Reduced nocturnal cardiac output associated with preeclampsia is minimized with the use of nocturnal nasal CPAP
Reduced nocturnal cardiac output associated with preeclampsia is minimized with the use of nocturnal nasal CPAP
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DOI：
10.1093/sleep/27.1.79
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发表时间：
2004-02-01
期刊：
影响因子：
5.6
通讯作者：
Edwards, N
中科院分区：
文献类型：
--
作者：
Blyton, DM;Sullivan, CE;Edwards, N
研究目标：最近的研究表明先兆子痫中常见的宫内生长受限与母亲心输出量减少之间存在特定关联。睡眠与先兆子痫的明显高血压有关。因此，我们的目的是确定睡眠如何影响先兆子痫的其他血流动力学参数，特别是确定睡眠引起的高血压恶化是否与心输出量减少相关。研究设计：经鼻持续气道正压通气的随机对照试验。地点：乔治五世国王，皇家阿尔弗雷德王子医院。患者：24 名患有严重先兆子痫的女性和 15 名未生育的对照受试者。干预：完整的多导睡眠图，包括逐次心跳血压记录。每搏输出量、心率、心输出量、总外周阻力和射血持续时间均来自血压波形。 24 名先兆子痫受试者中的一半被随机分配接受经鼻持续气道正压通气治疗，另一半则不接受治疗。 测量和结果：清醒时，对照组和先兆子痫患者的心率、每搏输出量和心输出量相似，而总外周阻力显着升高。睡眠会导致先兆子痫受试者的心率、每搏输出量和心输出量显着下降，并导致总外周阻力进一步增加。睡眠期间的心输出量与胎儿出生体重相关（r(2) = 0.64，P < .001）。当先兆子痫受试者接受持续气道正压治疗时，心输出量的减少最小化，同时总外周阻力的增量也减少。结论：这些数据表明，睡眠与先兆子痫女性的不良血流动力学变化相关。通过使用持续气道正压通气可以最大限度地减少这些变化。睡眠期间心输出量减少可能会对胎儿发育产生不利影响。
Study Objectives: Recent studies suggest a specific association between intrauterine growth restriction that commonly occurs in preeclampsia and decreased maternal cardiac output. Sleep is associated with marked hypertension in preeclampsia. We therefore aimed to determine how sleep influences other hemodynamic parameters in preeclampsia, specifically to determine if sleep-induced exacerbation of hypertension was associated with reductions in cardiac output.Study Design: Randomized controlled trial of nasal continuous positive airway pressure.Setting: King George V, Royal Prince Alfred Hospital.Patients: Twenty-four women with severe preeclampsia and 15 control nulliparous subjects.Intervention: Full polysomnography including beat-to-beat blood-pressure recording. Stroke volume, heart rate, cardiac output, total peripheral resistance, and ejection duration were derived from the blood pressure waveform. Half of the 24 preeclamptic subjects were randomly assigned to receive treatment with nasal continuous positive airway pressure and the other half to receive no treatment.Measurements and Results: Heart rate, stroke volume, and cardiac out-put were similar in controls and patients with preeclampsia during wakefulness, while total peripheral resistance was significantly elevated. Sleep induced marked decrements in heart rate, stroke volume, and cardiac output in preeclamptic subjects and resulted in further increments in total peripheral resistance. Cardiac output during sleep was correlated with fetal birth weight (r(2) = 0.64, P < .001). When preeclamptic subjects were treated with continuous positive airway pressure, reductions in cardiac output were minimized, while increments in total peripheral resistance were also reduced.Conclusions: These data indicate that sleep is associated with adverse hemodynamic changes in women with preeclampsia. These changes are minimized with the use of continuous positive airway pressure. Reduced cardiac output during sleep may have an adverse effect on fetal development.