Rao Archana, Georgiadou Panagiota, Francis Darrel P, Johnson Andrew, Kremastinos Dimitris Th, Simonds Anita K, Coats Andrew J S, Cowley Alan, Morrell Mary J
Queen's Medical Centre, University of Nottingham, Nottingham, UK.
J Sleep Res. 2006 Mar;15(1):81-8. doi: 10.1111/j.1365-2869.2006.00494.x.
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.
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。