慢性心力衰竭中的睡眠和运动周期性呼吸:预后重要性和相互依赖
Ugo Corrà1, Massimo Pistono, Alessandro Mezzani
1Divisione di Cardiologia, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy. ucorra@fsm.it
Circulation
|December 29, 2005
概括
在慢性心力衰竭中,强力振荡呼吸 (EOV) 和高呼吸暂停-呼吸暂停指数 (AHI) 是常见的. EOV和AHI的组合显著预测死亡率,突出显示了这些呼吸障碍的预后重要性.
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:
- 睡眠呼吸障碍和运动性周期性呼吸在慢性心力衰竭 (CHF) 中很普遍,并且独立地与预后不佳有关.
- 这些呼吸系统疾病与CHF患者的整体预后之间的关系尚不清楚.
研究的目的:
- 调查运动振荡呼吸 (EOV) 与睡眠相关的呼吸障碍,特别是呼吸暂停-呼吸暂停指数 (AHI) 之间的联系.
- 确定EOV和AHI对CHF死亡率的综合预后影响.
主要方法:
- 研究了一组133名CHF患者的队列,其左心室喷射率 (LVEF) ≤40%.
- 患者接受了多睡眠测试以评估AHI和心肺运动测试以确定EOV.
- 进行了生存分析,以确定心脏事件的预测因素,平均随访时间约为3.2年.
主要成果:
- 与幸存者相比,未幸存者表现出更高的AHI,更大的呼吸反应 (VE/VCO2倾斜),以及较低的VO2峰值.
- 强迫振荡呼吸 (EOV) 在未幸存者中明显更频繁 (42%对15%).
- 高AHI (>30/h) 与EOV有很强的关联 (78%的EOV患者的AHI>30/h).
- 多变量分析确定了AHI (HR 5.66),峰值VO2 (HR 0.93) 和β-阻断剂处方 (HR 0.34) 作为心脏事件的独立预测因素.
- EOV和AHI>30/h的组合成为死亡率最强的预测因素 (HR 6.65).
结论:
- 强迫振荡呼吸 (EOV) 与慢性心力衰竭患者的高呼吸暂停-呼吸暂停指数 (AHI) 有显著的关联.
- 虽然EOV和高AHI都独立预测死亡率,但它们的同时发生会使预后明显恶化.
- 联合呼吸系统疾病代表了CHF的临界预后负担.
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