Skobel Erik C, Sinha Anil-Martin, Norra Christine, Randerath Winfried, Breithardt Ole-Alexander, Breuer Christian, Hanrath Peter, Stellbrink Christoph
Center of Sleep Medicine and Ventilatory Care, Clinic for Pneumology and Allergology, Bethanien Hospital, University Witten-Herdecke, Witten, Germany.
Sleep Breath. 2005 Dec;9(4):159-66. doi: 10.1007/s11325-005-0030-1.
Patients with heart failure (HF) often suffer from sleep-related breathing disorders (SRBD) like Cheyne-Stokes respiration (CSR). Cardiac resynchronization therapy (CRT) improves myocardial function and exercise capacity in patients with HF and conduction disturbances. As CRT has been shown to reduce CSR in patients with HF, it is not clear whether CRT improves quality of life and symptomatic depression by improvement of apnea/hypopnea index (AHI) and sleep quality. Forty-two HF patients with conduction disturbance before CRT were screened for CSR and evaluated for sleep quality [Pittsburgh Sleep Quality Index (PSQI)], quality of life score [36-item short form (SF-36)], depression, and exercise capacity (VO2 peak) and ejection fraction (EF). Eighteen patients (three females, age 61+/-10, body mass index 24+/-4 kg m(-2), EF 24+/-4%, QRS complex duration 156+/-32 ms) presented CSR with an AHI of 18+/-8 (11 CSR, 7 mixed). Fourteen patients showed no SRBD (PSQI<5,AHI<5). All patients received CRT and were reevaluated after 18+/-7 weeks. CSR worsen quality of life in seven of eight terms compared to patients without SRBD. Symptomatic depressive symptoms (Beck Depression Inventory>10) were only present in patients with CSR. CRT results in improvement of peak VO2 and EF. There was no difference between patients with CSR and without SRBD on exercise capacity or EF under CRT, whereas CRT led to a significant decrease in AHI (18+/-8 to 3+/-2, p<0.0001), PSQI (18+/-4 to 6+/-3, p=0.0007), with reduction of depression score (12+/-3 to 4.8+/-3, p=0.004). In patients with HF, CSR is associated with symptomatic depressive syndromes and impaired quality of life. CRT reduced CSR with improvement of sleep quality and symptomatic depression.
心力衰竭（HF）患者常患有与睡眠相关的呼吸障碍（SRBD），如潮式呼吸（CSR）。心脏再同步治疗（CRT）可改善HF合并传导障碍患者的心肌功能和运动能力。由于CRT已被证明可减少HF患者的CSR，因此尚不清楚CRT是否通过改善呼吸暂停/低通气指数（AHI）和睡眠质量来提高生活质量并缓解症状性抑郁。对42例CRT治疗前合并传导障碍的HF患者进行CSR筛查，并评估其睡眠质量[匹兹堡睡眠质量指数（PSQI）]、生活质量评分[36项简明健康调查（SF-36）]、抑郁情况、运动能力（最大摄氧量峰值）和射血分数（EF）。18例患者（3例女性，年龄61±10岁，体重指数24±4 kg/m²，EF 24±4%，QRS波时限156±32 ms）存在CSR，AHI为18±8（11例为CSR，7例为混合型）。14例患者未出现SRBD（PSQI<5，AHI<5）。所有患者均接受CRT治疗，并在18±7周后进行重新评估。与无SRBD的患者相比，CSR在八个方面中的七个方面使生活质量恶化。有症状的抑郁症状（贝克抑郁量表>10）仅出现在CSR患者中。CRT可使最大摄氧量峰值和EF得到改善。在CRT治疗下，有CSR和无SRBD的患者在运动能力或EF方面没有差异，而CRT导致AHI显著降低（从18±8降至3±2，p<0.0001），PSQI降低（从18±4降至6±3，p=0.0007），抑郁评分降低（从12±3降至4.8±3，p=0.004）。在HF患者中，CSR与症状性抑郁综合征和生活质量受损相关。CRT减少了CSR，改善了睡眠质量和症状性抑郁。
