Prognostic Importance of Novel Oxygen Desaturation Metrics in Patients With Heart Failure and Central Sleep Apnea.
Prognostic Importance of Novel Oxygen Desaturation Metrics in Patients With Heart Failure and Central Sleep Apnea.
复制标题
心力衰竭和中央睡眠呼吸暂停患者的新型氧饱和度指标的预后重要性。
DOI：
10.1016/j.cardfail.2016.09.004
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发表时间：
2017-02
影响因子：
6
通讯作者：
Ozaki Y
中科院分区：
文献类型：
--
作者：
Watanabe E;Kiyono K;Matsui S;Somers VK;Sano K;Hayano J;Ichikawa T;Kawai M;Harada M;Ozaki Y
睡眠呼吸障碍，特别是中枢性睡眠呼吸暂停（CSA），在心力衰竭（HF）中非常普遍，并且是一种独立的预后标志物。我们评估了这一假设，即睡眠期间低氧血症负荷增加可能比呼吸暂停和呼吸不足发作的频率具有更大的预后价值。我们前瞻性地对2008年至2011年期间转诊至我院的连续HF患者进行了过夜心肺多导描记术。我们研究了CSA，其定义为呼吸暂停低通气指数（AHI）≥5起事件/h，其中>75%的事件起源于中枢。我们确定了AHI、SpO 2 <90%的睡眠时间比例（T90%）和发生4%去饱和事件的记录时间百分比（4%POD）。我们研究了112例收缩或舒张功能不全的HF患者。在37±25个月的随访期内，32例患者（29%）死亡。与存活者相比，非存活者具有更高的4%POD（11± 6.4vs. 19± 13%，p=0.001），但是与存活者相比，在AHI和T90%方面没有显著差异。经校正的Logistic回归分析显示，4%POD是死亡率的最佳独立预测因子。4%POD是一种新的夜间低氧负荷指标，是CSA影响的HF患者的独立预后指标。
Sleep-disordered breathing, particularly central sleep apnea (CSA), is highly prevalent in heart failure (HF) and an independent prognostic marker. We assessed the hypothesis that an increased hypoxemic burden during sleep may have greater prognostic value than the frequency of apneic and hypopneic episodes. We prospectively conducted overnight cardiorespiratory polygraphy on consecutive HF patients referred to our hospital between 2008 and 2011. We studied CSA defined by an apnea-hypopnea index (AHI) of ≥5 events/h, whereby >75% of all events were central in origin. We determined the AHI, proportion of the sleep time with an SpO2<90% (T90%), and percent of the recording time that 4% desaturation events occurred (4%POD). We studied 112 HF patients with either systolic or diastolic dysfunction. During a follow-up period of 37±25 months, 32 patients (29%) died. Non-survivors had a higher 4%POD compared to survivors (11±6.4 vs. 19±13%, p=0.001), but did not differ significantly regarding the AHI and T90% compared to survivors. An adjusted logistic regression analysis revealed that the 4%POD was the best independent predictor of mortality. The 4%POD, a novel metric for the nocturnal hypoxemic burden, is an independent prognostic marker in HF patients affected by CSA.