Effects of continuous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure
Effects of continuous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure
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DOI：
10.1161/01.cir.101.4.392
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发表时间：
2000-02-01
期刊：
影响因子：
37.8
通讯作者：
Javaheri, S
中科院分区：
文献类型：
--
作者：
Javaheri, S
心力衰竭和收缩功能障碍患者在睡眠时可能发生呼吸紊乱。呼吸暂停和呼吸不足的反复发作可能导致去饱和和觉醒，这可能对左心室功能产生不利影响。本研究的目的是确定持续气道正压通气（CPAP）对睡眠呼吸障碍及其后果在heart failure patients.Methods和Results-The作者前瞻性研究了29例男性患者的初始多导睡眠图显示15个或更多的事件呼吸暂停和呼吸不足每小时（呼吸暂停低通气指数，AHI）的短期影响。21例患者主要为中枢性睡眠呼吸暂停，8例患者为阻塞性睡眠呼吸暂停。所有患者均在随后的夜间接受CPAP治疗。在16名患者中，CPAP导致呼吸紊乱的虚拟消除。在这些患者中，平均AHI（36 +/- 12 [SD] vs 4 +/- 3/小时，P = 0.0001），呼吸紊乱引起的觉醒指数（每小时16 +/- 9对2 +/- 2，P = 0.0001），总睡眠时间低于饱和度90%的百分比（20 +/- 23%至0.3 +/-0.7%，P = 0.0001）降低，最低饱和度（76 +/- 8%对90 +/-3%，P = 0.0001）增加。在13名对CPAP无反应的患者中，这些值没有显著变化。在对CPAP有反应的睡眠呼吸暂停患者中，夜间室性期前收缩的每小时发作次数（66 +/- 117与18 +/- 20）。P = 0.055）和对联体（3.2 +/- 6对0.2 +/- 0.21，P = 0.031）减少。相比之下，在睡眠呼吸暂停患者没有响应CPAP，室性心律失常并没有显着改变conclusion-in 55%的心力衰竭和睡眠呼吸暂停患者，第一夜鼻CPAP消除呼吸紊乱，减少心室应激。
Background-Patients with heart failure and systolic dysfunction may develop disordered breathing during sleep. Repeated episodes of apnea and hypopnea may result in desaturation and arousals, which could adversely affect left ventricular function. The purpose of this study was to determine the short-term effects of continuous positive airway pressure (CPAP) on sleep-disordered breathing and its consequences in heart failure patients.Methods and Results-The author prospectively studied 29 male patients whose initial polysomnograms showed 15 or more episodes of apnea and hypopnea per hour (apnea-hypopnea index, AHI). Twenty-one patients had predominately central and 8 patients obstructive sleep apnea. All were treated with CPAP during the subsequent night. In 16 patients, CPAP resulted in virtual elimination of disordered breathing. In these patients, the mean AHI (36 +/- 12 [SD] versus 4 +/- 3 per hour, P = 0.0001), arousal index due to disordered breathing (16 +/- 9 versus 2 +/- 2 per hour, P = 0.0001), and percent of total sleep time below saturation of 90% (20 +/- 23% to 0.3 +/- 0.7%, P = 0.0001) decreased, and lowest saturation (76 +/- 8% versus 90 +/- 3%, P = 0.0001) increased with CPAP. In 13 patients who did not respond to CPAP, these values did not change significantly. In patients whose sleep apnea responded to CPAP, the number of hourly episodes of nocturnal premature ventricular contractions (66 +/- 117 versus 18 +/- 20. P = 0.055) and couplets (3.2 +/- 6 versus 0.2 +/- 0.21, P = 0.031) decreased. In contrast, in patients whose sleep apnea did not respond to CPAP, ventricular arrhythmias did not change significantly.Conclusions-In 55% of patients with heart failure and sleep apnea, first-night nasal CPAP eliminates disordered breathing and reduces ventricular irritability.