Effects of Sleep Apnea on Nocturnal Free Fatty Acids in Subjects with Heart Failure
Effects of Sleep Apnea on Nocturnal Free Fatty Acids in Subjects with Heart Failure
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DOI：
10.5665/sleep.1240
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发表时间：
2011-09-01
期刊：
影响因子：
5.6
通讯作者：
Polotsky, Vsevolod Y.
中科院分区：
文献类型：
--
作者：
Jun, Jonathan C.;Drager, Luciano F.;Polotsky, Vsevolod Y.
研究目的：睡眠呼吸暂停在充血性心力衰竭患者中很常见，并可能导致基础心脏病的进展。睡眠呼吸暂停的心血管和代谢并发症归因于间歇性缺氧。游离脂肪酸（FFA）升高也与代谢、血管和心脏功能障碍的进展相关。本研究的目的是确定间歇性缺氧对心衰患者睡眠期间FFA水平的影响。设计和干预：在睡眠期间，频繁采集心脏稳定（射血分数< 40%）患者的血液样本，检查FFA。重度睡眠呼吸暂停患者（呼吸暂停低通气指数= 15.4 +/- 3.7次/h;平均低SpO（2）= 93.6%）。在严重的睡眠呼吸暂停患者中，在2-4升/分钟的补充氧气在随后的夜晚，以消除低氧血症。测量和结果：在睡眠发作前，控制和严重呼吸暂停患者表现出类似的FFA水平。在睡眠开始后，严重睡眠呼吸暂停患者的FFA相对于对照组显著而快速地增加。这种增加持续整个NREM和REM睡眠超过血清FFA水平在对照组由0.134 mmol/L（P = 0.0038）补充氧气正常化FFA配置文件，而不影响睡眠结构或呼吸觉醒frequency.Conclusion：在心力衰竭患者中，严重的睡眠呼吸暂停导致浪涌夜间FFA，可能有助于加速潜在的心脏疾病的进展。补充氧气可以防止FFA升高。
Study Objectives: Sleep apnea is common in patients with congestive heart failure, and may contribute to the progression of underlying heart diseae. Cardiovascular and metabolic complications of sleep apnea have been attributed to intermittent hypoxia. Elevated free fatty acids (FFA) are also associated with the progression of metabolic, vascular, and cardiac dysfunction. The objective of this study was to determine the effect of intermittent hypoxia on FFA levels during sleep in patients with heart failure.Design and interventions: During sleep, frequent blood samples were examined for FFA in patients with stable heart (ejection fraction < 40%). In patients with severe sleep apnea (apnea-hypopnea index = 15.4 +/- 3.7 events/h; average low SpO(2) = 93.6%). In patients with severe sleep apnea, supplemental oxygen at 2-4 liters/min was administered on a subsequent night to eliminate hypoxemia.Measurements and Results: Prior to sleep onset, controls and patients with severe apnea exhibited a similar FFA level. After sleep onset, patients with severe sleep apnea exhibited a marked and rapid increase in FFA relative to control subjects. This increase persisted throughout NREM and REM sleep exceeding serum FFA levels in control subjects by 0.134 mmol/L (P = 0.0038) Supplemental oxygen normalized the FFA profile without affecting sleep architecture or respiratory arousal frequency.Conclusion: In patients with heart failure, severe sleep apnea causes surges in nocturnal FFA that may contribute to the accelerated progression of underlying heart disease. Supplemental oxygen prevents that FFA elevation.