Oldenburg O, Lamp B, Töpfer V, Faber L, Teschler H, Horstkotte D
Klinik für Kardiologie, Herz- und Diabeteszentrum Nordrhein--Westfalen, Universitätsklinikum der Ruhr--Universität Bochum, Bad Oeynhausen.
Dtsch Med Wochenschr. 2007 Mar 30;132(13):661-6. doi: 10.1055/s-2007-973599.
The prevalence of sleep-disordered breathing (SDB) in patients with chronic heart failure seems to be remarkably high, but existing studies are based on small cohorts of patients who were not receiving guideline-based drug treatment for heart failure. The aim of this study was to investigate the prevalence of SDB in patients with ischemic (ICM) or non-ischemic (DCM) cardiomyopathy.
A total of 647 consecutive patients (130 females, 517 males; mean age 63.23 10.4 years) in stable, symptomatic chronic heart failure (NYHA class at least II) and with impaired systolic left ventricular function (ejection fraction < or = 40%) were screened by cardiorespiratory polygraphy for the presence and type of SDB. Sleep apnea was classified as obstructive (OSA) or central (CSA) according to the majority of events, and as ICM or DCM according to the results of current left heart catheterization. SDB was defined according to the apnea-hypopnea index (AHI) as: no SDB: < or = 5/h, mild: 6 -14/h, moderate: 15-29/h, and severe > or = 30/h.
Prevalence of SDB was 70% among DCM and 82% among ICM patients (p < 0.05). Central sleep apnea was found in 32% of DCM and 46% of ICM patients, obstructive sleep apnea in 38% of DCM and 36% of ICM patients. Moderate (15.7% vs. 9.9%, p < 0.05) and severe central sleep apnea (24.4% vs. 15.5%, p < 0.05) was documented more often in ICM than DCM patients. Severity of obstructive sleep apnea was similar in ICM and DCM patients. ICM patients were older than DCM patients (66.4 11 years vs. 66.0 9.0 years, p < 0.01) and in general presented with a greater impairment of cardiopulmonary function.
There is a high prevalence of SDB in patients in chronic heart failure. Central sleep apnea can be documented particularly in ICM patients and seems to be a marker for the severity of heart failure. Because of their prognostic implications, risk stratification and identification of patients eligible for specific SDB treatment, screening for such disorders should be part of every heart failure work-up.
慢性心力衰竭患者睡眠呼吸障碍（SDB）的患病率似乎非常高，但现有研究是基于未接受心力衰竭指南推荐药物治疗的小样本患者队列。本研究的目的是调查缺血性心肌病（ICM）或非缺血性心肌病（DCM）患者中SDB的患病率。
共有647例连续的稳定、有症状的慢性心力衰竭患者（纽约心脏协会心功能分级至少为Ⅱ级，左心室收缩功能受损[射血分数≤40%]）接受了心肺多导睡眠图检查，以筛查SDB的存在及类型（130例女性，517例男性；平均年龄63.2±10.4岁）。根据大多数事件将睡眠呼吸暂停分为阻塞性（OSA）或中枢性（CSA），并根据当前左心导管检查结果分为ICM或DCM。SDB根据呼吸暂停低通气指数（AHI）定义为：无SDB：≤5次/小时，轻度：6 - 14次/小时，中度：15 - 29次/小时，重度：≥30次/小时。
DCM患者中SDB的患病率为70%，ICM患者中为82%（p<0.05）。32%的DCM患者和46%的ICM患者存在中枢性睡眠呼吸暂停，38%的DCM患者和36%的ICM患者存在阻塞性睡眠呼吸暂停。ICM患者中中度（15.7%对9.9%，p<0.05）和重度中枢性睡眠呼吸暂停（24.4%对15.5%，p<0.05）的记录比DCM患者更常见。ICM和DCM患者阻塞性睡眠呼吸暂停的严重程度相似。ICM患者比DCM患者年龄更大（66.4±11岁对66.0±9.0岁，p<0.01），且总体心肺功能损害更大。
慢性心力衰竭患者中SDB的患病率很高。中枢性睡眠呼吸暂停在ICM患者中尤为常见，似乎是心力衰竭严重程度的一个指标。鉴于其对预后的影响、风险分层以及识别适合特定SDB治疗的患者，对这些疾病的筛查应成为每次心力衰竭检查的一部分。
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