慢性心不全および中枢睡眠時無呼吸症の患者における運動に対する呼吸器応答の強化
Michael Arzt1, Martina Harth, Andreas Luchner
1Klinik und Poliklinik für Innere Medizin II, Universität Regensburg, Germany. michael.arzt@klinik.uni-regensburg.de
Circulation
|April 16, 2003
まとめ
慢性心不全の患者では,中央睡眠時無呼吸は,運動中の呼吸器応答の増加と関連しています. これは,CO2に対する増強された化学反応感受性が,両方の状態に共通するメカニズムであることを示唆しています.
科学分野:
- 心臓病学 心臓病学
- 肺内科 肺内科 肺内科
- スリープ・メディシン (睡眠医学)
背景:
- 中枢睡眠時無呼吸症 (CSA) と呼吸器応答の強化 (VE/VCO2斜率) は,慢性心不全 (CHF) でよく見られる.
- 両方の症状は,CHF患者の予後不良と関連しています.
- CO2に対する増幅された化学反応感受性は,一般的なメカニズムであると疑われるが,CHFにおけるCSAとVE/VCO2の傾きとの関係は不明である.
研究 の 目的:
- 慢性心不全 (CHF) の患者における中央睡眠時無呼吸症 (CSA) と運動に対する呼吸器応答 (VE/VCO2斜率) の関係を調査する.
主な方法:
- 臨床的に有意なCSA (アプネア・ヒポネア指数>or=15) を有するCHF患者20人を,CSAのないCHF患者10人と比較した.
- 心肺運動テストを使用して,VE/VCO2の傾きと運動能力 (ピークVO2) を決定しました.
- 評価された左心室射出分数 (LVEF) とアプレア・ヒポプレア・インデックス (AHI).
主要な成果:
- CSAとCSAのない患者は,運動能力 (ピークVO2) またはLVEFにおいて有意な差異を示さなかった.
- アプネア・ヒポネア指数 (AHI) はピークVO2またはLVEFと相関しませんでした.
- VE/VCO2の傾きとAHI (P<0.001) の間で非常に有意な正の相関が認められた.
- VE/VCO2の傾きは,CSAを有するCHF患者では,CSAのない患者と比較して (29.7対24.9,P<0.001) 顕著に高かった.
結論:
- CSAを有するCHF患者は,CSAのない患者と比較して,運動に対する呼吸器応答が著しく増加しています.
- VE/VCO2の傾きは,ピークVO2とLVEFとは異なり,CHFにおけるCSAの重症度と強く関連しています.
- これらの発見は,CSAとCHFの強化呼吸器応答の両方を裏付ける一般的な病理生理学的メカニズムとして,CO2に対する増強された化学反応性を支持しています.
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