阻塞性睡眠呼吸暂停诱导残余胆固醇升高与冠心病机制及研究进展

doi:10.3969/j.issn.1004-583X.2025.11.012

摘要/Abstract

摘要：

冠状动脉粥样硬化性心脏病(冠心病)作为一种高发病率、高病死率、高致残率、高复发率的心血管疾病,是导致我国中老年人残疾和死亡的重要原因。因此,识别冠心病相关危险因素并进行适当预防十分关键。有研究表明,阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)是冠心病发生的独立危险因素之一,但其具体机制尚未明确。随着相关研究进展,进一步发现OSA可引起残余胆固醇升高,而残余胆固醇也与冠心病密切相关。因此,本文就OSA诱导残余胆固醇升高与冠心病的相关机制进行综述,以期为阐明OSA引起冠心病的潜在病理机制提供一定依据。

关键词: 睡眠呼吸暂停, 阻塞性, 残余胆固醇, 冠心病, 危险因素, 共病

中图分类号:

R749.79

温甜甜, 魏星, 马苗苗, 马丽群. 阻塞性睡眠呼吸暂停诱导残余胆固醇升高与冠心病机制及研究进展[J]. 临床荟萃, 2025, 40(11): 1035-1042.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.11.012

https://www.lchc.cn/CN/Y2025/V40/I11/1035

参考文献 62

[1]	中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24): 1902-1914. doi: 10.3760/cma.j.issn.0376-2491.2018.24.003.
[2]	Bikov A, Frent SM, Meszaros M, et al. Triglyceride-glucose index in non-diabetic, non-obese patients with obstructive sleep apnoea[J]. J Clin Med, 2021, 10(9):1932. doi: 10.3390/jcm10091932.
[3]	Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis[J]. Lancet Respir Med, 2019, 7(8): 687-698. doi: 10.1016/s2213-2600(19)30198-5. pmid: 31300334
[4]	Lao M, Cheng Y, Gao X, et al. The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: A randomized controlled trial[J]. BMC Pulm Med, 2022, 22(1): 99. doi: 10.1186/s12890-022-01879-2. pmid: 35313858
[5]	王越, 王志强, 张晓江, 等. 阻塞性睡眠呼吸暂停低通气综合征对不稳定型心绞痛患者炎症补体水平的影响及其与冠状动脉狭窄程度的相关性研究[J]. 中国心血管病研究, 2021, 19(3): 203-207. doi: 10.3969/j.issn.1672-5301.2021.03.003.
[6]	王丽丽, 于瀚宇, 黄晓, 等. 阻塞性睡眠呼吸暂停综合征对冠心病患者心脏的TIB以及Gensini评分影响的研究[J]. 中华保健医学杂志, 2018, 20(4): 324-326. doi: 10.3969/.issn.1674-3245.2018.04.018.
[7]	杨晶晶, 马丽群, 苟丽沙, 等. 冠状动脉血管狭窄程度与睡眠呼吸暂停的相关性研究[J]. 临床荟萃, 2020, 35(5): 408-412. doi: 10.3969/j.issn.1004-583X.2020.05.004.
[8]	Hsu SH, Jang MH, Torng PL, et al. Positive association between small dense low-density lipoprotein cholesterol concentration and biomarkers of inflammation, thrombosis, and prediabetes in non-diabetic adults[J]. J Atheroscler Thromb, 2019, 26(7): 624-635. doi: 10.5551/jat.43968.
[9]	Drager LF, Tavoni TM, Silva VM, et al. Obstructive sleep apnea and effects of continuous positive airway pressure on triglyceride-rich lipoprotein metabolism[J]. J Lipid Res, 2018, 59(6): 1027-1033. doi: 10.1194/jlr.M083436. pmid: 29628442
[10]	Mach F, Baigent C, Catapano AL, et al. ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk[J]. Eur Heart J, 2020, 41(1): 111-188. doi: 10.1093/eurheartj/ehz455.
[11]	Wang K, Wang R, Yang J, et al. Remnant cholesterol and atherosclerotic cardiovascular disease: Metabolism, mechanism, evidence, and treatment[J]. Front Cardiovasc Med, 2022, 9:913869. doi: 10.3389/fcvm.2022.913869.
[12]	Navarese EP, Vine D, Proctor S, et al. Independent causal effect of remnant cholesterol on atherosclerotic cardiovascular outcomes: A mendelian randomization study[J]. Arterioscler Thromb Vasc Biol, 2023, 43(9): e373-e380. doi: 10.1161/atvbaha.123.319297. pmid: 37439258
[13]	Drexel H, Mader A, Larcher B, et al. Remnant cholesterol and long-term incidence of death in coronary artery disease patients[J]. Atherosclerosis, 2025, 401:119048. doi: 10.1016/j.atherosclerosis.2024.119048.
[14]	Elshazly MB, Mani P, Nissen S, et al. Remnant cholesterol, coronary atheroma progression and clinical events in statin-treated patients with coronary artery disease[J]. Eur J Prev Cardiol, 2019, 27(10): 1091-1100. doi: 10.1177/2047487319887578.
