Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure
Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure
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DOI：
10.1378/chest.128.4.2116
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发表时间：
2005-10-01
期刊：
影响因子：
9.6
通讯作者：
Neill, A
中科院分区：
文献类型：
--
作者：
Ferrier, K;Campbell, A;Neill, A
背景：睡眠呼吸障碍（SDB）在充血性心力衰竭（CHF）的发病机制中具有潜在的作用。在严重CHF患者中发现中枢性睡眠呼吸暂停（CSA）的发生率很高，并且在睡眠诊所中发现CHF患者中阻塞性睡眠呼吸暂停（OSA）和CSA的比例相等。SDB的患病率，类型和严重程度在稳定的CHF门诊患者是unknown. Study objectives：确定SDB的频率和类型在稳定的CHF门诊患者，并检查SDB和受损的心功能指标之间的关系。参会人员：87名合格门诊患者中的53名（左心室射血分数[LVEF]<45%）主要为男性（77%），平均年龄60.1 ± 9.8岁，平均体重指数27.9 ± 5.3 kg/m2，平均LVEF 34.0 ± 8.5%（± SD）。多导睡眠图、临床问卷、超声心动图、尿儿茶酚胺和前脑钠肽氨基末端片段（NT-BNP）。36例（68%）患者出现呼吸暂停低通气指数> 10次/h，其中包括两个亚组：OSA（n = 28，53%）和CSA（n = 8，15%）。睡眠呼吸暂停与房颤（0% vs 28%，p = 0.02）、更严重的血氧饱和度下降（血氧饱和度<90%的时间百分比：0.4% vs 7.9%，p = 0.003）、睡眠中断（p = 0.003）和更高的尿去甲肾上腺素水平（p = 0.013）相关。主观嗜睡（埃普沃思嗜睡量表，7.5 vs 8.5; p = 0.心功能受损指标包括明尼苏达心力衰竭生活问卷评分、穿梭步行距离和NT-BNP水平与SDB的存在无关（p> 0.05）。CSA患者LVEF较低（p = 0.0013）。结论：SDB在稳定的CHF门诊患者中很常见，在我们的样本中OSA占主导地位。房颤和严重的左心室损害增加了SDB（特别是CSA）的可能性，而症状严重程度、主观日间嗜睡、运动能力和NT-BNP水平则没有增加。如果SDB的特异性治疗（如持续气道正压通气）可改善主要心血管终点，则这些结果支持筛选临床稳定的CHF患者。
Background: Sleep-disordered breathing (SDB) has a potential role in the pathogenesis of congestive heart failure (CHF). High rates of central sleep apnea (CSA) are found in patients with severe CHF, and equal proportions of obstructive sleep apnea (OSA) and CSA in are found CHF patients referred to sleep clinics. The prevalence, type, and severity of SDB in unselected stable outpatients with CHF are unknown.Study objectives: To determine the frequency and type of SDB in stable CHF outpatients and to examine the relationship between indexes of SDB and impaired cardiac function. Participants: Fifty-three of 87 eligible outpatients (left ventricular ejection fraction [LVEF] < 45%) were predominantly male (77%), with an average age of 60.1 +/- 9.8 years, mean body mass index of 27.9 +/- 5.3 kg/m(2), and mean LVEF of 34.0 +/- 8.5% (+/- SD).Measurements: Polysomnography, clinical questionnaire, echocardiography, urinary catecholamines, and amino-terminal fragment of pro-brain natriuretic peptide (NT-BNP).Results: SDB (apnea-hypopnea index > 10 events/h) was demonstrated in 36 patients (68%) including two subgroups: OSA (n = 28, 53%) and CSA (n = 8, 15%). SDB was associated with atrial fibrillation (0% vs 28%, p = 0.02), more severe oxyhemoglobin desaturation (percentage of time with oxygen saturation < 90%: 0.4% vs 7.9%, p = 0.003), sleep disruption (p = 0.003), and higher urinary noradrenaline levels (p = 0.013) in OSA patients and CSA patients, respectively. Subjective sleepiness (Epworth sleepiness scale, 7.5 vs 8.5; p = 0. 11), indexes of impaired cardiac function including Minnesota Living With Heart Failure Questionnaire scores, shuttle walk distance, and NT-BNP levels were not related to the presence of SDB (p > 0.05). CSA patients had lower LVEF (p = 0.0013).Conclusions: SDB is very common in stable outpatients with CHF, and in our sample OSA predominates. Atrial fibrillation and severe left ventricular impairment increased the likelihood of SDB (particularly CSA), whereas symptom severity, subjective daytime sleepiness, exercise capacity, and NT-BNP levels did not. If specific therapy for SDB such as continuous positive airway pressure can be shown to improve major cardiovascular end points, these results support screening of clinically stable CHF patients.