Arzt Michael, Bradley T Douglas
Sleep Research Laboratories of the Toronto Rehabiliation Institute, Toronto General Hospital/University Health Network, 9N-943, 200 Elizabeth Street, Toronto, ON, M5G 2C4 Canada.
Am J Respir Crit Care Med. 2006 Jun 15;173(12):1300-8. doi: 10.1164/rccm.200511-1745PP. Epub 2006 Mar 9.
Obstructive and central sleep apnea are common in heart failure, and may participate in its progression by exposing the heart to intermittent hypoxia, increased preload and afterload, sympathetic activation, and vascular endothelial dysfunction. Treatment of sleep apnea in patients with heart failure may reverse these detrimental effects, in addition to alleviating symptoms of sleep apnea. In patients with heart failure and obstructive sleep apnea, short-term randomized trials have demonstrated that continuous positive airway pressure (CPAP) improves cardiac function, and lowers sympathetic activity and blood pressure. However, there are no data on whether treating obstructive sleep apnea in patients with heart failure improves morbidity and mortality. Various treatments have been tested in heart failure patients with central sleep apnea, particularly oxygen and CPAP. Both reduce the frequency of central respiratory events, and lower sympathetic activity. In addition, CPAP improves cardiac function. However, the largest randomized trial did not demonstrate any beneficial effect of CPAP on the rate of mortality and cardiac transplantation (32 vs. 32 events in the control and treatment groups, respectively; p=0.54), but ultimately lacked power to conclude with certainty whether CPAP has an effect on morbidity and mortality in such patients. Thus, although there are data to indicate that treating both obstructive and central sleep apnea in patients with heart failure improves cardiovascular function, larger randomized trials involving interventions such as oxygen, CPAP, or other forms of positive airway pressure will be required to determine whether treating these sleep-related breathing disorders reduces clinically important outcomes such as morbidity and mortality.
阻塞性睡眠呼吸暂停和中枢性睡眠呼吸暂停在心力衰竭患者中很常见，可能通过使心脏暴露于间歇性缺氧、前负荷和后负荷增加、交感神经激活以及血管内皮功能障碍而参与其病情进展。治疗心力衰竭患者的睡眠呼吸暂停除了能缓解睡眠呼吸暂停症状外，还可能逆转这些有害影响。在心力衰竭合并阻塞性睡眠呼吸暂停的患者中，短期随机试验表明，持续气道正压通气（CPAP）可改善心脏功能，并降低交感神经活性和血压。然而，尚无关于治疗心力衰竭患者的阻塞性睡眠呼吸暂停是否能改善发病率和死亡率的数据。针对心力衰竭合并中枢性睡眠呼吸暂停的患者，已经对多种治疗方法进行了测试，尤其是吸氧和CPAP治疗。两者都能降低中枢性呼吸事件的频率，并降低交感神经活性。此外，CPAP还能改善心脏功能。然而，最大规模的随机试验并未证明CPAP对死亡率和心脏移植率有任何有益影响（对照组和治疗组分别有32例事件；p = 0.54），但最终没有足够的说服力来确定CPAP对此类患者的发病率和死亡率是否有影响。因此，尽管有数据表明治疗心力衰竭患者的阻塞性和中枢性睡眠呼吸暂停可改善心血管功能，但仍需要进行更大规模的随机试验，涉及吸氧、CPAP或其他形式的气道正压通气等干预措施，以确定治疗这些与睡眠相关的呼吸障碍是否能降低发病率和死亡率等临床重要结局。
