Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure
Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure
复制标题
睡眠呼吸障碍对急性心力衰竭住院患者的预后影响
DOI：
10.1007/s00392-021-01969-x
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发表时间：
2021
影响因子：
5
通讯作者：
Minamino Tohru
中科院分区：
文献类型：
--
作者：
Ishiwata Sayaki;Kasai Takatoshi;Sato Akihiro;Suda Shoko;Matsumoto Hiroki;Shitara Jun;Yatsu Shoichiro;Murata Azusa;Shimizu Megumi;Kato Takao;Hiki Masaru;Matsue Yuya;Naito Ryo;Daida Hiroyuki;Minamino Tohru
背景：鉴别急性心力衰竭（AHF）后有不良临床预后风险的患者至关重要。然而，关于睡眠呼吸障碍（SDB）和气道正压通气（PAP）治疗对AHF住院患者临床结局的预后影响的数据缺乏。目的探讨SDB、PAP治疗及PAP治疗依从性对患者临床预后的影响。对左心室射血分数< 50%的住院患者进行多导睡眠图检查。根据SDB是否被定义为呼吸暂停-低通气指数≥15以及是否接受PAP治疗将患者分为两组。将SDB和PAP患者再细分为依从性高组和依从性低组。我们评估了因心力衰竭而死亡和再住院的发生率。结果共纳入241例患者；73%的患者患有SDB， 29%的患者开始接受PAP治疗。在中位随访1.7年期间，发生了74例临床事件（32例死亡，42例再住院）。在多变量分析中，与非SDB组相比，未接受PAP治疗的SDB与临床结局风险增加相关（危险比[HR] 1.79，P= 0.049），而接受PAP治疗的SDB与临床结局风险增加无关（危险比[HR] 0.78，P= 0.582）。在接受PAP治疗的患者中，依从性越高的组与临床事件也呈负相关（HR 0.11，P= 0.012）。结论在AHF住院患者中，未经治疗的SDB与较差的临床结果相关，并且可能通过PAP治疗逆转。然而，这种潜力可能会在依从性较差的患者中被抑制。
BackgroundIdentifying patients at risk for poor clinical outcomes following acute heart failure (AHF) is essential. However, data regarding the prognostic effect of sleep-disordered breathing (SDB) and treatment with positive airway pressure (PAP) on clinical outcomes of hospitalized patients following AHF is lacking.ObjectivesThis study investigated the prognostic effect of SDB, PAP treatment, and compliance with PAP treatment on patient clinical outcomes. Polysomnography was performed in hospitalized patients whose left ventricular ejection fraction was < 50%. Patients were divided into groups based on whether SDB was defined as an apnea–hypopnea index ≥ 15 and if they had received PAP treatment. Furthermore, patients with SDB and PAP were subdivided into more and less compliant groups. We assessed the incidences of deaths and rehospitalizations due to heart failure.ResultsOverall, 241 patients were enrolled; 73% had SDB and 29% were initiated on PAP treatment. At a median follow-up of 1.7 years, 74 clinical events (32 deaths, 42 rehospitalizations) occurred. In the multivariable analysis, compared with the non-SDB group, SDB without PAP treatment was associated with an increased risk of clinical outcomes (hazard ratio [HR] 1.79,P= 0.049), whereas SDB with PAP treatment was not (HR 0.78,P= 0.582). Among patients with PAP treatment, a more compliant group was also inversely associated with clinical events (HR 0.11,P= 0.012).ConclusionsIn hospitalized patients with AHF, untreated SDB was associated with worse clinical outcomes that might be reversible by PAP treatment. However, this potential may be suppressed in less compliant patients.
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影响因子：
158.5
作者：
Bradley, TD;Logan, AG;Floras, JS
通讯作者：
Floras, JS
影响因子：
4.3
作者：
Kapur, Vishesh K.;Auckley, Dennis H.;Harrod, Christopher G.
通讯作者：
Harrod, Christopher G.
影响因子：
158.5
作者：
Peppard, PE;Young, T;Skatrud, J
通讯作者：
Skatrud, J
影响因子：
6
作者：
Khayat, Rami;Abraham, William;Patt, Brian;Brinkman, Vincent;Wannemacher, Jacob;Porter, Kyle;Jarjoura, David
通讯作者：
Jarjoura, David
DOI：
10.1164/ajrccm.163.1.2001008
发表时间：
2001-01-01
影响因子：
24.7
作者：
Shahar, E;Whitney, CW;Samet, JM
通讯作者：
Samet, JM