[15]	Ference BA, Kastelein JJP, Ray KK, et al. Association of triglyceride-lowering LPL variants and LDL-C-lowering LDLR variants with risk of coronary heart disease[J]. JAMA, 2019, 321(4):364-373. doi: 10.1001/jama.2018.20045. pmid: 30694319
[16]	米洁. 低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇和载脂蛋白B与老年人心血管疾病发生的关系研究[J]. 中国医学工程, 2024, 32(9): 100-104. doi: 10.19338/j.issn.1672-2019.2024.09.019.
[17]	Sniderman AD, Thanassoulis G, Glavinovic T, et al. Apolipoprotein B particles and cardiovascular disease: A narrative review[J]. JAMA Cardiol, 2019, 4(12): 1287-1295.doi: 10.1001/jamacardio.2019.3780. pmid: 31642874
[18]	Sandesara PB, Virani SS, Fazio S, et al. The forgotten lipids: Triglycerides, remnant cholesterol, and atherosclerotic cardiovascular disease risk[J]. Endocr Rev, 2019, 40(2): 537-557. doi: 10.1210/er.2018-00184.
[19]	Lu J, Wang C, Shen Y, et al. Time in range in relation to all-cause and cardiovascular mortality in patients with type 2 diabetes: A prospective cohort study[J]. Diabetes Care, 2021, 44(2): 549-555. doi: 10.2337/dc20-1862. pmid: 33097560
[20]	Wang L, Peng W, Zhao Z, et al. Prevalence and treatment of diabetes in china, 2013-2018[J]. JAMA, 2021, 326(24):2498-2506. doi: 10.1001/jama.2021.22208. pmid: 34962526
[21]	杨永恒. OSAHS患者血清RLP-C与颈动脉内中膜厚度的关系[D]. 太原: 山西医科大学, 2020.
[22]	Barros D, García-río F. Obstructive sleep apnea and dyslipidemia: From animal models to clinical evidence[J]. Sleep, 2019, 42(3):zsy236. doi: 10.1093/sleep/zsy236.
[23]	李娟, 秦彦文. 阻塞性睡眠呼吸暂停与血脂异常的研究进展[J]. 心肺血管病杂志, 2018, 37(8): 4.
[24]	王云, 何燕, 刘师节, 等. 阻塞性睡眠呼吸暂停低通气综合征与糖脂代谢紊乱的机制研究进展[J]. 中国全科医学, 2022, 25(2): 5.
[25]	徐瑞燚. 阻塞性睡眠呼吸暂停低通气综合征患者胆固醇外流功能的改变及机制研究[D]. 北京: 清华大学医学部;北京协和医学院;中国医学科学院, 2010.
[26]	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. pmid: 36899115
[27]	Zhang H, Peng L, Wang Y, et al. Extracellular vesicle-derived miR-144 as a novel mechanism for chronic intermittent hypoxia-induced endothelial dysfunction[J]. Theranostics, 2022, 12(9): 4237-4249. doi: 10.7150/thno.69035. pmid: 35673562
[28]	Zhang Y, Li JJ, Xu R, et al. Nogo-B mediates endothelial oxidative stress and inflammation to promote coronary atherosclerosis in pressure-overloaded mouse hearts[J]. Redox Biol, 2023, 68: 102944. doi: 10.1016/j.redox.2023.102944.
[29]	胡月, 李潞, 赵红丽. 血管内皮功能与冠状动脉粥样硬化发生发展的研究进展[J]. 中西医结合心脑血管病杂志, 2018, 16(11): 1525-1528. doi: 10.12102/j.issn.1672-1349.2018.11.016.
[30]	Gao S, Emin M, Thoma T, et al. Complement promotes endothelial von willebrand factor and angiopoietin-2 release in obstructive sleep apnea[J]. Sleep, 2021, 44(4):zsaa286. doi: 10.1093/sleep/zsaa286.
[31]	Zhang Q, Shen X, Yuan X, et al. Lipopolysaccharide binding protein resists hepatic oxidative stress by regulating lipid droplet homeostasis[J]. Nat Commun, 2024, 15(1): 3213. doi: 10.1038/s41467-024-47553-5. pmid: 38615060
[32]	Du H, Zhao Y, Wen J, et al. LncRNA DCRT protects against dilated cardiomyopathy by preventing NDUFS2 alternative splicing by binding to PTBP1[J]. Circulation, 2024, 150(13): 1030-1049. doi: 10.1161/circulationaha.123.067861. pmid: 38841852
[33]	Tao P, Zhang H-F, Zhou P, et al. Growth differentiation factor 11 alleviates oxidative stress-induced senescence of endothelial progenitor cells via activating autophagy[J]. Stem Cell Res Ther, 2024, 15(1): 370. doi: 10.1186/s13287-024-03975-y. pmid: 39420391
