Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea
Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea
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DOI：
10.1056/nejmoa022479
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发表时间：
2003-03-27
影响因子：
158.5
通讯作者：
Bradley, TD
中科院分区：
文献类型：
--
作者：
Kaneko, Y;Floras, JS;Bradley, TD
背景：阻塞性睡眠呼吸暂停使衰竭的心脏承受不利的血流动力学和肾上腺素能负荷，从而可能促进心力衰竭的进展。我们假设，治疗阻塞性睡眠呼吸暂停持续气道正压通气在心力衰竭患者将改善左心室收缩功能。方法：24例抑郁的左心室射血分数（45%或更低）和阻塞性睡眠呼吸暂停谁是接受最佳的医疗心力衰竭的患者进行多导睡眠图。第二天早晨，通过数字光电容积描记术测量血压和心率，并通过超声心动图评估左心室尺寸和左心室射血分数。然后将受试者随机分配到单独接受药物治疗（12例患者）或接受持续气道正压通气治疗（12例患者）一个月。评估协议，然后repeated.RESULTS：在对照组的患者只接受药物治疗，有阻塞性睡眠呼吸暂停，白天血压，心率，左心室收缩末期尺寸，或左心室射血分数的严重程度没有显着变化在研究期间。相比之下，持续气道正压通气显著降低了阻塞性睡眠呼吸暂停，将白天收缩压从平均（+/-SE）126 +/-6 mm Hg降至116 +/-5 mm Hg（P = 0.02），心率从每分钟68 +/-3次降至64 +/-3次左室收缩末期内径从54.5 ± 1.8 mm降至51.7 ± 1.2 mm（P = 0.009），左室射血分数从25.0 ± 2.8%提高至33.8 ± 2.4%（P
BACKGROUND:Obstructive sleep apnea subjects the failing heart to adverse hemodynamic and adrenergic loads and may thereby contribute to the progression of heart failure. We hypothesized that treatment of obstructive sleep apnea by continuous positive airway pressure in patients with heart failure would improve left ventricular systolic function.METHODS:Twenty-four patients with a depressed left ventricular ejection fraction (45 percent or less) and obstructive sleep apnea who were receiving optimal medical treatment for heart failure underwent polysomnography. On the following morning, their blood pressure and heart rate were measured by digital photoplethysmography, and left ventricular dimensions and left ventricular ejection fraction were assessed by echocardiography. The subjects were then randomly assigned to receive medical therapy either alone (12 patients) or with the addition of continuous positive airway pressure (12 patients) for one month. The assessment protocol was then repeated.RESULTS:In the control group of patients who received only medical therapy, there were no significant changes in the severity of obstructive sleep apnea, daytime blood pressure, heart rate, left ventricular end-systolic dimension, or left ventricular ejection fraction during the study. In contrast, continuous positive airway pressure markedly reduced obstructive sleep apnea, reduced the daytime systolic blood pressure from a mean (+/-SE) of 126+/-6 mm Hg to 116+/-5 mm Hg (P=0.02), reduced the heart rate from 68+/-3 to 64+/-3 beats per minute (P=0.007), reduced the left ventricular end-systolic dimension from 54.5+/-1.8 to 51.7+/-1.2 mm (P=0.009), and improved the left ventricular ejection fraction from 25.0+/-2.8 to 33.8+/-2.4 percent (P