Benzodiazepines in congestive heart failure: effects of temazepam on arousability and Cheyne-Stokes respiration.
Benzodiazepines in congestive heart failure: effects of temazepam on arousability and Cheyne-Stokes respiration.
复制标题
充血性心力衰竭中的苯二氮卓类药物：替马西泮对觉醒性和潮式呼吸的影响。
作者：
D. Biberdorf;R. Steens;T. Millar;M. Kryger
我们研究了 7 名患有中度至重度充血性心力衰竭 (CHF) 的男性患者 [左心室射血分数 (LVEF) = 22.4 +/- 6.7；左心室射血分数 (LVEF) = 22.4 +/- 6.7；平均值 +/- SD] 在一项双盲交叉试验中确定替马西泮 15 mg 对觉醒能力、睡眠结构、潮式呼吸 (CSR) 和夜间氧饱和度的影响。替马西泮没有显着改善睡眠结构。总睡眠时间 (TST)（383.1 +/- 14.1 分钟至 396.6 +/- 15.4 分钟，p = ns）（平均值 +/- SE，安慰剂与替马西泮）或总唤醒时间 (TWT)（96.9 +/- 14.0 与 81.4 +/- 14.0 分钟，p = ns）没有显着变化。除了第一阶段睡眠减少外，睡眠阶段比例没有明显变化（6.7 +/- 1.2% vs. 4.0 +/- 1.0%，p < 0.05）。替马西泮组每小时睡眠的微唤醒次数减少（21.1 +/- 2.7/小时对比安慰剂 13.9 +/- 2.1/小时，p < 0.05），最大变化发生在第 2 阶段（24.9 +/- 5.4/小时对比 15.0 +/- 3.1/小时，p < 0.05）。睡眠期间唤醒时间 (WDS) 从 82.5 +/- 11.7 分钟减少到 54.5 +/- 9.4 分钟，p < 0.03。替马西泮治疗后日间警觉性得到改善，如替马西泮治疗后数天内平均睡眠潜伏期增加[多次睡眠潜伏期测试 (MSLT) = 7.1 +/- 2.4 vs. 5.7 +/- 2.0 分钟，p < 0.04] 所示。 CSR 占 TST 的百分比没有显着变化（38.7 +/- 13.6% 与 32.5 +/- 11.8%，p = ns）。然而，呼吸暂停/呼吸不足指数 (AHI)（10% 过滤器）在第 1 阶段有所下降（28.1 +/- 9.7/小时 vs. 15.6 +/- 8.2/小时）。替马西泮组过夜氧饱和度没有变化（两晚均为 95.1 +/- 0.6%），两种情况下低于 90% 氧饱和度的 TST 百分比都很小（1.5 +/- 1.1% 与 2.2 +/- 1.7%，p = ns）。我们得出的结论是，患有 CSR 的 CHF 患者会经历频繁的觉醒，而替马西泮可以减少这些觉醒。白天嗜睡有所改善。夜间氧饱和度没有恶化。
We studied seven male patients with moderate to severe congestive heart failure (CHF) [left ventricular ejection fraction (LVEF) = 22.4 +/- 6.7; mean +/- SD] in a double-blind crossover trial to determine the effects of temazepam 15 mg on arousability, sleep architecture, Cheyne-Stokes respiration (CSR) and nighttime oxygen saturation. Sleep architecture was not markedly improved with temazepam. There was no significant change in total sleep time (TST) (383.1 +/- 14.1 minutes to 396.6 +/- 15.4 minutes, p = ns) (mean +/- SE, placebo vs. temazepam) or total wake time (TWT) (96.9 +/- 14.0 vs. 81.4 +/- 14.0 minutes, p = ns). Sleep stage proportions did not change appreciably except for a reduction in stage 1 sleep (6.7 +/- 1.2% vs. 4.0 +/- 1.0%, p < 0.05). Microarousals per hour of sleep decreased with temazepam (21.1 +/- 2.7/hour vs. 13.9 +/- 2.1/hour placebo, p < 0.05), with the largest change occurring in stage 2 (24.9 +/- 5.4/hour vs. 15.0 +/- 3.1/hour, p < 0.05). Wake time during sleep (WDS) was reduced from 82.5 +/- 11.7 minutes to 54.5 +/- 9.4 minutes, p < 0.03. Daytime alertness was improved with temazepam as was indicated by an increase in mean latency to sleep [multiple sleep latency test (MSLT) = 7.1 +/- 2.4 vs. 5.7 +/- 2.0 minutes, p < 0.04) on days following treatment with temazepam. There was no significant change in CSR as a percentage of TST (38.7 +/- 13.6% vs. 32.5 +/- 11.8%, p = ns). However, the apnea/hypopnea index (AHI) (10% filter) was decreased in stage 1 (28.1 +/- 9.7/hour vs. 15.6 +/- 8.2/hour). Overnight oxygen saturation did not change with temazepam (95.1 +/- 0.6% both nights) and the percentage of TST spent below 90% oxygen saturation was minimal for both conditions (1.5 +/- 1.1% vs. 2.2 +/- 1.7%, p = ns). We conclude that CHF patients with CSR experience frequent arousals and that these arousals can be reduced with temazepam. There was an improvement in daytime somnolence. There was no worsening of nighttime oxygen saturation.