Daytime Cheyne-Stokes respiration in ambulatory patients with severe congestive heart failure is associated with increased mortality
Daytime Cheyne-Stokes respiration in ambulatory patients with severe congestive heart failure is associated with increased mortality
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DOI：
10.1378/chest.07-0121
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发表时间：
2007-11-01
期刊：
影响因子：
9.6
通讯作者：
Bloch, Konrad E.
中科院分区：
文献类型：
--
作者：
Brack, Thomas;Thueer, Irene;Bloch, Konrad E.
背景：严重心力衰竭患者睡眠时常发生潮式呼吸（CSR），可能增加死亡率。白天的CSR被认为会带来更大的风险，但它的患病率和预后重要性仍然难以捉摸。因此，我们研究了CSR的昼夜患病率及其对心力衰竭患者生存率的影响。（平均年龄+/- SE，58.0 +/- 1.5岁; 6名女性），伴有稳定的重度心力衰竭（左心室射血分数，26 +/- 1%;纽约心脏协会[NYHA]分级，2.6 +/- 0.1），在24小时的日常活动期间用便携式呼吸感应体积描记器不显眼地监测呼吸模式。在夜间，62%的患者有：每小时15个周期性呼吸周期;在白天，相应的患病率为16%。CSR在32例患者中占优势：夜间+/- 3%，白天10 +/- 2%，峰值出现在4：00 AM、2：00 PM和6：00 PM。在836 ± 27天的随访中，18例白天CSR>= 10%的患者比42例白天CSR < 10%的患者在没有心脏移植的情况下生存时间短（p < 0.05）。当控制年龄、性别、脑钠肽、左心室射血分数和NYHA分级时，白天CSR ≥ 10%是死亡率的独立预测因子（危险比，3.8; 95%可信区间，1.1 ~ 12.7; p < 0.05）。结论：62%的严重心力衰竭患者在夜间发生CSR，16%在白天发生。由于日间CSR与生存率降低相关，因此仅进行睡眠研究可能无法充分评估严重心力衰竭患者的预后和定制治疗。
Background: Cheyne-Stokes respiration (CSR) frequently occurs in patients with severe heart failure during sleep and may increase mortality. Daytime CSR supposedly poses an even greater risk, but its prevalence and prognostic importance remain elusive. Therefore, we investigated the circadian prevalence of CSR and its influence on survival in patients with heart failure.Methods: In 60 consecutive ambulatory patients (mean age +/- SE, 58.0 +/- 1.5 years; 6 women) with stable severe heart failure (left ventricular ejection fraction, 26 +/- 1%; New York Heart Association [NYHA] class, 2.6 +/- 0.1), the breathing pattern was unobtrusively monitored during 24 h of usual activities with a portable respiratory inductive plethysmograph.Results: During nights, 62% of patients had : 15 periodic breathing cycles per hour; during days, the corresponding prevalence was 16%. CSR prevailed in 32 :+/- 3% of the night and in 10 +/- 2% of the day, with peaks at 4:00 AM, 2:00 Pm, and 6:00 Pm. Eighteen patients with CSR during >= 10% of the daytime lived shorter without heart transplantation than 42 patients with < 10% of daytime CSR (p < 0.05) during 836 :+/- 27 clays of follow-up. CSR during >= 10% of the daytime was an independent predictor of mortality (hazard ratio, 3.8; 95% confidence interval, 1.1 to 12.7; p < 0.05) when controlling for age, sex, brain natriuretic peptide, left ventricular ejection fraction, and NYHA class.Conclusions: CSR occurs in 62% of patients with severe heart failure at night and in 16% during the day. Since daytime CSR is associated with reduced survival, solely performing sleep studies may not allow to adequately assess prognosis and tailor treatment in patients with severe heart failure.