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一般心力衰竭人群中的睡眠呼吸障碍:与神经体液激活及主观症状的关系。

Sleep-disordered breathing in a general heart failure population: relationships to neurohumoral activation and subjective symptoms.

作者信息

Rao Archana, Georgiadou Panagiota, Francis Darrel P, Johnson Andrew, Kremastinos Dimitris Th, Simonds Anita K, Coats Andrew J S, Cowley Alan, Morrell Mary J

机构信息

Queen's Medical Centre, University of Nottingham, Nottingham, UK.

出版信息

J Sleep Res. 2006 Mar;15(1):81-8. doi: 10.1111/j.1365-2869.2006.00494.x.

Abstract

The aim of this study was to determine the prevalence of sleep-related breathing disorders (SDB) in a UK general heart failure (HF) population, and assess its impact on neurohumoral markers and symptoms of sleepiness and quality of life. Eighty-four ambulatory patients (72 male, mean (SD) age 68.6 (10) yrs) attending UK HF clinics underwent an overnight recording of respiratory impedance, SaO2 and heart rate using a portable monitor (Nexan). Brain natriuretic peptide (BNP) and urinary catecholamines were measured. Subjective sleepiness and the impairment in quality of life were assessed (Epworth Sleepiness Scale (ESS), SF-36 Health Performance Score). SDB was classified using the Apnoea/Hypopnoea Index (AHI). The prevalence of SDB (AHI > 15 events h(-1)) was 24%, increasing from 15% in mild-to-moderate HF to 39% in severe HF. Patients with SDB had significantly higher levels of BNP and noradrenaline than those without SDB (mean (SD) BNP: 187 (119) versus 73 (98) pg mL(-1), P = 0.02; noradrenaline: 309 (183) versus 225 (148) nmol/24 h, P = 0.05). There was no significant difference in reported sleepiness or in any domain of SF-36, between groups with and without SDB (ESS: 7.8 (4.7) versus 7.5 (3.6), P = 0.87). In summary, in a general HF clinic population, the prevalence of SDB increased with the severity of HF. Patients with SDB had higher activation of a neurohumoral marker and more severe HF. Unlike obstructive sleep apnoea, SDB in HF had little discernible effect on sleepiness or quality of life as measured by standard subjective scales.

摘要

本研究的目的是确定英国一般心力衰竭(HF)人群中睡眠相关呼吸障碍(SDB)的患病率,并评估其对神经体液标志物以及嗜睡症状和生活质量的影响。84名到英国心力衰竭诊所就诊的非卧床患者(72名男性,平均(标准差)年龄68.6(10)岁)使用便携式监测仪(Nexan)进行了整夜呼吸阻抗、血氧饱和度(SaO2)和心率记录。测量了脑钠肽(BNP)和尿儿茶酚胺。评估了主观嗜睡情况和生活质量损害程度(爱泼华嗜睡量表(ESS)、SF - 36健康表现评分)。使用呼吸暂停/低通气指数(AHI)对SDB进行分类。SDB(AHI > 15次/小时)的患病率为24%,从中度至重度心力衰竭患者的15%增至重度心力衰竭患者的39%。患有SDB的患者的BNP和去甲肾上腺素水平显著高于未患SDB的患者(平均(标准差)BNP:187(119)对73(98)pg/mL,P = 0.02;去甲肾上腺素:309(183)对225(148)nmol/24小时,P = 0.05)。在报告的嗜睡情况或SF - 36的任何领域方面,患SDB和未患SDB的组之间均无显著差异(ESS:7.8(4.7)对7.5(3.6),P = 0.87)。总之,在一般心力衰竭诊所人群中,SDB的患病率随心力衰竭严重程度增加。患有SDB的患者神经体液标志物的激活程度更高且心力衰竭更严重。与阻塞性睡眠呼吸暂停不同,心力衰竭中的SDB对通过标准主观量表测量的嗜睡情况或生活质量几乎没有明显影响。

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