阻塞性睡眠呼吸暂停的饮食干预：将机制通路转化为临床实践

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）是一种高度流行且异质性强的睡眠障碍，其特征为睡眠期间反复发生上气道塌陷，导致间歇性低氧、睡眠碎片化、交感神经激活以及心血管代谢风险增加。尽管肥胖是最受关注的可改变危险因素，但越来越多的证据表明，营养因素通过超越体重调节的机制影响OSA，包括全身性炎症、氧化应激、内皮功能障碍、肠道菌群改变和代谢失调。精准医学和基于肠促胰素的疗法的出现，进一步凸显了将个体化营养方法整合到OSA管理中的必要性。
方法： 在PubMed/MEDLINE、Scopus和Web of Science中进行了文献检索，以识别针对OSA成人营养机制、饮食模式、肠道菌群、时间营养学、基于肠促胰素的疗法和精准营养的实验研究、观察性研究、随机临床试验、系统综述、荟萃分析和国际临床指南。
结果： 当前证据提示，营养干预可能通过减重之外的多种生物学通路影响OSA。地中海饮食和DASH饮食模式与有利的心血管代谢效应相关，而膳食纤维、多酚、omega-3脂肪酸和其他抗氧化化合物可能调节与炎症、氧化应激、内皮功能和代谢调节相关的通路。然而，直接证明客观呼吸结局改善的证据仍然有限且异质。新兴研究还提示肠道菌群调节和时间营养学在代谢和睡眠调节中的潜在作用，尽管大多数证据仍为机制性、观察性或间接性。此外，胰高血糖素样肽-1受体激动剂和双重肠促胰素激动剂已显示出对体重和OSA严重程度的临床相关降低，为与营养管理整合提供了机会。然而，支持表型特异性和生物标志物指导的营养干预的证据仍不充分。
结论： 营养通过靶向减重之外的炎症、代谢、血管和微生物组相关机制，代表了一种有前景的OSA多学科管理辅助策略。未来研究应聚焦于整合代谢表型分析、生物标志物、肠道菌群和数字健康技术的精准营养方法，以优化个体化治疗并改善长期临床结局。

英文摘要

Obstructive sleep apnea (OSA) is a highly prevalent and heterogeneous sleep disorder characterized by recurrent upper airway collapse during sleep, resulting in intermittent hypoxia, sleep fragmentation, sympathetic activation, and increased cardiometabolic risk. Although obesity is the most recognized modifiable risk factor, growing evidence indicates that nutritional factors influence OSA through mechanisms extending beyond body weight regulation, including systemic inflammation, oxidative stress, endothelial dysfunction, gut microbiota alterations, and metabolic dysregulation. The emergence of precision medicine and incretin-based therapies has further highlighted the need to integrate personalized nutritional approaches into OSA management. A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify experimental studies, observational studies, randomized clinical trials, systematic reviews, meta-analyses, and international clinical guidelines addressing nutritional mechanisms, dietary patterns, gut microbiota, chrononutrition, incretin-based therapies, and precision nutrition in adults with OSA. Current evidence suggests that nutritional interventions may influence OSA through multiple biological pathways beyond weight reduction. Mediterranean and DASH dietary patterns are associated with favorable cardiometabolic effects, while dietary fiber, polyphenols, omega-3 fatty acids, and other antioxidant compounds may modulate pathways related to inflammation, oxidative stress, endothelial function, and metabolic regulation. However, evidence directly demonstrating improvements in objective respiratory outcomes remains limited and heterogeneous. Emerging research also suggests potential roles for gut microbiota modulation and chrononutrition in metabolic and sleep regulation, although most evidence remains mechanistic, observational, or indirect. In addition, glucagon-like peptide-1 receptor agonists and dual incretin agonists have demonstrated clinically relevant reductions in body weight and OSA severity, providing opportunities for integration with nutritional management. Nevertheless, evidence supporting phenotype-specific and biomarker-guided nutritional interventions remains insufficient. Nutrition represents a promising adjunctive strategy in the multidisciplinary management of OSA by targeting inflammatory, metabolic, vascular, and microbiome-related mechanisms that extend beyond weight loss alone. Future research should focus on precision nutrition approaches integrating metabolic phenotyping, biomarkers, gut microbiota, and digital health technologies to optimize personalized treatment and improve long-term clinical outcomes.