Sleep and exertional periodic breathing in chronic heart failure -: Prognostic importance and interdependence
Sleep and exertional periodic breathing in chronic heart failure -: Prognostic importance and interdependence
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DOI：
10.1161/circulationaha.105.543173
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发表时间：
2006-01-03
期刊：
影响因子：
37.8
通讯作者：
Giannuzzi, P
中科院分区：
文献类型：
--
作者：
Corrà, U;Pistono, M;Giannuzzi, P
背景-睡眠和劳力性周期性呼吸在慢性心力衰竭（CHF）中是众所周知的，并且每一种单独存在都预示着不良预后。方法和结果-我们研究了133名左心室射血分数（LVEF）= 60%的运动持续时间的CHF患者，其幅度>=平均静息值的15%，死亡者中的发生率明显高于未存活者（42%比15%，P < 0.01）。多变量分析选择AHI（风险比[HR] 5.66，95% CI 2.3 - 19.9，P < 0.01）、峰值VO 2（HR 0.93，95% CI 0.90 - 0.97，P < 0.01）和β受体阻滞剂处方（HR 0.34，95% CI 0.13 - 0.87，P < 0.05）作为心脏事件的预测因子。AHI的最佳临界值为> 30次/h。EOV与AHI > 30/h有显著相关性（χ 2 = 14.6，P < 0.01）：78%的EOV患者AHI > 30/h。多变量分析，包括呼吸障碍单独（EOV，AHI > 30/h）或联合（EOV + AHI > 30/h），选择联合障碍作为事件的最强预测因子（HR 6.65，95%CI 2.6 - 17.1，P < 0.01）。虽然每种呼吸障碍单独与总死亡率有关，但它们的组合具有关键的预后负担。
Background-Sleep and exertional periodic breathing are proverbial in chronic heart failure (CHF), and each alone indicates poor prognosis. Whether these conditions are associated and whether excess risk may be attributed to respiratory disorders in general, rather than specifically during sleep or exercise, is unknown.Methods and Results-We studied 133 CHF patients with left ventricular ejection fraction (LVEF) = 60% of exercise duration with an amplitude >= 15% of the average resting value, was significantly more frequent in nonsurvivors (42% versus 15%, P < 0.01). Multivariable analysis selected AHI (hazard ratio [HR] 5.66, 95% CI 2.3 to 19.9, P < 0.01), peak VO2 (HR 0.93, 95% CI 0.90 to 0.97, P < 0.01), and beta-blocker prescription (HR 0.34, 95% CI 0.13 to 0.87, P < 0.05) as predictors of cardiac events. The best cutoff for AHI was > 30/h. EOV was significantly related to AHI > 30/h (chi(2) 14.6, P < 0.01): 78% of EOV patients showed AHI > 30/h. Multivariable analysis, including breathing disorders alone (EOV, AHI > 30/h) or in combination (EOV plus AHI > 30/h), selected combined disorders as the strongest predictor of events (HR 6.65, 95% CI 2.6 to 17.1, P < 0.01).Conclusions-In CHF, EOV is significantly associated with AHI > 30/h. Although each breathing disorder alone is linked to total mortality, their combination has a crucial prognostic burden.