Cycle length of periodic breathing in patients with and without heart failure
Cycle length of periodic breathing in patients with and without heart failure
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DOI：
10.1164/ajrccm.154.2.8756809
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发表时间：
1996-08-01
影响因子：
24.7
通讯作者：
Bradley, TD
中科院分区：
文献类型：
--
作者：
Hall, MJ;Xie, AL;Bradley, TD
由于周期性呼吸期间的呼吸暂停长度随先前通气量的增加和PaCO2的减少而不同，心功能正常和受损患者之间周期性呼吸周期长度的差异可能是肺到颈动脉体循环延迟的影响，如肺到耳循环时间(LECT)对高呼吸暂停长度的影响，而不是对呼吸暂停长度的影响。因此假设循环延迟是周期性呼吸暂停时间长度的重要决定因素，而不是呼吸暂停时间长度。为了验证这一假设，对10例心功能正常的特发性中枢性睡眠呼吸暂停(ICSA)患者和10例伴有充血性心力衰竭(CHF)的Cheyne-Stokes呼吸和中枢性睡眠呼吸暂停(CSR-CSA)患者进行了LECT、周期呼吸周期长度、呼吸暂停长度和高呼吸长度的比较。与I-CsA患者相比，CsR-CsA患者的周期明显延长(37.3±3.0vs59.0+/-4.9S，p<；0.005)。这一差异是由于CSR-CSA患者的呼吸暂停长度明显延长(16.7+/-2.8VS36.7+/-3.4S，p<；0.001)，因为两组的呼吸暂停长度相似。此外，CSR-CSA患者的LECT较长(24.3+/-2.0 S vs10.3+/-1.0 S，p<；0.001)，且与周期长度(r=0.88，p<；0.001)和高呼吸暂停长度(r=0.9，p<；0.001)显著相关，而与呼吸暂停长度无关。LECT与心输出量呈负相关(r=-0.72p<；0.006)，提示LECT是衡量循环延迟的有效指标。因此，在ICSA和CSR-CSA患者中，循环延迟是高呼吸暂停长度的重要决定因素，但不是呼吸暂停长度的重要决定因素。
Because apnea length during periodic breathing varies according to the preceding increase in ventilation and reduction in Pa-CO2, differences in the cycle length of periodic breathing among patients with normal and impaired cardiac function might be explained by the influence of lung-to-carotid body circulatory delay, as reflected by lung-to-ear circulation time (LECT), on hyperpnea length rather than on apnea length. It was therefore hypothesized that circulatory delay is an important determinant of periodic-breathing hyperpnea length but not apnea length. To test this hypothesis, LECT, periodic-breathing cycle length, apnea length, and hyperpnea length were compared in 10 patients with idiopathic central sleep apnea (ICSA), whose cardiac function was normal, as opposed to 10 with Cheyne-Stokes respiration and central sleep apnea (CSR-CSA) in association with congestive heart failure (CHF). As compared with I CSA patients, cycle length was significantly longer in patients with CSR-CSA (37.3 +/- 3.0 s versus 59.0 +/- 4.9 s, p < 0.005). This difference was due to significantly longer hyperpnea length in the CSR-CSA patients (16.7 +/- 2.8 s versus 36.7 +/- 3.4 s, p < 0.001), since apnea length was similar in the two groups. In addition, LECT was longer in the CSR-CSA patients (24.3 +/- 2.0 s versus 10.3 +/- 1.0 s, p < 0.001), and correlated strongly with cycle length (r = 0.88, p < 0.001) and hyperpnea length (r = 0.90, p < 0.001) but not with apnea length. LECT correlated inversely with cardiac output (r = -0.72, p < 0.006), indicating that LECT is a valid measure of circulatory delay. Thus, circulatory delay is an important determinant of hyperpnea length but not of apnea length in patients with ICSA and CSR-CSA.