[34]	Miceli V, Gerfo EL, Russelli G, et al. Circulating biomarkers to predict post-operative cognitive decline in patients undergoing coronary artery bypass grafting[J]. Cell Mol Neurobiol, 2025, 45(1): 37. doi: 10.1007/s10571-025-01553-1.
[35]	Sun H, Du Z, Yu H, et al. Excessive daytime sleepiness is associated with increased residual cardiovascular risks among coronary artery disease patients with obstructive sleep apnea[J]. Sleep Med, 2024, 115: 131-136. doi: 10.1016/j.sleep.2024.02.004. pmid: 38359592
[36]	Ma L, Zhang J, Liu Y. Roles and mechanisms of obstructive sleep apnea-hypopnea syndrome and chronic intermittent hypoxia in atherosclerosis: Evidence and prospective[J]. Oxid Med Cell Longev, 2016, 2016: 8215082. doi: 10.1155/2016/8215082.
[37]	Baessler A, Nadeem R, Harvey M, et al. Treatment for sleep apnea by continuous positive airway pressure improves levels of inflammatory markers-a meta-analysis[J]. J Inflamm (Lond), 2013, 10: 13. doi: 10.1186/1476-9255-10-13.
[38]	Xiong CC, Gao F, Zhang JH, et al. Investigating the impact of remnant cholesterol on new-onset stroke across diverse inflammation levels: Insights from the China Health and Retirement Longitudinal Study (CHARLS)[J]. Int J Cardioll, 2024, 405:131946. doi: 10.1016/j.ijcard.2024.131946.
[39]	Ryan S. Adipose tissue inflammation by intermittent hypoxia: Mechanistic link between obstructive sleep apnoea and metabolic dysfunction[J]. J Physiol, 2017, 595(8): 2423-2430. doi: 10.1113/jp273312.
[40]	Murphy AM, Thomas A, Crinion SJ, et al. Intermittent hypoxia in obstructive sleep apnoea mediates insulin resistance through adipose tissue inflammation[J]. Eur Respir J, 2017, 49(4):1601731. doi: 10.1183/13993003.01731-2016.
[41]	Shechter A, Grandner MA, St-Onge MP. The role of sleep in the control of food intake[J]. Am J Lifestyle Med, 2014, 8(6): 371-374. doi: 10.1177/1559827614545315.
[42]	Zhu B, Shi C, Park CG, et al. Effects of sleep restriction on metabolism-related parameters in healthy adults: A comprehensive review and meta-analysis of randomized controlled trials[J]. Sleep Med Rev, 2019, 45: 18-30. doi: 10.1016/j.smrv.2019.02.002. pmid: 30870662
[43]	Baud MO, Magistretti PJ, Petit JM. Sustained sleep fragmentation affects brain temperature, food intake and glucose tolerance in mice[J]. J Sleep Res, 2013, 22(1): 3-12. doi: 10.1111/j.1365-2869.2012.01029.x. pmid: 22734931
[44]	Yao X, Ji J, Chen D, et al. EZH2-induced histone methylation in the Nrf2 promoter region mediates pyroptosis in inflammatory cardiomyocyte injury[J]. Biochim Biophys Acta Gen Subj, 2025, 1869(6): 130799. doi: 10.1016/j.bbagen.2025.130799.
[45]	Wang D, Chen Y, Ding Y, et al. Application value of cardiometabolic index for the screening of obstructive sleep apnea with or without metabolic syndrome[J]. Nat Sci Sleep, 2024, 16: 177-191. doi: 10.2147/nss.S449862. pmid: 38404482
[46]	Taylor KS, Murai H, Millar PJ, et al. Arousal from sleep and sympathetic excitation during wakefulness[J]. Hypertension, 2016, 68(6): 1467-1474. doi: 10.1161/hypertensionaha.116.08212. pmid: 27698070
[47]	Treptow E, Pepin JL, Bailly S, et al. Reduction in sympathetic tone in patients with obstructive sleep apnoea: Is fixed CPAP more effective than APAP? A randomised, parallel trial protocol[J]. BMJ Open, 2019, 9(4): e024253. doi: 10.1136/bmjopen-2018-024253.
