中西医结合视角下阻塞性睡眠呼吸暂停导致夜尿/夜间遗尿的潜在机制与治疗

doi:10.3969/j.issn.1003-9198.2026.04.005

摘要/Abstract

摘要： 阻塞性睡眠呼吸暂停(OSA)与夜尿症/夜间遗尿在老年人群中常合并存在,严重影响患者生活质量并增加跌倒、骨折等风险。本文旨在从中西医结合的角度系统综述二者共病的潜在机制与治疗策略。从病理生理学角度看,OSA引发的间歇性缺氧、胸腔内压波动通过神经-体液轴失调、直接肾脏损伤以及膀胱功能障碍等多种途径,共同导致夜间多尿与膀胱储尿功能异常。中医认为,二者病机核心属本虚标实,涉及三焦气化不利、肺脾肾三脏虚损以致水液代谢失调,以及心神失养、脑髓空虚所致的“神机”失用。治疗上,西医以持续气道正压通气、药物、手术等手段进行治疗;中医通过中药与针灸等方法进行整体调节。本文强调,对老年夜尿症患者进行OSA筛查至关重要,并指出未来需建立中西医结合的综合诊疗模式以优化管理。

关键词: 阻塞性睡眠呼吸暂停, 夜尿症, 夜间遗尿, 病理生理机制, 治疗

Abstract: Obstructive sleep apnea (OSA) and nocturia/nocturnal enuresis frequently co-occur in the elderly population, significantly impairing quality of life and elevating risks such as falls and fractures. This article aims to systematically review the underlying mechanisms and therapeutic strategies for this comorbidity from an integrated Traditional Chinese and Western Medicine perspective. From a pathophysiological perspective, intermittent hypoxia and intrathoracic pressure fluctuations induced by OSA collectively contribute to nocturnal polyuria and abnormal bladder storage function through multiple pathways. These include dysregulation of the neuro-humoral axis, direct renal injury, and bladder dysfunction. Traditional Chinese Medicine (TCM) posits that the core pathogenesis involves a root deficiency with superficial excess. This encompasses impaired transformation and transportation functions of the triple energizer (Sanjiao), deficiency of the lung, spleen, and kidney leading to water metabolism disorder, as well as malnourishment of the heart-spirit and emptiness of the marrow-sea, resulting in the loss of "mental control" over urination. In terms of treatment, Western medicine employs methods such as continuous positive airway pressure, pharmacotherapy, and surgery, while TCM utilizes approaches including herbal medicine and acupuncture for holistic regulation. This article emphasizes the critical importance of screening for OSA in elderly patients presenting with nocturia and suggests that future efforts should focus on establishing an integrated diagnostic and therapeutic model combining TCM and Western medicine to optimize patient management.

Key words: obstructive sleep apnea, nocturia, nocturnal enuresis, pathophysiological mechanisms, treatment

中图分类号:

R 766
R 694

翟瑞雪, 杨晨曦, 张智霖, 林可妮, 宋奇翔, 汤康敏. 中西医结合视角下阻塞性睡眠呼吸暂停导致夜尿/夜间遗尿的潜在机制与治疗[J]. 实用老年医学, 2026, 40(4): 350-356.

ZHAI Ruixue, YANG Chenxi, ZHANG Zhilin, LIN Keni, SONG Qixiang, TANG Kangmin. Potential mechanisms and treatment of nocturia/nocturnal enuresis caused by obstructive sleep apnea from an integrated traditional Chinese and Western medicine perspective[J]. Practical Geriatrics, 2026, 40(4): 350-356.

