Meguro Kentaro, Adachi Hitoshi, Oshima Shigeru, Taniguchi Koichi, Nagai Ryozo
Department of Cardiovascular Medicine, Tokyo University Graduate School of Medicine, Tokyo, Japan.
Circ J. 2005 Jun;69(6):695-9. doi: 10.1253/circj.69.695.
Sleep apnea syndrome (SAS) and exercise hyperpnea are common in patients with chronic heart failure (CHF), and although it is not known whether they are both regulated by the same mechanisms, the hypothesis of the present study was that they are related to augmented central chemosensitivity.
The oxygen desaturation index (ODI) was evaluated in 29 patients and those with ODI > 5 times/h underwent polysomnography. Patients with an apnea-hypopnea index (AHI) > 15 /h without evidence of obstructive apnea were defined as central SAS (CSAS). Cardiopulmonary exercise testing was performed to determine peak oxygen uptake and the VE-VCO2 slope. A hypercapnic gas mixture (7% CO2/93% O2) was used to activate the central chemoreflex. Nine patients had central SAS (CHF-CSAS) and 20 did not have apnea (CHF-nonSAS). Patients with CHF-CSAS had a lower peak oxygen uptake than the CHF-nonSAS group (13.0+/-2.4 vs 16.9+/-4.3 ml x kg(-1) x min(-1), p < 0.05). There was a significant correlation between central chemosensitivity and the AHI (r = 0.63, p < 0.05), between central chemosensitivity and the VE - VCO2 slope (r = 0.50, p < 0.01), whereas the VE-VCO2 slope showed an insignificant tendency to correlate with AHI (r = 0.44, p = 0.07). Conclusion CHF-CSAS is associated with impaired exercise tolerance and elevated central chemosensitivity is the responsible mechanism for CSAS and exercise hyperpnea.
睡眠呼吸暂停综合征（SAS）和运动性通气过度在慢性心力衰竭（CHF）患者中很常见，虽然尚不清楚它们是否受相同机制调节，但本研究的假设是它们与增强的中枢化学敏感性有关。
对29例患者评估了氧饱和度下降指数（ODI），ODI>5次/小时的患者进行了多导睡眠图检查。呼吸暂停低通气指数（AHI）>15次/小时且无阻塞性呼吸暂停证据的患者被定义为中枢性SAS（CSAS）。进行心肺运动试验以确定峰值摄氧量和VE-VCO2斜率。使用高碳酸气体混合物（7%CO2/93%O2）激活中枢化学反射。9例患者有中枢性SAS（CHF-CSAS），20例无呼吸暂停（CHF-非SAS）。CHF-CSAS患者的峰值摄氧量低于CHF-非SAS组（13.0±2.4 vs 16.9±4.3 ml·kg-1·min-1，p<0.05）。中枢化学敏感性与AHI之间存在显著相关性（r=0.63，p<0.05），中枢化学敏感性与VE-VCO2斜率之间存在显著相关性（r=0.50，p<0.01），而VE-VCO2斜率与AHI的相关性无统计学意义（r=0.44，p=0.07）。结论CHF-CSAS与运动耐力受损有关，中枢化学敏感性升高是CSAS和运动性通气过度的相关机制。
