在心力衰竭患者中,从阻塞性呼吸暂停到中央呼吸暂停的夜间转移:PCO2和循环延迟的作用
R Tkacova1, M Niroumand, G Lorenzi-Filho
1Sleep Research Laboratory of the Toronto Rehabilitation Institute and the Department of Medicine of the Toronto General Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.
Circulation
|February 24, 2001
概括
在患有充血性心力衰竭 (CHF) 的患者中,二氧化碳 (PCO2) 水平的降低与从阻塞性睡眠呼吸暂停 (OSA) 转向中央睡眠呼吸暂停 (CSA) 的转变有关. 这种变化可能表明心脏功能在一夜之间恶化.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 睡眠医学 睡眠医学
背景情况:
- 患有充血性心力衰竭 (CHF) 的患者经常经历阻塞性睡眠呼吸暂停 (OSA) 和中央睡眠呼吸暂停 (CSA).
- 这些患者的OSA与CSA发生波动的根本原因尚不清楚.
- 一个假设表明,二氧化碳 (PCO2) 部分压力变化会影响观察到的呼吸暂停类型,而减少的PCO2可能会触发CSA.
研究的目的:
- 为了研究PCO2水平的变化和CHF患者的睡眠呼吸暂停类型 (OSA与CSA) 之间的关系.
- 为了确定PCO2的变化是否与睡眠期间OSA和CSA之间的转移有关.
- 在CHF患者中探索心脏功能和呼吸暂停类型之间的潜在联系.
主要方法:
- 在12名患有心脏不全症和同时存在的OSA和CSA的患者身上进行了夜间多睡眠记录.
- 测量包括每分钟通风 (VI),皮肤间PCO2 (PtcCO2),循环时间和周期性呼吸周期的长度.
- 呼吸暂停事件被分类为阻塞性 (OSA) 或中心性 (CSA),并在整个晚上进行分析.
主要成果:
- 与OSA发作相比,CSA发作的特点是每分钟通风量显著增加,PtcCO2降低.
- 在CSA发作期间观察到循环时间和周期性呼吸周期长度的显著延长.
- 一夜之间发生了显著的转变,OSA事件的比例下降,CSA事件增加,与PtcCO2.2显著减少相关.
结论:
- 在CHF患者中,睡眠期间从OSA过渡到CSA与PCO2的减少有关.
- 这种PCO2的减少和随之而来的呼吸暂停类型的转变可能表明心脏功能在一夜之间恶化,如循环时间延长所表明的那样.
- 心脏功能变化似乎在确定心脏病患者经历的睡眠呼吸暂停类型方面发挥着重要作用.
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