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阻塞性睡眠呼吸暂停与视网膜病变的研究现状和展望OACSTPCD

Research status and prospect of obstructive sleep apnea and retinopathy

中文摘要英文摘要

阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)综合征是常见的以慢性间歇性缺氧为主要特征的睡眠疾病,它是2型糖尿病(type 2 diabetes mellitus,T2DM)、高血压及心脑血管疾病等多种慢性病的"源头病".OSA的异质性高,不仅体现在诱因多种、机制多变、临床表现多样,更突出在合并症的个体差异和错综复杂的交互作用.因此对OSA患者进行精准诊疗,除了针对临床表现、发病因素的分层外,对靶器官损伤的精准归因及合并症预后的精准预测也十分重要.眼底视网膜是耗氧量高、对缺氧敏感度最高的组织之一,视网膜的血管和神经是缺氧损害重要的靶器官,也是监测疾病发生发展的直视"窗口".OSA可能通过低氧、氧化应激、炎症反应、内皮损伤等多种机制,导致视网膜和脉络膜直接及间接损害,减弱视神经和视网膜血管的自我调节能力,从而在疾病的不同阶段及不同个体中引发视网膜病变,其中既包括突发的致盲性视网膜神经血管疾病,又包括慢性进展性视网膜改变.这篇论文将回顾视网膜作为OSA靶器官的临床和研究现状,并展望新检测技术下视网膜作为生物标志物,助力评估OSA发病风险、筛查OSA相关并发症、实现精准分层干预及防治的前景.

Obstructive sleep apnea(OSA)syndrome is a common sleep disorder characterized by chronic inter-mittent hypoxia.It serves as the"primary disease"for various chronic conditions such as type 2 diabetes mellitus(T2DM),hypertension,and cardiovascular diseases.OSA exhibits high heterogeneity,not only in its multifactorial etiol-ogy and diverse mechanisms but also in the individual differences in complications and intricate interactions.Therefore,accurate diagnosis and treatment of OSA patients are crucial,requiring stratification based not only on clinical manifesta-tions and predisposing factors but also on precise attribution of target organ damage and accurate prediction of complica-tions'prognosis.The retinal fundus,being one of the tissues with high oxygen consumption and sensitivity to hypoxia,har-bors vital blood vessels and nerves susceptible to hypoxic damage.It serves as a direct"window"for monitoring the occur-rence and progression of diseases.OSA may lead to direct and indirect damage to the retina and choroid through various mechanisms such as hypoxia,oxidative stress,inflammation,and endothelial injury.This weakens the autoregulation abil-ity of retinal vessels and optic nerves,leading to retinal pathology at different stages of the disease and in different individ-uals,including both acute blinding retinal neurovascular diseases and chronic progressive retinal changes.This article re-views the current clinical and research status of the retina as a target organ in OSA and prospects the role of retinal imaging as a biomarker under new detection technologies,facilitating the assessment of OSA risk,screening for OSA-related com-plications,and achieving precise stratified intervention and prevention.

董梦璐;冯媛

南方医科大学南方医院精神心理科(睡眠医学中心)(广东广州 510515)

临床医学

阻塞性睡眠呼吸暂停;视网膜病变;精准诊疗;缺氧;生物标志物

obstructive sleep apnea;retinopathy;precise diagnosis and treatment;hypoxia;biomarker

《广东医学》 2024 (003)

268-273 / 6

国家自然科学基金委员会青年项目(81900089)

10.13820/j.cnki.gdyx.20224618

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