Diuretics in obstructive sleep apnea with Diastolic heart failure
Diuretics in obstructive sleep apnea with Diastolic heart failure
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DOI：
10.1378/chest.07-0311
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发表时间：
2007-08-01
期刊：
影响因子：
9.6
通讯作者：
Cicolin, Alessandro
中科院分区：
文献类型：
--
作者：
Bucca, Caterina B.;Brussino, Luisa;Cicolin, Alessandro
背景资料：上呼吸道水肿可能是导致咽部阻塞的原因之一，也是心脏病患者阻塞性睡眠呼吸暂停（OSA）的高发原因。本研究的目的是评估，如果密集卸载利尿剂改善睡眠呼吸障碍，并增加咽口径的患者严重OSA和舒张性heartfault.Methods：15例严重OSA，高血压，舒张性心力衰竭住院接受静脉呋塞米，20毫克，螺内酯，100毫克，每日2次，3天。应用多导睡眠图（PSG）检测呼吸暂停低通气指数（AHI），咽声学测量法检测口咽交界区（OPJ）面积，并分别测定利尿剂治疗前后用力吸气中段流量（FIF 50）、用力呼气中段流量（FEF 50）/FIF 50百分比和呼出气一氧化氮（FeNO）。利尿剂治疗使体重、血压和AHI显著降低（从74.89.：+/- 6.95至57.17 +/- 5.40/h，p < 0.001），与OPJ面积的改善相关（从1.33 +/- 0.10至1.78 +/- 0.16 cm（2），P = 0.007），FIF 50（从3.16 +/- 0.4至3.94 +/- 0.4 L/s，p = 0.006）和FEF 50/FEF 50 50%（从117.9 +/- 11.8至93.15 +/-10.1%，p = 0.002）。体重下降与AHI下降显著相关（R = 0.602; p= 0.018），增加FIF 50（R = 0.68; p = 0.005），以及FEF 50/FIF 50的降低（R = 0.635; p = 0.011）。这些发现表明，咽部水肿有助于睡眠呼吸障碍的严重阻塞性睡眠呼吸暂停综合征，高血压和舒张性心力衰竭的肥胖患者。上呼吸道水肿可能是导致心脏病患者OSA频繁发生的原因之一。
Background: Upper airway edema might contribute to pharyngeal collapsibility and account for the high prevalence of obstructive sleep apnea (OSA) in patients with heart disease. The aim of this study was to evaluate if intensive unloading with diuretics improves sleep-disordered breathing and increases pharyngeal caliber in patients with severe OSA and diastolic heart failure.Methods: Fifteen patients with severe OSA, hypertension, and diastolic heart failure were hospitalized to receive IV furosemide, 20 mg, and spironolactone, 100 mg, bid for 3 days. Polysomnography was performed for assessment of apnea-hypopnea index (AHI), acoustic pharyngometry was performed for assessment of the oropharyngeal junction (OPJ) area, and forced midinspiratory flow (FIF50) forced midexpiratory flow (FEF50)/FIF50 percentage, and exhaled nitric oxide (FeNO) were measured before and after diuretic treatment.Results: Diuretic treatment produced a significant decrease in body weight, BP, and AHI (from 74.89.:+/- 6.95 to 57.17 +/- 5.40/h, p < 0.001), associated with an improvement in OPJ area (from 1.33 +/- 0.10 to 1.78 +/- 0.16 cm(2), P = 0.007), FIF50 (from 3.16 +/- 0.4 to 3.94 +/- 0.4 L/s, p = 0.006), and FEF50/FEF50 50 percentage (from 117.9 +/- 11.8 to 93.15 +/- 10.1%, p = 0.002). Weight loss was significantly related to the decrease of AHI (R = 0.602; p= 0.018), to the increase of FIF50 (R = 0.68; p = 0.005), and to the decrease of FEF50/FIF50(R = 0.635; p = 0.011).Conclusions: These findings suggest that pharyngeal edema contributes to sleep-disordered breathing in obese patients with severe OSA, hypertension, and diastolic heart failure. Upper airway edema may contribute to the frequent occurrence of OSA in patients with heart disease.