参考文献

[1] SANCHEZ-AZOFRA A, MALHOTRA A, OWENS R L, et al. Obstructive sleep apnea:pathophysiology and endotypes[J]. ATS Sch, 2023, 4(4):567-568.
[2] BENJAFIELD A V, AYAS N T, EASTWOOD P R, 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.
[3] MALMSTEN U G, MILSOM I, MOLANDER U, et al. Urinary incontinence and lower urinary tract symptoms:an epidemiological study of men aged 45 to 99 years[J]. J Urol, 1997, 158(5):1733-1737.
[4] CHANG T L, KUO H C. Nocturia, nocturnal polyuria, and nocturnal enuresis in adults:what we know and what we do not know[J]. Tzu Chi Med J, 2024, 36(4):370-376.
[5] PESONEN J S, VERNOOIJ R W M, CARTWRIGHT R, et al. The impact of nocturia on falls and fractures:a systematic review and meta-analysis[J]. J Urol, 2020, 203(4):674-683.
[6] HAJDUK I A, STROLLO P J Jr, JASANI R R, et al. Prevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome:a retrospective study[J]. Sleep, 2003, 26(1):61-64.
[7] GUOLEMINAULT C, LIN C M, GONÇALVES M A, et al. A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia[J]. J Psychosom Res, 2004, 56(5):511-515.
[8] KRIEGER J, FOLLENIUS M, SFORZA E, et al. Effects of treatment with nasal continuous positive airway pressure on atrial natriuretic peptide and arginine vasopressin release during sleep in patients with obstructive sleep apnoea[J]. Clin Sci:Lond, 1991, 80(5):443-449.
[9] UMLAUF M G, CHASENS E R, GREEVY R A, et al. Obstructive sleep apnea, nocturia and polyuria in older adults[J]. Sleep, 2004, 27(1):139-144.
[10] SONG Q X, SUADICANI S O, NEGORO H, et al. Disruption of circadian rhythm as a potential pathogenesis of nocturia[J]. Nat Rev Urol, 2025, 22(5):276-293.
[11] ATTA A G, MARINGONI R L, TRINDADE JÚNIOR A S. Role of the atria in controlling body fluids[J]. Rev Paul Med, 1989, 107(1):37-40.
[12] SAMSON W K. Atrial natriuretic factor inhibits dehydration and hemorrhage-induced vasopressin release[J]. Neuroendocrinology, 1985, 40(3):277-279.
[13] HOEKEMA A, VOORS A A, WIJKSTRA P J, et al. Effects of oral appliances and CPAP on the left ventricle and natriuretic peptides[J]. Int J Cardiol, 2008, 128(2):232-239.
[14] SVATIKOVA A, SHAMSUZZAMAN A S, WOLK R, et al. Plasma brain natriuretic peptide in obstructive sleep apnea[J]. Am J Cardiol, 2004, 94(4):529-532.
[15] LIANG K, UNRUH M. Does sleep apnea damage the kidneys?[J]. Sleep, 2015, 38(2):167-169.
[16] KATO K, TAKATA Y, USUI Y, et al. Severe obstructive sleep apnea increases cystatin C in clinically latent renal dysfunction[J]. Respir Med, 2011, 105(4):643-649.
[17] KEMMER H, MATHES A M, DILK O, et al. Obstructive sleep apnea syndrome is associated with overactive bladder and urgency incontinence in men[J]. Sleep, 2009, 32(2):271-275.
[18] PRESSMAN M R, FIGUEROA W G, KENDRICK-MOHAMED J, et al. Nocturia. A rarely recognized symptom of sleep apnea and other occult sleep disorders[J]. Arch Intern Med, 1996, 156(5):545-550.
[19] JORDAN A S, MCSHARRY D G, MALHOTRA A. Adult obstructive sleep apnoea[J]. Lancet, 2014, 383(9918):736-747.
[20] WHITE L H, BRADLEY T D. Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea[J]. J Physiol, 2013, 591(5):1179-1193.
[21] YOUNG T, PALTA M, DEMPSEY J, et al. The occurrence of sleep-disordered breathing among middle-aged adults[J]. N Engl J Med, 1993, 328(17):1230-1235.
