Targeting Sleep Disordered Breathing to Prevent Heart Failure: What is the Evidence?
Targeting Sleep Disordered Breathing to Prevent Heart Failure: What is the Evidence?
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DOI：
10.1007/s12170-014-0403-8
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发表时间：
2014-10-01
影响因子：
1.9
通讯作者：
Mehra R
中科院分区：
文献类型：
--
作者：
Kusunose K;Mehra R
睡眠呼吸障碍（SDB）和心力衰竭（HF）的相互关系正变得越来越好的特点。连接这两个实体的途径可能是双向的，起作用的关键基础病理生理机制包括自主神经系统波动、间歇性缺氧、胸内心脏机械影响、喙部液体转移以及全身炎症和氧化应激的上调。鉴于伴随心力衰竭的发病率和死亡率增加，识别和治疗睡眠呼吸障碍等因素对于减轻这些不利的下游健康后果至关重要。最近，HF的管理需要结合几种治疗方法，包括药物治疗，电生理治疗和心脏手术，以针对HF的各个复杂方面。尽管HF治疗的发展，HF仍然对普通心脏病学家构成巨大挑战。在此，我们回顾了几项干预性研究，强调了SDB治疗对HF发病率和死亡率的影响，重点关注HF射血分数降低（HF-REF）的文献以及描述SDB治疗对HF保留EF（HF-PEF）的影响的新数据。这些数据是令人信服的，但有内在的局限性，强调需要适当的把握度的临床试验，采用严格的临床试验方法，以检查SDB治疗对HF进展和相关不良结局的影响。
The inter-relationships of sleep disordered breathing (SDB) and heart failure (HF) are becoming increasingly well-characterized. The pathways linking the two entities are likely bi-directional and key underlying pathophysiological mechanisms at play include autonomic nervous system fluctuations, intermittent hypoxia, intrathoracic cardiac mechanical influences, rostral fluid shifts and up-regulation of systemic inflammation and oxidative stress. Given the increased morbidity and mortality which accompanies heart failure, the recognition and treatment of factors such as sleep disordered breathing is paramount in order to mitigate these untoward downstream health consequences. Recently, the management of HF requires combining several treatments including pharmacotherapy, electrophysiologic therapy, and cardiac surgery to target the various complex facets of HF. Despite the development of HF treatments, HF remains to pose a great challenge to the general cardiologist. Herein we review several interventional studies highlighting the effects of treating SDB on HF morbidity and mortality with a notable predominance of literature focusing on HF reduced ejection fraction (HF-REF) as well as emerging data describing SDB treatment effects in HF preserved EF (HF-PEF). These data are compelling yet with intrinsic limitations which underscore the need for appropriately powered clinical trials employing rigorous clinical trials methodology to examine the effect of SDB treatment on HF progression and associated adverse outcomes.