Pepperell Justin C T, Maskell Nick A, Jones David R, Langford-Wiley Beverley A, Crosthwaite Nicky, Stradling John R, Davies Robert J O
Oxford Sleep Unit, Oxford Centre for Respiratory Medicine, Oxford Radcliffe Hospital, Oxford, United Kingdom.
Am J Respir Crit Care Med. 2003 Nov 1;168(9):1109-14. doi: 10.1164/rccm.200212-1476OC. Epub 2003 Aug 19.
Heart failure is associated with Cheyne-Stokes breathing, which fragments patients' sleep. Correction of respiratory disturbance may reduce sleep fragmentation and excessive daytime sleepiness. This randomized prospective parallel trial assesses whether nocturnal-assist servoventilation improves daytime sleepiness compared with the control. A total of 30 subjects (29 male) with Cheyne-Stokes breathing (mean apnea-hypopnea index 19.8 [SD 2.6] and stable symptomatic chronic heart failure (New York Heart Association Class II-IV) were treated with 1 month's therapeutic (n = 15) or subtherapeutic adaptive servoventilation. Daytime sleepiness (Osler test) was measured before and after the trial with change in measured sleepiness the primary endpoint. Secondary endpoints included brain natriuretic peptide levels and catecholamine excretion. Active treatment reduced excessive daytime sleepiness; the mean Osler change was +7.9 minutes (SEM 2.9), when compared with the control, the change was -1.0 minutes (SEM, 1.7), and the difference was 8.9 minutes (95% confidence interval, 1.9-15.9 minutes; p = 0.014, unpaired t test). Significant falls occurred in plasma brain natriuretic peptide and urinary metadrenaline excretion. We conclude that adaptive servoventilation produces an improvement in excessive daytime sleepiness in patients with Cheyne-Stokes breathing and chronic heart failure. This study suggests improvements in neurohormonal activation with this treatment.
心力衰竭与潮式呼吸相关，潮式呼吸会破坏患者的睡眠。纠正呼吸紊乱可能会减少睡眠片段化和日间过度嗜睡。这项随机前瞻性平行试验评估了夜间辅助伺服通气与对照组相比是否能改善日间嗜睡。共有30名患有潮式呼吸（平均呼吸暂停低通气指数19.8[标准差2.6]）且症状稳定的慢性心力衰竭（纽约心脏协会II-IV级）患者（29名男性）接受了1个月的治疗性（n = 15）或亚治疗性适应性伺服通气治疗。在试验前后测量日间嗜睡情况（奥斯勒试验），以嗜睡程度的变化作为主要终点。次要终点包括脑钠肽水平和儿茶酚胺排泄。积极治疗减少了日间过度嗜睡；平均奥斯勒变化为+7.9分钟（标准误2.9），与对照组相比，变化为-1.0分钟（标准误1.7），差异为8.9分钟（95%置信区间，1.9 - 15.9分钟；p = 0.014，非配对t检验）。血浆脑钠肽和尿间肾上腺素排泄显著下降。我们得出结论，适应性伺服通气可改善潮式呼吸和慢性心力衰竭患者的日间过度嗜睡。这项研究表明这种治疗可改善神经激素激活情况。
