Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure
Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure
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DOI：
10.1164/ajrccm.153.1.8542128
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发表时间：
1996-01-01
影响因子：
24.7
通讯作者：
ZuberiKhokhar, NS
中科院分区：
文献类型：
--
作者：
Hanly, PJ;ZuberiKhokhar, NS
我们假设在睡眠中发生Cheyne-Stokes呼吸(CSR)的充血性心力衰竭(CHF)患者的死亡率高于没有CSR的CHF患者。对16例慢性稳定性充血性心力衰竭(CHF)男性患者进行了夜间多导睡眠监测，其中9例有CSR(CSR组)，7例无CSR(CHF组)。CSR组有更高的呼吸暂停-低呼吸指数(AHI：41+/-17比6+/-5/小时)，并经历了更多的睡眠干扰。年龄、体重、心功能和肺功能之间没有显著的组间差异。在最初的睡眠研究后，所有患者都接受标准的CHF内科治疗，没有补充氧气或鼻腔持续正压。在接下来的3.1年至4.5年期间，每组的死亡人数之间存在显著差异。CSR组有5名患者死亡，2名患者接受了心脏移植，而CHF组只有1名患者死亡。回归分析显示，病死率与CSR、AHI、觉醒指数、第1、2期非快速眼动睡眠次数呈正相关，与总睡眠时间呈负相关。我们的结论是，在睡眠中发生CSR的CHF患者的死亡率高于没有CSR的CHF患者。虽然CSR的发展可能只是反映了更严重的心脏损害，但我们认为CSR本身会加速心功能的恶化。
We hypothesized that mortality is higher in patients with congestive heart failure (CHF) who develop Cheyne-Stokes respiration (CSR) during sleep than CHF patients without CSR. Overnight polysomnography was performed on 16 male patients with chronic, stable CHF: nine had CSR during sleep (CSR group) and seven did not (CHF group). The CSR group had a higher apnea-hypopnea index (AHI: 41 +/- 17 versus 6 +/- 5/hr) and experienced greater sleep disruption. There were no significant intergroup differences between age, weight, cardiac function, and pulmonary function. After the initial sleep study, all patients were maintained on standard medical therapy for CHF without supplemental oxygen or nasal continuous positive al rway pressu re. Over the next 3.1 to 4.5 yr there was a significa nt difference between the number of deaths in each group. Five patients died in the CSR group and two received a heart transplant, whereas only one patient died in the CHF group. Regression analysis revealed that mortality was positively correlated with CSR, AHI, arousal index, and the amount of stage 1, 2 non-REM sleep and was inversely related to the total sleep time. We conclude that mortality is higher in CHF patients who develop CSR during sleep than CHF patients without CSR. Although the development of CSR may simply reflect more severe cardiac impairment, we suggest that CSR itself accelerates the deterioration in cardiac function.