Obstructive sleep apnea (OSA) is an increasingly prevalent health concern characterized by repeated episodes of pharyngeal collapse during sleep. It is frequently associated with daytime sleepiness and impaired functional capacity, but it is also linked to cardiovascular disease by a growing body of epidemiological, clinical, and translational research. The severity of OSA is traditionally evaluated by the apnea‑hypopnea index (AHI), but the value of this marker as a predictor of cardiovascular outcomes is limited. Thus, there is an increasing focus on alternative classification methods such as the hypoxic burden, other polysomnographic traits, and phenotypic subgroups based on clinical symptoms. There is a need to identify subgroups of patients with OSA who will benefit most from treatment, as recent large randomized controlled trials in selected populations have failed to show benefit in reducing overall cardiovascular mortality. Obstructive sleep apnea adversely affects cardiovascular structure and function by several distinct mechanisms such as intermittent hypoxia, sleep fragmentation, and intrathoracic pressure swings. These mechanisms lead to sympathetic activation, inflammation, and oxidative stress, which may result in the clinical consequences of OSA such as hypertension, coronary artery disease, heart failure, and cerebrovascular disease. This review focuses on the epidemiology and potential mechanisms of cardiovascular diseases in OSA. Furthermore, we will briefly discuss the role of personalized medicine, alternative treatment options, and precise phenotyping to optimize treatment of this complex condition and its associated cardiovascular risk.

中文翻译：

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阻塞性睡眠呼吸暂停的心血管表现：当前证据和潜在机制。

阻塞性睡眠呼吸暂停 (OSA) 是一种日益普遍的健康问题，其特征是在睡眠期间反复发作咽部塌陷。它经常与白天嗜睡和功能受损有关，但越来越多的流行病学、临床和转化研究表明它也与心血管疾病有关。OSA 的严重程度传统上通过呼吸暂停低通气指数 (AHI) 进行评估，但该标志物作为心血管结局预测指标的价值有限。因此，人们越来越关注替代分类方法，例如缺氧负荷、其他多导睡眠图特征和基于临床症状的表型亚组。需要确定将从治疗中获益最多的 OSA 患者亚组，因为最近在选定人群中进行的大型随机对照试验未能显示出降低总体心血管死亡率的益处。阻塞性睡眠呼吸暂停通过多种不同的机制（如间歇性缺氧、睡眠片段化和胸腔内压力波动）对心血管结构和功能产生不利影响。这些机制导致交感神经激活、炎症和氧化应激，这可能导致 OSA 的临床后果，如高血压、冠状动脉疾病、心力衰竭和脑血管疾病。本综述侧重于 OSA 中心血管疾病的流行病学和潜在机制。此外，我们将简要讨论个性化医疗的作用、替代治疗方案、