EFFECTS OF NASAL CPAP ON SYMPATHETIC ACTIVITY IN PATIENTS WITH HEART-FAILURE AND CENTRAL SLEEP-APNEA
EFFECTS OF NASAL CPAP ON SYMPATHETIC ACTIVITY IN PATIENTS WITH HEART-FAILURE AND CENTRAL SLEEP-APNEA
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DOI：
10.1164/ajrccm.152.2.7633695
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发表时间：
1995-08-01
影响因子：
24.7
通讯作者：
BRADLEY, TD
中科院分区：
文献类型：
--
作者：
NAUGHTON, MT;BENARD, DC;BRADLEY, TD
我们假设：（1）充血性心力衰竭（CHF）和Cheyne-Stokes呼吸伴中枢性睡眠呼吸暂停（CSR-CSA）患者夜间尿和白天血浆去甲肾上腺素浓度较高，（分别为UNE和PNE），因为呼吸暂停，（2）经鼻持续气道正压通气（NCPAP）减弱CSR-CSA可降低UNE和PNE浓度。研究了18例CSR-CSA患者和17例非CSR-CSA患者（非CSR-CSA组）。两组的左心室射血分数相似，但CSR-CSA组的夜间UNE和清醒PNE浓度更高（30.2 +/- 2.5 nmol/mmol肌酐和3.32 +/- 0.29 nmol/L）（分别为15.8 +/- 2.1 nmol/mmol肌酐，p < 0.005和2.06 +/- 0.56 nmol/L，p < 0.05）。CSR-CSA患者随机分为对照组或夜间NCPAP治疗1个月。NCPAP组的CSR-CSA减弱，但对照组没有减弱。NCPAP组的UNE和PNE浓度（-12.5 +/- 3.3 nmol/mmol肌酐和-0.74 +/- 0.40 nmol/L）比对照组（分别为-1.3 +/- 2.8 nmol/mmol肌酐，p < 0.025和1.16 +/- 0.66 nmol/L，p < 0.025）降低得更大。总之，在CHF患者中，CSR-CSA与交感神经活性升高相关，NCPAP可降低交感神经活性。
We hypothesized that (1) patients with congestive heart failure (CHF) and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) would have greater nocturnal urinary and daytime plasma norepinephrine concentrations (UNE and PNE, respectively) than those without CSR-CSA because of apneas, hypoxia and arousals from sleep and (2) attenuation of CSR-CSA by nasal continuous positive airway pressure (NCPAP) would reduce UNE and PNE concentrations. Eighteen patients with and 17 without CSR-CSA (Non-CSR-CSA group) were studied. Left ventricular ejection fraction was similar in the two groups, but overnight UNE and awake PNE concentrations were greater in the CSR-CSA group (30.2 +/- 2.5 nmol/mmol creatinine and 3.32 +/- 0.29 nmol/L) than in the Non-CSR-CSA group (15.8 +/- 2.1 nmol/mmol creatinine, p < 0.005, and 2.06 +/- 0.56 nmol/L, p < 0.05, respectively). Patients with CSR-CSA were randomized to a control group or to nightly NCPAP for 1 mo. CSR-CSA was attenuated in the NCPAP but not in the control group. The NCPAP group experienced greater reductions in UNE and PNE concentrations (-12.5 +/- 3.3 nmol/mmol creatinine and -0.74 +/- 0.40 nmol/L) than did the control group (-1.3 +/- 2.8 nmol/mmol creatinine, p < 0.025 and 1.16 +/- 0.66 nmol/L, p < 0.025, respectively). In conclusion, in patients with CHF, CSR-CSA is associated with elevated sympathoneural activity, which can be reduced by NCPAP.