 619-624.
[9]	赵术彤, 丁运, 李月川, 赵晓赟, 耿华, 徐美林. 轻度慢性阻塞性肺疾病的病理特征及其与炎性因子的相关性[J]. 天津医药, 2024, 52(6): 643-647.
[10]	冯李婷, 李莉, 谢鑫, 王星. 天津地区部分居民慢性阻塞性肺疾病影响因素分析[J]. 天津医药, 2024, 52(4): 427-431.
[11]	刘丹, 万南生, 王杰, 句仁华, 谢巍, 田羽, 冯靖. 多导睡眠图辅助药物诱导睡眠内镜正压呼吸机压力滴定的操作要点[J]. 天津医药, 2024, 52(3): 324-326.
[12]	刘燕, 许靖, 马蕾, 曹冠亚, 赵凤德. AECOPD患者外周血EOS、D-D和NLR与肺通气功能的关系[J]. 天津医药, 2024, 52(12): 1261-1265.
[13]	屠昌明, 田园, 汪鹏程, 任鹏, 赵寅生. SII、RAR与AECOPD患者病情严重程度及并发呼吸衰竭的关系[J]. 天津医药, 2024, 52(12): 1317-1321.
[14]	于志鸿, 王小琴. 欧前胡素衍生物对COPD肺泡Ⅱ型细胞活性及耐药蛋白的影响[J]. 天津医药, 2024, 52(11): 1127-1130.
[15]	张朝霞, 南星梅, 李占强, 芦殿香. 钾离子通道在低氧性肺动脉高压中的作用及药物干预研究进展[J]. 天津医药, 2023, 51(8): 892-896.