Shigemitsu Meiei, Nishio Kazuaki, Kusuyama Taro, Itoh Seiji, Konno Noboru, Katagiri Takashi
The Department of Internal Medicine, Yamanashi Red Cross hospital, 6663-1 Funatsu, Fujikawaguchiko-machi, Minamitsuru-gun, Yamanashi, 401-0301 Japan.
Int J Cardiol. 2007 Feb 14;115(3):354-60. doi: 10.1016/j.ijcard.2006.03.018. Epub 2006 Jun 23.
Sleep disordered breathing has been reported to be associated with congestive heart failure (CHF). Nocturnal oxygen has been shown to abolish apnea. The aim of this study is to examine whether nocturnal oxygen reduces sympathetic nerve activity, and prevents progress of CHF.
93 patients with left ventricular ejection fractions < 60%, were examined with overnight saturation monitoring for an oxygen desaturation index. Subjects with oxygen desaturation of 4% > or = 4/h were examined with polysomnography. Apnea-hypopnea index (AHI) was calculated as the total number of episodes of apnea and hypopnea per hour of sleep. We started nocturnal oxygen for the patients with AHI > or = 20. Urinary and plasma catecholamines concentrations, serum brain natriuretic peptide, human atrial natriuretic peptide, and endothelial nitric oxide synthase levels were measured before and after starting oxygen.
Compared among the three groups, CHF with central sleep apnea (CHF-CSA) group had significantly higher 24-h urinary adrenaline (CHF-CSA: 4.411+/-2.940 micromol/day, CHF with obstructive sleep apnea (CHF-OSA): 2.686+/-1.084 micromol/day, CHF without apnea (CHF-N): 3.178+/-1.778 micromol/day, P<0.05). Oxygen therapy significantly decreased AHI and 4 serum BNP levels (from 91.75+/-80.35 pg/ml to 52.75+/-45.70 pg/ml, mean change=33.85 pg/ml, P=0.0208). Serum eNOS levels were lower in CHF-CSA group and CHF-OSA group than in CHF-N group (CHF-CSA: 15.89+/-10.75 pg/ml, CHF-OSA: 7.46+/-3.91 pg/ml, CHF-N: 27.33+/-14.83 pg/ml, P<0.05).
Nocturnal oxygen may prevent progress of CHF with central sleep apnea.
据报道，睡眠呼吸障碍与充血性心力衰竭（CHF）有关。夜间吸氧已被证明可消除呼吸暂停。本研究的目的是探讨夜间吸氧是否能降低交感神经活动，并预防CHF的进展。
对93例左心室射血分数<60%的患者进行夜间饱和度监测，以获取氧饱和度下降指数。氧饱和度下降≥4%/小时的受试者进行多导睡眠图检查。呼吸暂停低通气指数（AHI）计算为每小时睡眠中呼吸暂停和低通气发作的总数。我们对AHI≥20的患者开始夜间吸氧。在开始吸氧前后测量尿和血浆儿茶酚胺浓度、血清脑钠肽、人心房钠尿肽和内皮型一氧化氮合酶水平。
三组比较，中枢性睡眠呼吸暂停的CHF（CHF-CSA）组24小时尿肾上腺素水平显著更高（CHF-CSA：4.411±2.940微摩尔/天，阻塞性睡眠呼吸暂停的CHF（CHF-OSA）：2.686±1.084微摩尔/天，无呼吸暂停的CHF（CHF-N）：3.178±1.778微摩尔/天，P<0.05）。氧疗显著降低了AHI和4种血清BNP水平（从91.75±80.35皮克/毫升降至52.75±45.70皮克/毫升，平均变化=33.85皮克/毫升，P=0.0208）。CHF-CSA组和CHF-OSA组的血清eNOS水平低于CHF-N组（CHF-CSA：15.89±10.75皮克/毫升，CHF-OSA：7.46±3.91皮克/毫升，CHF-N：27.33±14.83皮克/毫升，P<0.05）。
夜间吸氧可能预防中枢性睡眠呼吸暂停CHF进展。
