肥胖与阻塞性睡眠呼吸暂停交织的流行病：一项综合分析

文献信息

中文摘要

背景： 肥胖和阻塞性睡眠呼吸暂停（OSA）在全球范围内的患病率不断上升，由于二者对个体健康结局和医疗基础设施的共同影响，构成了重大的公共卫生挑战。本综述对这两种疾病之间复杂的双向关系进行了分析性评估。
方法： 证据表明，OSA患病率随着体重指数（BMI）类别的进展而显著上升，在III级肥胖个体中可达90%。这种关联由机械机制驱动——如上气道咽部脂肪堆积和肺容积减少——以及全身代谢性炎症和细胞功能障碍。
结果： 反之，OSA通过睡眠碎片化、日间过度嗜睡以及食欲调节激素紊乱（胃饥饿素升高和瘦素抵抗）促进体重增加和代谢失调。
结论： 能够减轻体重的干预措施，包括结构化生活方式调整、新型胰高血糖素样肽-1（GLP-1）受体激动剂和减重手术，可显著降低呼吸暂停低通气指数（AHI）和心血管代谢风险。鉴于未治疗OSA的高共病率和严重心血管风险，针对这两种疾病的常规临床筛查和整合多学科管理策略至关重要。

英文摘要

The escalating global prevalence of both obesity and obstructive sleep apnea (OSA) represents a major public health challenge due to their combined impact on individual health outcomes and healthcare infrastructure. This review provides an analytical evaluation of the complex, bidirectional relationship between these conditions. Evidence demonstrates that OSA prevalence rises markedly across progressive body mass index (BMI) categories, reaching up to 90% in individuals with Class III obesity. This association is driven by mechanical mechanisms-such as upper airway pharyngeal fat accumulation and reduced lung volumes-as well as systemic metabolic inflammation and cellular dysfunction. Conversely, OSA promotes weight gain and metabolic dysregulation through sleep fragmentation, excessive daytime somnolence, and disruption of appetite-regulating hormones (elevated ghrelin and leptin resistance). Interventions yielding weight loss, including structured lifestyle modifications, novel glucagon-like peptide-1 (GLP-1) receptor agonists, and bariatric surgery, demonstrate significant reductions in the apnea-hypopnea index (AHI) and cardiometabolic risk. Given the high co-occurrence and severe cardiovascular risk associated with untreated OSA, routine clinical screening and integrated multidisciplinary management strategies targeting both conditions are essential.