[22] 李建委. 中医对阻塞性睡眠呼吸暂停低通气综合征的认识与治疗进展[J]. 中国实用医药, 2008, 3(28):185-187.
[23] 刘薇. 300例阻塞性睡眠呼吸暂停综合征中医证候分析[J]. 北京中医药, 2010, 29(4):289-290.
[24] 李然, 张海滨, 王振裕. 阻塞性睡眠呼吸暂停患者中医证型分布规律及特征分析[J]. 北京中医药, 2022, 41(11):1287-1290.
[25] 韩秀丽, 谭智敏. 从三焦痰瘀阻滞论治成人鼾症[J]. 长春中医药大学学报, 2022, 38(8):854-857.
[26] 唐可伟, 朱娣, 冯马龙. 从六经探讨阻塞性睡眠呼吸暂停低通气综合征证治[J]. 浙江中医杂志, 2024, 59(11):1013-1014.
[27] 陈志斌, 兰岚. 鼾症中医诊疗专家共识意见[J]. 中国中医药信息杂志, 2019, 26(1):1-5.
[28] 陈豪, 王洋. 以夜间遗尿为首发症状的阻塞性睡眠呼吸暂停低通气综合征一例[J]. 中国呼吸与危重监护杂志, 2023, 22(2):133-134.
[29] SWEETMAN A, LACK L, MCEVOY R D, et al. Bi-directional relationships between co-morbid insomnia and sleep apnea (COMISA)[J]. Sleep Med Rev, 2021, 60:101519.
[30] 夜尿症临床诊疗中国专家共识编写组. 夜尿症临床诊疗中国专家共识[J]. 中华泌尿外科杂志, 2018, 39(8):561-564.
[31] 曾凌枫, 张慧, 雷思, 等. 《成年人阻塞性睡眠呼吸暂停低通气综合征筛查:美国预防临床服务指南工作组推荐声明》解读[J]. 中国全科医学, 2024, 27(12):1412-1416.
[32] 《中国循环杂志》编辑部. 美发布阻塞性睡眠呼吸暂停治疗指南[J]. 中国循环杂志, 2013, 28(8):628.
[33] 何权瀛, 王莞尔. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(基层版)[J]. 中国呼吸与危重监护杂志, 2015, 14(4):398-405.
[34] PLATON A L, STELEA C G, BOIŞTEANU O, et al. An update on obstructive sleep apnea syndrome-a literature review[J]. Medicina:Kaunas, 2023, 59(8):1459.
[35] VROOMAN O P J, VAN KERREBROECK P E V, VAN BALKEN M R, et al. Nocturia and obstructive sleep apnoea[J]. Nat Rev Urol, 2024, 21(12):735-753.
[36] WANG T, HUANG W, ZONG H, et al. The efficacy of continuous positive airway pressure therapy on nocturia in patients with obstructive sleep apnea:a systematic review and meta-analysis[J]. Int Neurourol J, 2015, 19(3):178-184.
[37] PATAKA A, KOTOULAS S C, GAVRILIS P R, et al. Adherence to CPAP treatment:can mindfulness play a role?[J]. Life, 2023, 13(2):296.
[38] 林志烽, 陈旭, 董孟龙, 等. 失眠共病阻塞性睡眠呼吸暂停患者持续正压通气治疗依从性研究进展[J]. 中国实用内科杂志, 2025, 45(4):336-341.
[39] KEUN H P,HYUN S P,GON H K, et al. Nocturia improvement with surgical correction of sleep apnea[J]. Int Neurourol J, 2016, 20(4):329-334.
[40] LUU S, CHAN D E C Y, MARSHALL N S, et al. Pharmacotherapy for obstructive sleep apnea:a critical review of randomized placebo-controlled trials[J]. Sleep Med Rev, 2025, 84:102169.
[41] TARANTO-MONTEMURRO L, MESSINEO L, SANDS S A, et al. The combination of atomoxetine and oxybutynin greatly reduces obstructive sleep apnea severity. A randomized, placebo-controlled, double-blind crossover trial[J]. Am J Respir Crit Care Med, 2019, 199(10):1267-1276.
[42] LANDRY S A, BEATTY C, THOMSON L D J, et al. A review of supine position related obstructive sleep apnea:classification, epidemiology, pathogenesis and treatment[J]. Sleep Med Rev, 2023, 72:101847.
[43] MESSINEO L, BAKKER J P, CRONIN J, et al. Obstructive sleep apnea and obesity:a review of epidemiology, pathophysiology and the effect of weight-loss treatments[J]. Sleep Med Rev, 2024, 78:101996.
[44] 赵洋, 杨胜昌, 吉恩生. 阻塞性睡眠呼吸暂停的中医药治疗研究进展[J]. 中国中医基础医学杂志, 2021, 27(3):531-534.
[45] 雷丽芳, 孙健, 邓秀红. 中药穴位贴敷双涌泉治疗老年夜尿症的临床疗效[J]. 中国老年学杂志, 2015, 35(3):632-633.
[46] WANG L, XU J, ZHAN Y, et al. Acupuncture for obstructive sleep apnea (OSA) in adults:a systematic review and meta-analysis[J]. Biomed Res Int, 2020, 2020:6972327.
[47] 汪新华, 黄方, 赵焰. 针刺“下三皇”联合八髎灸治疗老年夜尿症疗效观察[J]. 时珍国医国药, 2020, 31(2):380-382.