[48]	Knauert M, Naik S, Gillespie MB, et al. Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome[J]. World J Otorhinolaryngol Head Neck Surg, 2015, 1(1): 17-27. doi: 10.1016/j.wjorl.2015.08.001.
[49]	孙海丽, 秦彦文, 魏永祥. 阻塞性睡眠呼吸暂停与动脉粥样硬化关系的研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(10): 958-960. doi: 10.13201/j.issn.2096-7993.2020.10.023.
[50]	Gleeson M, Mcnicholas WT. Bidirectional relationships of comorbidity with obstructive sleep apnoea[J]. Eur Respir Rev, 2022, 31(164):210256. doi: 10.1183/16000617.0256-2021.
[51]	Reutrakul S, Mokhlesi B. Obstructive sleep apnea and diabetes: A state of the art review[J]. Chest, 2017, 152(5): 1070-1086. doi: 10.1016/j.chest.2017.05.009. pmid: 28527878
[52]	Cheng Q, Li Z, Wang X, et al. Relation between new york heart association functional class and remnant cholesterol, and non-high density lipoprotein cholesterol in coronary heart disease patients with type 2 diabetes mellitus[J]. Angiology, 2023, 74(1): 39-46. doi: 10.1177/00033197221091315.
[53]	Wu X, Qiu W, He H, et al. Associations of the triglyceride-glucose index and remnant cholesterol with coronary artery disease: A retrospective study[J]. Lipids Health Dis, 2024, 23(1): 45. doi: 10.1186/s12944-024-02036-w. pmid: 38341581
[54]	Vergès B. Dyslipidemia in type 1 diabetes: A masked danger[J]. Trends Endocrinol Metab, 2020, 31(6): 422-434. doi: 10.1016/j.tem.2020.01.015.
[55]	王钰哲, 孔璐璐, 葛丹, 等. 残余胆固醇与糖尿病视网膜病变相关性的研究[J]. 中国糖尿病杂志, 2023, 31(10): 741-744. doi: 10.3969/j.issn.1006-6187.2023.10.005.
[56]	Ding M, Shi R, Du Y, et al. O-GlcNAcylation-mediated endothelial metabolic memory contributes to cardiac damage via small extracellular vesicles[J]. Cell Metab, 2025, 37(6):1344-1363.doi: 10.1016/j.cmet.2025.03.006.
[57]	Li P, Wu J, Zhao L, et al. Effects and relationship of intermittent hypoxia on serum lipid levels, hepatic low-density lipoprotein receptor-related protein 1, and hypoxia-inducible factor 1α[J]. Sleep Breath, 2016, 20(1): 167-173. doi: 10.1007/s11325-015-1200-4. pmid: 26084411
[58]	Prabhakar NR, Peng YJ, Nanduri J. Hypoxia-inducible factors and obstructive sleep apnea[J]. J Clin Invest, 2020, 130(10): 5042-5051. doi: 10.1172/jci137560. pmid: 32730232
[59]	Tang JJ, Li GX, Liu ZG, et al. Danlou tablet improves chronic intermittent hypoxia-induced dyslipidemia and arteriosclerosis by HIF-1α-Angptl4 mRNA signaling pathway[J]. Chin J Integr Med, 2022, 28(6): 509-517. doi: 10.1007/s11655-020-3255-8.
[60]	Gu S, Hua H, Guo X, et al. PGC-1α participates in the protective effect of chronic intermittent hypobaric hypoxia on cardiomyocytes[J]. Cell Physiol Biochem, 2018, 50(5): 1891-1902. doi: 10.1159/000494869. pmid: 30396162
[61]	Yu L, Gong B, Duan W, et al. Melatonin ameliorates myocardial ischemia/reperfusion injury in type 1 diabetic rats by preserving mitochondrial function: Role of AMPK-PGC-1α-SIRT3 signaling[J]. Sci Rep, 2017, 7: 41337. doi: 10.1038/srep41337. pmid: 28120943
[62]	Zhang X, Zhao H, Sheng Q, et al. Regulation of microRNA-33, SREBP and ABCA1 genes in a mouse model of high cholesterol[J]. Arch Anim Breed, 2021, 64(1): 103-108. doi: 10.5194/aab-64-103-2021. pmid: 34084908

阻塞性睡眠呼吸暂停诱导残余胆固醇升高与冠心病机制及研究进展

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